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Zheng X, Liu X, Zhang J, Liu H, Xu Y, Meng L, Zhang Y, Wang L, Jia L. 5-Aminolevulinic acid photodynamic therapy is a safe and effective treatment for female patients with intractable vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2024; 49:104330. [PMID: 39245302 DOI: 10.1016/j.pdpdt.2024.104330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/25/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Female vulvar lichen sclerosus (VLS) is a chronic inflammatory skin disease of the vulva and its etiology is unknown. The main clinical symptoms are itching, burning and dyspareunia, and there is a lack of effective treatment. METHODS Clinical and follow-up data of women with VLS who underwent 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) from January 2023 to December 2023 in the department of obstetrics and gynecology, Qilu Hospital of Shandong University, were retrospectively analyzed. According to the inclusion and exclusion criteria, 36 patients with VLS who received ineffective conventional treatment (intractable VLS) were enrolled. Objective signs and subjective symptoms of vulvar lesions were recorded before treatment and 6 months after the end of treatment according to corresponding scoring criteria. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI). RESULTS All patients received six sessions of ALA-PDT treatment and follow-up visits. After ALA-PDT treatment, 24 of 36 (66.67 %) patients' itching symptoms completely disappeared, 10 of 36 (27.78 %) patients' itching symptoms were relieved from severe to mild, and only 2 of 36 (5.56 %) patients' symptoms were not significantly relieved. 16 of 36 (44.4 %) patients' itching symptoms completely disappeared, 9 of 36 (25 %) patients' itching symptoms were relieved from severe to mild, and only 2 of 36 (5.56 %) patients still had severe pain. Compared to 22 patients with dyspareunia before treatment, only 9 patients still had dyspareunia with varying degrees of dyspareunia relief after treatment. Clinical signs improved significantly in the patients after ALA-PDT treatment. The total scores of clinical signs were (5.31 ± 1.67 vs 3.67 ± 1.71) before and after treatment. All patients showed improvement in DLQI after treatment. The main side effects of ALA-PDT were pain, erythema and swelling which were transient and tolerable. All patients were "satisfied" or "very satisfied" with the results of the treatment. CONCLUSIONS ALA-PDT is a safe and effective treatment for women with intractable vulva lichen sclerosus.
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Affiliation(s)
- Xiangrong Zheng
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China; School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, China
| | - Xiaoli Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China; Key Laboratory of Gynecologic Oncology of Shandong Province, China
| | - Junhua Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China; Key Laboratory of Gynecologic Oncology of Shandong Province, China
| | - Hongli Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China
| | - Ying Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China
| | - Lihua Meng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China
| | - Lili Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China.
| | - Lin Jia
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, China.
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Qu Z, Lin X, Liu M, Wang J, Wang F, Zhang B, Shen L, Wang Z. Clinical efficacy analysis of 5-aminolevulinic acid photodynamic therapy for vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2024; 46:104035. [PMID: 38442799 DOI: 10.1016/j.pdpdt.2024.104035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The purpose of this study is to analyze the efficacy of photodynamic therapy in the treatment of vulvar lichen sclerosus who do not respond to topical glucocorticoid therapy, analyze whether there are factors that affect the efficacy, and identify adverse reactions to the treatment. METHOD This retrospective study included 42 patients with vulval lichen sclerosis treated with ALA-PDT. Basic data of all patients were collected, and the clinical symptoms and signs of the patients before treatment were evaluated. After one year of treatment, the clinical efficacy was evaluated and analyzed whether there were any factors that affected the treatment effect. RESULT One year after the ALA-PDT treatment, the clinical effective rate was 64.29 % (27/42), the general effective rate was 19.05 % (8/42), the ineffective rate was 4.76 % (2/42), and the recurrence rate was 11.90 % (5/42). There was no correlation between menopause, number of births given, body mass index, duration of disease, treatment times and treatment effect. For patients with severe itching and atrophy, PDT was less effective. Adverse effects were minimal and no structural complications were reported. CONCLUSION ALA-PDT can obviously alleviate itching in VLS patients, improve skin elasticity, skin color and reduce lesion area. ALA-PDT for VLS has a low recurrence rate and few side effects.
