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Su C, Liu X, Wu C, Wang X, Li C. Feasibility study of focused ultrasound in the treatment of vulvar low-grade squamous intraepithelial lesions with persistent symptoms. Int J Hyperthermia 2024; 41:2365975. [PMID: 38862420 DOI: 10.1080/02656736.2024.2365975] [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: 12/11/2023] [Accepted: 06/05/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the feasibility, efficacy, and safety of focused ultrasound (FUS) for the treatment of vulvar low-grade squamous intraepithelial lesions (VLSIL) with persistent symptoms. METHODS This retrospective analysis included 24 VLSIL patients who underwent FUS treatment. At each follow-up visit, the clinical response was assessed including changes in symptoms and signs. In addition, the histological response was assessed based on the vulvar biopsy results of the 3rd follow-up. Clinical and histological response were assessed to elucidate the efficacy. RESULTS A total of 22 patients completed follow-up and post-treatment pathological biopsies. After treatment, the clinical scores of itching decreased from 2.55 ± 0.51 to 0.77 ± 0.81 (p < 0.05). Furthermore, the clinical response rate and histological response rate were 86.4% and 81.8%, respectively. Only two cured patients indicated recurrence in the 3rd and 4th year during the follow-up period and achieved cure after re-treatment. In terms of adverse effects, only one patient developed ulcers after treatment, which healed after symptomatic anti-inflammatory treatment without scarring, and no other treatment complications were found in any patients. None of the patients developed a malignant transformation during the follow-up period. CONCLUSION This study revealed that FUS is feasible, effective, and safe for treating VLSIL patients with persistent symptoms, providing a new solution for the noninvasive treatment of symptomatic VLSIL.
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Affiliation(s)
- Chang Su
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory 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
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Can Wu
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Xi Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory 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
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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2
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Shang X, Chen C, Ma H, Zhao P, Mao Y, Liu H, Wang C, Mao K, Luo Z, Li Y, Zhou G, Tan H. Application of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma injection + chemexfoliation in vulvar lichen sclerosus. Front Pediatr 2023; 11:1276786. [PMID: 38111623 PMCID: PMC10725975 DOI: 10.3389/fped.2023.1276786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction To investigate the therapeutic effect of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma (PRP) injection + chemexfoliation on vulvar lichen sclerosus (VLS). Methods Twenty children with VLS (under 14 years old) at our hospital from July 2020 to November 2022 were enrolled and treated with clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation. Additionally, symptomatic changes and improvements in signs were recorded. Results Significant therapeutic effects were achieved in all children enrolled in this study. The Cattanco score was 8.02 ± 1.22 points before surgery, 2.21 ± 0.70 points 3 months after surgery, and 2.61 ± 0.59 points 6 months after surgery, demonstrating that the score after surgery was significantly lower than that before surgery (p < 0.05). Mild complications (one case of mild vulvar swelling, one case of minor bleeding, and one case of superficial ulcer) were observed in three children after surgery, with an overall complication incidence of 15%; all complications were improved after the intervention, and no severe adverse reactions were observed. Recurrence was observed in one child (5%) 6 months after surgery. Conclusion Clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation is an effective approach for the treatment of VLS. Systematic Review Registration https://www.chictr.org.cn/searchproj.html, identifier: ChiCTR2100054787.