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Affiliation(s)
- Zhongyu Qu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xueyan Lin
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ming Liu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Jia Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Fei Wang
- Department of Eastern Hospital Emergency Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Bei Zhang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Liang Shen
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Zhifeng Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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Wei D, Luo C, Chen Y, Li J, Niu X. A large sample-based case-control study of related risk factors of two types of lichenoid vulvar disease (LVD). Eur J Obstet Gynecol Reprod Biol 2024; 293:15-20. [PMID: 38100936 DOI: 10.1016/j.ejogrb.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The purpose of this study is to identify the associated factors of two types of lichenoid vulvar disease (LVD) and to compare the differences in related factors between the different pathological types of lichenoid vulvar disease (LVD). METHODS The study conducted at the West China second Hospital of Sichuan University included a total of 1770 patients with biopsy-confirmed vulvar lichen simplex chronicus (VLSC)and vulvar lichen sclerosus(VLS), along with 1209 patients with normal vulvovagina as control. Further pathological subtype analysis was carried out on 163 cases of vulvar lichen simplex chronicus and 51 cases of vulvar lichen sclerosus. In addition, Univariate chi-square test and multivariate logistic regression were used to analyze the lichenoid vulvar disease group and vulvovaginal normal control group. RESULTS Univariate analysis revealed that there were statistically significant differences (P < 0.05) in factors between the LVD group and the control group, except for living type, sleep habit, history of drinking, and allergic diseases. There was no significant difference in late sleep, spicy diet, and coffee intake in the factors of life and eating habits and the concomitant disease factors. Furthermore, univariate analysis showed that except for eating seafood, humid living environment, residence, caffeinated drinks, hypertension, and vaginitis, there were statistical differences in the related factors of LVSC. CONCLUSION The incidence about lichenoid vulvar disease is influenced by various factors such as dietary habits, living environment, mental stress, concomitant diseases, hormone levels and so on, and there were no significant differences in these factors between VLS and VLSC except for income, work stress, systemic immune diseases, and menopause.
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Affiliation(s)
- Dongmei Wei
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Can Luo
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Yueyue Chen
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Jijie Li
- Medical Records Management Department, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Xiaoyu Niu
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
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Popa A, Dumitrascu MC, Petca A, Petca RC, Sandru F. Vulvar Lichen Sclerosus: Navigating Sex Hormone Dynamics and Pioneering Personalized Treatment Paradigm. J Pers Med 2024; 14:76. [PMID: 38248777 PMCID: PMC10817476 DOI: 10.3390/jpm14010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Vulvar lichen sclerosus (VLS) is a frequently overlooked inflammatory disorder affecting the skin and mucous membranes of the vulva. With a propensity for atrophy, severe scarring, functional impairment, and malignant evolution, VLS is a disease that recurs frequently; early diagnosis, rapid treatment, and ongoing patient follow-up are essential. Potent topical corticosteroids (TCSs) are now widely recognized as the most effective treatment for achieving remission in VLS, but considering the potential complications of long-term treatment with potent TCSs, understanding the evolution of VLS during puberty becomes particularly crucial in determining the necessity for aggressive or more conservative therapeutic interventions. Emerging treatments, including PRP (platelet-rich plasma), stem cell therapy, and energy-based lasers like fractional CO2 and Nd-YAG, are being investigated to identify more effective VLS treatments than ultrapotent topical corticosteroids. However, more research is needed to assess the efficacy and safety of these new medicines. Topical clobetasol 0.05% ointment daily for 4-12 weeks is the gold standard for treating VLS. This article is a narrative review of the English-language medical literature from 2017 to November 2023, following three main sections concerning VLS: studies of the evolution amid pubertal hormonal changes; studies of the outcomes of personalized conventional therapies; and studies addressing the spectrum of innovative modalities for VLS.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Jia R, Wu C, Tang X, He M, Liu X, Su C, Li C. Comparison of the efficacy of focused ultrasound at different focal depths in treating vulvar lichen sclerosus. Int J Hyperthermia 2023; 40:2172220. [PMID: 36710083 DOI: 10.1080/02656736.2023.2172220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of focused ultrasound (FU) at different focal depths in treating vulvar lichen sclerosus (VLS). METHODS A retrospective study was conducted on 84 patients with VLS. Among them, 43 cases were treated with FU at a focal depth of 2.5 mm and 41 cases at a focal depth of 4.0 mm. Therapeutic time, treatment energy, postoperative efficacy, complications and recurrence rates were compared. RESULTS No statistically substantially differences in age, disease course, history of immune system diseases, lesion size and severity of symptoms were found between the two groups. All patients successfully received FU therapy. No significant difference in curative rate was observed between the two groups at 3, 6 and 12 months after FU therapy. At 12 months after FU therapy, the recurrence rate of the experimental group (FU treatment at 2.5 mm focal depth) was lower than the control group (FU treatment at 4.0 mm focal depth) (7.0% vs 24.4%, p = 0.027). The experimental group was treated for a shorter period of time [22.69 ± 0.64 (min) vs 24.93 ± 0.72(min), p = 0.022] and at a lower dose[5,026.05 ± 148.00(J) vs 5,484.26 ± 160.60(J) p = 0.039]. CONCLUSION Compared with that at the routine focal depth (4.0 mm), FU therapy at a low treatment depth (2.5 mm) can achieve a similar therapeutic effect but lower recurrence rate, therapeutic time and treatment energy. This work provides insight into the optimization of clinical protocols.
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Affiliation(s)
- Ru Jia
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Can Wu
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Xiaoxu Tang
- Chongqing Ronghai Engineering Research Center of Ultrasound Medicine Co., Ltd., Chongqing, China
| | - Miaomiao He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xinglin Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chang Su
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chengzhi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Li Y, Hua C, Zhang M. Efficacy of non-invasive photodynamic therapy for female lower reproductive tract diseases associated with HPV infection: a comprehensive meta-analysis. Lasers Med Sci 2023; 38:42. [PMID: 36652121 DOI: 10.1007/s10103-023-03713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
Photodynamic therapy (PDT) is a proposed non-invasive, highly effective, and fertility-preserving method for the treatment of lower reproductive tract diseases in women. We aim to evaluate the effect of PDT on complete remission, recurrence, and HPV clearance in diseases of the female lower reproductive tract associated with the human papillomavirus (HPV) infection in this meta-analysis. PubMed, EMBASE, Scopus, Cochrane Library, and China National Knowledge Infrastructure databases were searched to compare PDT with other treatments for complete remission, recurrence, and HPV clearance in women with lower genital tract disease. Fixed or random effect models were performed to assess the pooled effect size. Sensitivity analysis was performed to detect heterogeneity in the included studies. The Begg and Egger test assessed publication bias. There were 12 studies qualified for inclusion; compared to other treatments, PDT had a significant advantage in complete remission (OR=2.97, 95%CI, 2.18-4.04, I2=0, P<0. 001) and recurrence (OR, 0.21; 95%CI, 0.11-0.39; I2=34.9%, P<0. 001). Furthermore, PDT clears HPV quickly and lastingly compared to other therapies (OR, 2.65; 95% CI, 1.41-4.95; I2=71.0%, P=0.002). In addition, the heterogeneity test of sensitivity analysis suggested that the results were robust. Begg test (P=0.73) and Egger test (P=0.71) showed no publication bias. PDT treats diseases of the female lower reproductive tract associated with HPV infection: high complete remission, low recurrence, and rapid and lasting HPV clearance. The PDT seems to be a non-invasive, effective, and promising treatment of female lower reproductive tract diseases associated with HPV infection.