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Affiliation(s)
- Xianhui Shang
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Changmei Chen
- Department of Physiology, Basic Medical College, Medicine & Technology College of Zunyi Medical University, Zunyi, China
| | - Hong Ma
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Peng Zhao
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuchen Mao
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Liu
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Cao Wang
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kaiyi Mao
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhen Luo
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yingbo Li
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangxu Zhou
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongyang Tan
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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3
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Patel PV, Hrin ML, Feldman SR, Pichardo R. Mycophenolate Mofetil for Genital and Extragenital Lichen Sclerosus Et Atrophicus. J Cutan Med Surg 2023; 27:654-655. [PMID: 37942581 DOI: 10.1177/12034754231211327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Palak V Patel
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Matthew L Hrin
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| | - Rita Pichardo
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
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4
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Jiang C, Muradova E, Lu J. Generalized extragenital lichen sclerosus et atrophicus in skin of color. JAAD Case Rep 2023; 40:63-66. [PMID: 37731673 PMCID: PMC10507054 DOI: 10.1016/j.jdcr.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- Christina Jiang
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Elnara Muradova
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Jun Lu
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
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5
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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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6
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Mazilu D, Boltașiu (Tătaru) LA, Mardale DA, Bijă MS, Ismail S, Zanfir V, Negoi F, Balanescu AR. Eosinophilic Fasciitis: Current and Remaining Challenges. Int J Mol Sci 2023; 24:ijms24031982. [PMID: 36768300 PMCID: PMC9916848 DOI: 10.3390/ijms24031982] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Eosinophilic fasciitis (EF), defined as diffuse fasciitis with eosinophilia by Shulman in 1974, is a disease with unknown etiology and whose pathogenesis is still being researched. The diagnosis is based on the clinical aspects (skin induration with an "orange peel" appearance), the lab results (eosinophilia, increased inflammatory markers), the skin biopsy with the pathognomonic histopathological result, as well as the typical MRI changes. The treatment includes glucocorticoids and immunosuppressive drugs. Due to severe refractory cases, the treatment remains a challenge. EF is still a disease with potential for further research.
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Affiliation(s)
- Diana Mazilu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Laura Alina Boltașiu (Tătaru)
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- Correspondence: (D.M.); (L.A.B.)
| | - Denise-Ani Mardale
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
| | - Maria Silviana Bijă
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Sermina Ismail
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Violeta Zanfir
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Florentina Negoi
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
| | - Andra Rodica Balanescu
- “Sfanta Maria” Clinical Hospital, Ion Mihalache blvd, 37-39, 011172 Bucharest, Romania
- “Carol Davila” University of Medicine, Dionisie Lupu Street, nr 37, 020021 Bucharest, Romania
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7
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Lichen Sclerosus: A Current Landscape of Autoimmune and Genetic Interplay. Diagnostics (Basel) 2022; 12:diagnostics12123070. [PMID: 36553077 PMCID: PMC9777366 DOI: 10.3390/diagnostics12123070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Lichen sclerosus (LS) is an acquired chronic inflammatory dermatosis predominantly affecting the anogenital area with recalcitrant itching and soreness. Progressive or persistent LS may cause urinary and sexual disturbances and an increased risk of local skin malignancy with a prevalence of up to 11%. Investigations on lipoid proteinosis, an autosomal recessive genodermatosis caused by loss-of-function mutations in the extracellular matrix protein 1 (ECM1) gene, led to the discovery of a humoral autoimmune response to the identical molecule in LS, providing evidence for an autoimmune and genetic counterpart targeting ECM1. This paper provides an overview of the fundamental importance and current issue of better understanding the immunopathology attributed to ECM1 in LS. Furthermore, we highlight the pleiotropic action of ECM1 in homeostatic and structural maintenance of skin biology as well as in a variety of human disorders possibly associated with impaired or gained ECM1 function, including the inflammatory bowel disease ulcerative colitis, Th2 cell-dependent airway allergies, T-cell and B-cell activation, and the demyelinating central nervous system disease multiple sclerosis, to facilitate sharing the concept as a plausible therapeutic target of this attractive molecule.
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8
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Gerkowicz A, Szczepanik-Kułak P, Krasowska D. Photodynamic Therapy in the Treatment of Vulvar Lichen Sclerosus: A Systematic Review of the Literature. J Clin Med 2021; 10:5491. [PMID: 34884193 PMCID: PMC8658411 DOI: 10.3390/jcm10235491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease involving the genital skin and mucous membrane. Patients exhibit focal atrophy and destructive scarring, with an increased risk of malignant transformation. Due to objective symptoms as well as subjective complaints, patients with VLS experience emotional distress, lowered mood, and sexual dysfunction, which is reflected in impaired health-related quality of life. Thus, the necessity of implementing appropriate therapy at the earliest possible stage of the disease in order to avoid serious complications is highlighted. We presented the systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, and Web of Science databases. We identified a total of twenty relevant studies which indicate that photodynamic therapy (PDT) is a valuable therapeutic modality in the treatment of VLS.