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Affiliation(s)
- Yanhui Li
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, 107 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China.
| | - Cuiju Hua
- Yiyuan People's Hospital, Zibo City, Shandong Province, China
| | - Mengyao Zhang
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, 107 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China
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Shi L, Liu J, Zhang H, Zhang Y, Wang P, Zhang G, Zhou Z, Wang X. Vulvar lichen sclerosus progressing to squamous cell carcinoma due to the poor compliance for the follow-up after ALA-PDT. Photodiagnosis Photodyn Ther 2022; 40:103171. [PMID: 36288766 DOI: 10.1016/j.pdpdt.2022.103171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
5-Aminolevulinic acid photodynamic therapy (ALA-PDT) is an effective modality for vulvar lichen sclerosus (VLS) and squamous cell carcinoma (SCC) in situ. Here we first describe a case of VLS that relapsed after ALA-PDT without follow-up and progressed to SCC eventually. The first two courses of ALA-PDT (total of 21 sessions) were effective for VLS. The third course of ALA-PDT (2 sessions) was changed to the surgery because of SCC was diagnosised. In our case, we emphasis that maintain regular follow-up to treat the recurrent lesions to prevent the development of SCC.
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Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongxia Zhou
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
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Campbell J, Vanni AJ, Kowalik CG. An Update on Female Urethral Stricture Disease. Curr Urol Rep 2022; 23:303-308. [PMID: 36308672 DOI: 10.1007/s11934-022-01113-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of female urethral stricture disease and updates on surgical outcomes. RECENT FINDINGS In a large retrospective case series, women reported significant improvements in urinary symptoms and quality of life following treatment of their urethral stricture. Both vaginal flap and buccal mucosal graft urethroplasty have higher short- and long-term success rates than urethral dilation. Female urethral stricture disease is rare and surgical reconstruction has the highest likelihood of long-term success. Due to the complexity of reconstruction, referral to a reconstructive trained urologist should be considered.
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Affiliation(s)
- Jack Campbell
- Urology Institute, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Alex J Vanni
- Urology Institute, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Casey G Kowalik
- Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA. .,Department of Urology, University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66201, USA.
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Qiu L, Li J, Chen F, Wang Y, Wang Y, Wang X, Lv Q, Li C, Li M, Yang Q, Wu D, Zhang Y, Zhang Y, Zhang M, Zhang Y, Qie M, Zhou H, Zhou J, Zhao W, Xia B, Liang X, Cai Y, Teng Y, Huang Z, Sui L, Wei L, Di W. Chinese Expert Consensus on the Clinical Applications of Aminolevulinic Acid-Based Photodynamic Therapy in Female Lower Genital Tract Diseases (2022). Photodiagnosis Photodyn Ther 2022; 39:102993. [PMID: 35781093 DOI: 10.1016/j.pdpdt.2022.102993] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION With the younger onset age of female lower genital tract diseases, there are increasing demands for protecting organ and tissue structures to preserve fertility and, therefore, effective fertility-sparing treatments that cause minimal normal tissue damage and less adverse reactions are urgently needed. OBJECTIVE This study is aimed at reviewing information and achieving consensus on recommendations on the clinical applications of aminolevulinic acid-based photodynamic therapy (ALA-PDT) in female lower genital tract diseases. METHODS Members of the expert panel held online and in-person meetings to discuss and revise drafts created by the steering committee based on the literature review and the clinical experiences of the expert panel. Opinions of the experts were transcribed and discussed in detail to ensure that the consensus statement best reflects the current advances in the field and the experts' view. RESULTS After numerous rounds of meetings, experts unanimously agreed on the importance of ALA-PDT in the treatment of cervical squamous intraepithelial lesions (SIL), vaginal SIL, vulvar SIL, vulvar lichen sclerosus (VLS), and condyloma acuminatumon (CA). Experts also reached consensus on the recommended treatment regimen and treatment methods. CONCLUSION This consensus aimed to provide practical basis and guidance for the clinical applications of ALA-PDT in female lower genital tract diseases in China. Of note, this is the only expert consensus prepared by board-certified specialists in gynecology and obstetrics in China. More evidence-based clinical studies should be made to update and expand the current recommendations.