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Affiliation(s)
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (A.G.); (D.K.)
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9
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Conteduca V, Medri M, Mazzoni L, De Giorgi U, Stanganelli I. Anogenital lichen sclerosus et atrophicus lesions in a case series of cancer patients on immunotherapy. Cancer Immunol Immunother 2021; 71:1545-1548. [PMID: 34705086 DOI: 10.1007/s00262-021-03094-0] [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: 05/21/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
Lichenoid reactions are one of the most frequently observed toxicities with anticancer agents and, recently, a rapid emergence of immunotherapies in oncology has hastened the need to better characterize their unique toxicity profiles, particularly for less common skin toxicities, including anogenital lichen sclerosus et atrophicus (LSA). This case series describes four patients with advanced cancer (one melanoma, two lung cancers, and one kidney tumor) developing LSA lesions while receiving an immunotherapy. Medical records from 2017 to 2020 were retrospectively reviewed. Two patients received pembrolizumab, anti-programmed cell death-1 (PD-1), one nivolumab, anti-programmed cell death-1 (PD-1), and one ipilimumab, an immune checkpoint inhibitor. LSA emerged after a median of 3 months (range, 2-4 months) from starting immunotherapy. All LSA cases were grade 2. Three cases occurred on the penis and one case on the anus. All patients improved after a specific treatment for LSA, and no LSA-related antineoplastic treatment interruption/life-threatening condition were reported. To date, this is the first case series of LSA lesions associated with immunotherapy. Early LSA recognition and management is helpful in cancer patients on immunotherapy allowing a long survival and treatment response.
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Affiliation(s)
- V Conteduca
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", via Piero Maroncelli 40, 47014, Meldola, Italy. .,Department of Medical and Surgical Sciences, Unit of Medical Oncology and Biomolecular Therapy, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy.
| | - M Medri
- Skin Cancer Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - L Mazzoni
- Skin Cancer Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", via Piero Maroncelli 40, 47014, Meldola, Italy
| | - I Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy.,Department of Dermatology, University of Parma, Parma, Italy
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10
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Vishwanath T, Ghate S, Shinde G, Lahoria V, Binny B, Sonwane A. Koebnerization of Lichen Sclerosus Et Atrophicus at Insulin Injection Sites - A Rare Case with Dermoscopic Features. Indian J Dermatol 2021; 66:224. [PMID: 34188297 PMCID: PMC8208266 DOI: 10.4103/ijd.ijd_634_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lichen sclerosus et atrophicus (LSEA), also known as lichen sclerosus (LS), is a disabling, cosmetically disfiguring condition predominantly affecting the anogenital region of pre- and postmenopausal females. Extragenital LS is relatively less common and occurs predominantly on the trunk and neck. Koebnerization or isomorphic phenomenon is reported occasionally in LS after trauma like radiotherapy. A few case reports describe koebnerization of LS at injection sites. We describe the first such case in India of LS koebnerizing at insulin injection sites with dermoscopic features.
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Affiliation(s)
- Tejas Vishwanath
- Department of Dermatology, Rajawadi Hospital, Mumbai, Maharashtra, India
| | - Sunil Ghate
- Department of Dermatology, Rajawadi Hospital, Mumbai, Maharashtra, India
| | - Geeta Shinde
- Department of Dermatology, Rajawadi Hospital, Mumbai, Maharashtra, India
| | - Vikram Lahoria
- Consultant Dermatologist, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Binny Binny
- Department of Dermatology, Rajawadi Hospital, Mumbai, Maharashtra, India
| | - Ankita Sonwane
- Department of Dermatology, Rajawadi Hospital, Mumbai, Maharashtra, India
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11
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Phan M, Sou E, Al Sannaa G, Erwin M, Sanchez R. Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus. Cureus 2020; 12:e9343. [PMID: 32850217 PMCID: PMC7444889 DOI: 10.7759/cureus.9343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Lichen sclerosus et atrophicus (LSA) may present in a rare bullous and hemorrhagic form that is often difficult to recognize both clinically and histopathologically. Clinically, the lesions may be characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Histologically, fully developed lesions of LSA are characterized by a thinned, effaced epidermis with interface change, a wide band of hyalinization in the upper dermis, and a lymphohistiocytic infiltrate below the hyalinized area. Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae. Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA. We present a case of extragenital LSA that mimics a dermal hemorrhage clinically and histologically in a 71-year-old Caucasian woman.