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Affiliation(s)
- Lihua Qiu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jingran Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Fei Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Yifeng Wang
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mingzhu Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Qiuyun Yang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dan Wu
- Department of Obstetrics and Gynecology, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China
| | - Yuquan Zhang
- Department of Obstetrics and Gynecology, Affiliated Hospital, Nantong University, Nantong, China
| | - Mengzhen Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Changsha, China
| | - Mingrong Qie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huaijun Zhou
- Department of Obstetrics and Gynecology, Naijing Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiade Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Weidong Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Bairong Xia
- Department of Obstetrics and Gynecology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xuefang Liang
- Department of Obstetrics and Gynecology, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Yunlang Cai
- Department of Obstetrics and Gynecology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Huang
- MOE Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou, China.
| | - Long Sui
- Department of Obstetrics and Gynecology, Obstetrics & Gynecology Hospital, Fundan University Shanghai, China.
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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He S, Jiang J. High-intensity focused ultrasound therapy for pediatric and adolescent vulvar lichen sclerosus. Int J Hyperthermia 2022; 39:579-583. [PMID: 35410566 DOI: 10.1080/02656736.2022.2060528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The study's objective was to retrospectively evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) for vulvar lichen sclerosus (VLS) in pediatric and adolescent patients. METHODS Pediatric and adolescent patients presenting to our hospital from June 2007 to July 2021, with VLS were retrospectively evaluated. The participants' information, including age, symptoms and vulvar examination, were documented, and they were treated with HIFU. The effectiveness of HIFU and its complications were analyzed. RESULTS A total of 36 patients with VLS undergoing HIFU for whom complete follow-up data were available participated in the study. The mean age of the patients at diagnosis was 13.3 ± 4.1 years. All patients successfully underwent HIFU therapy. The mean sonication time was 20.3 ± 8.6 min, and the median treatment energy was 3579.0 J. A few blisters developed in 8 (22.2%) patients and 2 (5.6%) had ulcers. The skin burns were treated medically without scar formation. On average, patients were followed up for 52.0 months after the procedure (a range of 6-175 months). At 6 months after therapy, the total response rate was 91.6%, and 86.6% at 12 months post HIFU. Overall, 16 patients were followed up for more than 5 years. The total response rate was 75%, and the recurrence rate was 12.5%. CONCLUSIONS Based on our results, HIFU was demonstrated to be effective and relatively safe for the treatment of VLS in pediatric and adolescent patients, but it is necessary to pay attention to the possible skin burns.
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Affiliation(s)
- Sili He
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfa Jiang
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
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11
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Bizoń M, Maślińska D, Sawicki W. Influence of Photodynamic Therapy on Lichen Sclerosus with Neoplastic Background. J Clin Med 2022; 11:jcm11041100. [PMID: 35207373 PMCID: PMC8877107 DOI: 10.3390/jcm11041100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Lichen sclerosus is the most common nonmalignant vulvar disease with morbidity in postmenopausal age. The first line of treatment is corticosteroid therapy. In case of insufficiency, tacrolimus or pimecrolimus can be provided. Photodynamic therapy (PDT) can be used as alternative way of treatment while symptoms recurrent despite other methods. Methods: the analyzed population of 182 women with diagnosis of lichen sclerosus treated using PDT was divided into three groups: patients with neoplastic disease or intraepithelial neoplasia; those with a positive family history of neoplastic disease; and a control group with no neoplastic disease and no familial history of neoplastic diseases. Results: Reduction of vulvar changes was assessed in the whole vulva in the groups as 21.9%, 21.2% and 21.8%, respectively. The most frequent symptom, itching, was reported to decrease in all groups, 39.3%, 35.5% and 42.5%, respectively. Improvement of quality of life was assessed in 91.3% of the whole group, stabilization of lichen sclerosus in 7.1% and progression in 1.6%. Conclusions: Photodynamic therapy gives positive results in most cases. Improvement after PDT is observed in objective vulvoscopic assessment and in subjective patients’ opinions. Neoplastic disease in the past can influence the effectiveness of PDT.
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Affiliation(s)
- Magdalena Bizoń
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warszawa, Poland;
- Correspondence: ; Tel.: +48-697-722-894
| | - Danuta Maślińska
- Department of General and Experimental Pathology, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | - Włodzimierz Sawicki
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warszawa, Poland;
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The Immunogenetic Aspects of Photodynamic Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:433-448. [DOI: 10.1007/978-3-030-92616-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects. Biomedicines 2021; 9:biomedicines9080950. [PMID: 34440154 PMCID: PMC8394941 DOI: 10.3390/biomedicines9080950] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.
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14
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Guidozzi F. Lichen sclerosus of the vulva. Climacteric 2021; 24:513-520. [PMID: 34313164 DOI: 10.1080/13697137.2021.1948004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Lichen sclerosus of the vulva (LSV) is seen frequently enough to warrant knowing how to diagnose it and institute appropriate treatment strategies. LSV is a chronic skin disorder, very likely of autoimmune origin, which may affect various areas of the perineum, although some women may be affected in extragenital areas. The disease has significant adverse impact on quality of life and sexual activity and may undergo malignant transformation. History of symptomatology and clinical examination is sufficient to make the diagnosis. Skin biopsy is only necessary in specific scenarios. Topical corticosteroids are still the mainstay of therapy, initially to institute remission and then for maintenance. Long-term therapy and surveillance are invariably necessary. Surgery does have a role, but only in specific associated conditions. A number of alternative treatment options have been mooted, especially if the disease is resistant to topical corticosteroids, but these options are still being assessed and studied.
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Affiliation(s)
- F Guidozzi
- Department of Obstetrics and Gynaecology, Parklane Clinic, Johannesburg, South Africa.,Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa
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Ferrara F, Filippi F, Messori S, Iommi M, Patrizi A, D'Antuono A, Gaspari V, Chessa MA, Baraldi C, Bardazzi F. Fractional CO2 laser and vulvar lichen sclerosus: an alternative resource during maintenance therapy? A prospective study. Ital J Dermatol Venerol 2021; 157:247-253. [PMID: 34282866 DOI: 10.23736/s2784-8671.21.07066-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lichen sclerosus is an autoimmune dermatosis that in women typically involves vulvar area. This condition can strongly impact on the quality of life.To date, topical steroids are the most effective treatment, although adverse effects are possible, especially in long-term application. The aim of this study is to investigate the efficacy of fractional CO2 laser in reducing symptoms of vulvar lichen sclerosus (VLS) during maintenance therapy with topical steroids (application twice weekly or less);(ii) to assess how long this reduction of symptoms persists during followup; (iii) histological comparison before and after treatment.To our knowledge, this is the first prospective study evaluating this treatment in women with VLS. METHODS Women with a diagnosis of VLS were prospectively enrolled and treated with fractional CO2 laser every 2 months, for a total of 3 sessions.Four questionnaires were periodically administered: the Dermatology Quality of Life Index (DLQI), the Female Sexual Functional Index (FSFI) and 2 specific questionnaires created to assess the severity of disease. RESULTS 23 adult women were enrolled. The fractional CO2 laser treatment significantly improved the scores of all scales from baseline to T4 questionnaires. CONCLUSIONS Fractional CO2 laser proved to be effective on VLS symptoms and can be considered an alternative to corticosteroids during maintenance therapy. Larger studies with a control group and randomization are needed to safely generalize our findings.
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Affiliation(s)
- Francesca Ferrara
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy -
| | - Stefano Messori
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonietta D'Antuono
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valeria Gaspari
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco A Chessa
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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The effect of vulvar lichen sclerosus on quality of life and sexual functioning. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.806578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhang F, Li D, Shi L, Gu Y, Xu Y, Wu C. Efficacy of 5-Aminolevulinic Acid (ALA)-Photodynamic Therapy (PDT) in Refractory Vulvar Lichen Sclerosus: Preliminary Results. Med Sci Monit 2021; 27:e927406. [PMID: 33411697 PMCID: PMC7802375 DOI: 10.12659/msm.927406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background As a chronic inflammatory skin disease of unknown etiology, vulvar lichen sclerosus (VLS) mainly affects postmenopausal and perimenopausal women. The main clinical manifestations of VLS include itching, burning pain, and sexual dysfunction, which can lead to a decline in quality of life. The existing treatment options include topical corticosteroid ointment, estrogen, and traditional Chinese medicine; however, their therapeutic effects on VLS remain unsatisfactory. Material/Methods Thirty patients with VLS and routine treatment failure were treated with 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT). A 20% ALA water-in-oil emulsion was applied to the vulvar lesions and sealed with plastic film for 3 h. Patients were irradiated at a power density of 60 to 90 mW/cm2 with a red light at a wavelength of 635±15 nm for 20 min, delivering a total dose of 100 to 150 J/cm2 per session. The treatment was repeated 3 times every 2 weeks. The objective parameters, female sexual function index (FSFI) and quality of life (QoL) scores, were used before and after treatment to evaluate the clinical curative effect. Results All patients completed 3 treatment cycles of ALA-PDT and follow-up visits. The clinical symptoms of pruritus completely disappeared in 27 cases, and itching improved from severe to mild in 3 cases. The pathological changes of all patients were objectively improved. FSFI score decreased significantly after treatment (P<0.001). The main adverse effects of ALA-PDT were pain, erythema, and swelling. These adverse effects were temporary and tolerable. The QoL score was significantly improved after treatment (P<0.001). Conclusions ALA-PDT is an effective and safe approach for the treatment of VLS.
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Affiliation(s)
- Fenghua Zhang
- Department of Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Daoyun Li
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Lijuan Shi
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Yijia Gu
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Yun Xu
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Changping Wu
- Department of Tumor Biological Treatment, Soochow University, Changzhou, Jiangsu, China (mainland).,Jiangsu Engineering Research Center for Tumor Immunotherapy, Soochow University, Changzhou, Jiangsu, China (mainland).,Institute of Cell Therapy, Soochow University, Changzhou, Jiangsu, China (mainland)
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Pergialiotis V, Bellos I, Biliou EC, Varnava P, Mitsopoulou D, Doumouchtsis SK. An arm-based network meta-analysis on treatments for vulvar lichen sclerosus and a call for development of core outcome sets. Am J Obstet Gynecol 2020; 222:542-550.e6. [PMID: 31697910 DOI: 10.1016/j.ajog.2019.10.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present systematic review is to evaluate the available medical treatments for vulvar lichen sclerosus, using an arm-based network meta-analysis protocol. DATA SOURCES We searched Medline (1966-2019), Scopus (2004-2019), Cochrane Central Register of Controlled Trials CENTRAL (1999-2019), Clinicaltrials.gov (2008-2019) databases, and Google Scholar (2004-2019) database along with the reference list of all included studies. STUDY ELIGIBILITY CRITERIA All observational, randomized, and single-arm studies that evaluated medical treatments for vulvar lichen sclerosus were considered eligible for inclusion in the present systematic review. STUDY APPRAISAL A network meta-analysis was carried out in R 3.4.3 using the pcnetmeta package, which uses a Bayesian hierarchical model (based in Markov chain Monte Carlo convergence simulation). RESULTS Sixteen studies were included in this present meta-analysis, which recruited 954 women with vulvar lichen sclerosus. Their quality was evaluated with the JADAD, Cochrane risk of bias, and risk of bias in nonrandomised studies of interventions-I tools. Clobetasol treatment ranked as the best treatment for disease remission after evaluating rank probabilities (40% chance of ranking first compared with tacrolimus [38%]). However, the density plot revealed partial overlapping with tacrolimus. The lowest probability of experiencing a relapse was observed with pimecrolimus (15% [2-48%]); however, the density plot revealed significant overlapping with mometasone furoate, testosterone, and clobetasol. CONCLUSION Robust evidence concerning the superiority of potent steroids at least over calcineurin inhibitors is still lacking in the field of vulvar lichen sclerosus. On the other hand, the gross heterogeneity in terms of selected population, duration of treatment, administered regimen, outcome reporting, and selection of outcome measures leaves several fields unanswered.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece; Third Department of Obstetrics and Gynecology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini-Chrysovalantou Biliou
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Varnava
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Mitsopoulou
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece; Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals National Health Service Trust, London, United Kingdom; St George's University of London, London, United Kingdom
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Geisler A, Lacouture ME, Goldfrank D, Noor S. Vulvar lichen sclerosus in the setting of cancer treatment – A case series and review of the literature. Int J Womens Dermatol 2020. [DOI: 10.1016/j.ijwd.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health 2020; 12:11-20. [PMID: 32021489 PMCID: PMC6970240 DOI: 10.2147/ijwh.s191200] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022] Open
Abstract
Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO2 laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.
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Affiliation(s)
- Jill M Krapf
- The George Washington University, Washington, DC, USA
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
| | - Leia Mitchell
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
| | - Michelle A Holton
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Andrew T Goldstein
- The George Washington University, Washington, DC, USA
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
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Li Z, Wang Y, Wang J, Li S, Xiao Z, Feng Y, Gu J, Li J, Peng X, Li C, Zeng K. Evaluation of the efficacy of 5-aminolevulinic acid photodynamic therapy for the treatment of vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2019; 29:101596. [PMID: 31704505 DOI: 10.1016/j.pdpdt.2019.101596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study aimed to evaluate the effects of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) on the improvement of symptoms and recurrence rate in patients with vulvar lichen sclerosus (VLS) and observe its side effects. METHODS The symptom scores before and after photodynamic therapy (PDT) in 13 enrolled patients with VLS were analyzed retrospectively. All patients were followed-up for at least 6 months to evaluate the recurrence rate after PDT. The patients were treated with PDT only during the study period. During the PDT treatment, a 20 % 5-aminolevulinic acid solution was applied to the lesions and marginal areas for 3 h, and the entire area was then irradiated with 635 nm red light of 80 J/cm2 at 80 mW/cm2 for 30 min. RESULTS In this study, the effective rate of PDT was 92.31 %. Lesions recurred in two patients at 6 months after PDT. Post-treatment, the total subjective, total objective, and the Dermatological Life Quality Index scores changed from 11.4, 4.3, and 13.4 at baseline to 4.9, 2, and 5.9, respectively. The difference was statistically significant (p <0.05). PDT was mildly toxic in most patients. CONCLUSIONS ALA-PDT is a safe and effective method for the treatment of VLS, and the therapeutic effects can be maintained for at least 3 months. The therapeutic effects may decrease during the 3-6-month period after PDT.
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Affiliation(s)
- Zhijia Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Yajie Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
| | - Jingying Wang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Songshan Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Zixuan Xiao
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Yingjun Feng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Jingjing Gu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
| | - Junpeng Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Xiaoming Peng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Changxing Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Kang Zeng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Hobson JG, Ibrahim SF, Mercurio MG. Recalcitrant Vulvar Lichen Sclerosus Treated With Erbium YAG Laser. JAMA Dermatol 2019; 155:254-256. [DOI: 10.1001/jamadermatol.2018.4461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Julia G. Hobson
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Sherrif F. Ibrahim
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Mary Gail Mercurio
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
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