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12
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Paulis G, Berardesca E. Lichen sclerosus: the role of oxidative stress in the pathogenesis of the disease and its possible transformation into carcinoma. Res Rep Urol 2019; 11:223-232. [PMID: 31687365 PMCID: PMC6709801 DOI: 10.2147/rru.s205184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Lichen sclerosus (LS) is an autoimmune chronic inflammatory disease usually involving the anogenital skin of both sexes; more rarely LS exclusively involves extragenital areas. As a chronic inflammatory disease, in most cases, LS evolves and progresses causing scleroatrophy of the skin or scars which may cause stenosis in the affected areas. A few LS patients are at risk of developing squamous cell carcinoma in their lifetime, but appropriate long-term treatment diminishes the possibility of a malignant evolution. Oxidative stress (OS) has been proven to play a role not only in the pathogenesis of LS, but also in the development and progression of the disease. OS, by causing DNA damage and lipid peroxidation, contributes directly to the possible malignant transformation of LS. Moreover, the increase in oxidative DNA damage is associated with mutations in tumor suppressor genes. Considering the role that OS plays in LS, therapeutic use of antioxidants appears to be rational and possible, in association with other treatments. Antioxidants would counteract the oxidative DNA damage, which is the most important factor for the progression of LS and its malignant transformation.
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Affiliation(s)
- Gianni Paulis
- Andrology Center, Villa Benedetta Clinic, Rome, Italy.,Department of Uro-andrology, Castelfidardo Medical Team, Rome, Italy
| | - Enzo Berardesca
- Department of Clinical Dermatology, S. Gallicano Dermatological Institute, Rome, Italy
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13
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Abstract
Eosinophilic fasciitis is a disease originally proposed as "diffuse fasciitis with eosinophilia" by Shulman in 1974. The patients with this disease often have history of strenuous exercise or labor a few days to 1-2 weeks before the onset. The chief symptoms are symmetrical, full-circumference swelling and plate-like hardness of the distal limbs. This is accompanied by redness and pain in the early stages, with many cases exhibiting systemic symptoms such as fever or generalized fatigue. The lesions have been observed extending to the proximal limbs, though never on the face or fingers. En bloc biopsies from the skin to the fascia show marked fascial thickening and inflammatory cell infiltration by the lymphocytes and plasma cells. Eosinophilic infiltration is useful for the diagnosis but is only seen in the early stages of the disease. Recently, "Diagnostic criteria, severity classification, and clinical guidelines for eosinophilic fasciitis" were published. This review article discusses about eosinophilic faciitis in detail, from its pathophysiology to the treatment.
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14
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Tran DA, Tan X, Macri CJ, Goldstein AT, Fu SW. Lichen Sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci 2019; 15:1429-1439. [PMID: 31337973 PMCID: PMC6643151 DOI: 10.7150/ijbs.34613] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022] Open
Abstract
Lichen sclerosus (LS) is an inflammatory dermatosis with a predilection for anogenital skin. Developing lesions lead to vulvar pain and sexual dysfunction, with a significant loss of structural anatomical architecture, sclerosis, and increased risk of malignancy. Onset may occur at any age in both sexes, but typically affects more females than males, presenting in a bimodal fashion among pre-pubertal children and middle-aged adults. A definitive cure remains elusive as the exact pathogenesis of LS remains unknown. A general review of LS, histologic challenges, along with amounting support for LS as an autoimmune disease with preference for a Th1 immune response against a genetic background is summarized. In addition to the classically referenced ECM1 (extracellular matrix protein 1), a following discussion of other immune and genetic targets more recently implicated as causative or accelerant agents of disease, particularly miR-155, downstream targets of ECM1, galectin-7, p53, and epigenetic modifications to CDKN2A, are addressed from the viewpoint of their involvement in three different, but interconnected aspects of LS pathology. Collectively, these emerging targets serve not only as inherently potential therapeutic targets for treatment, but may also provide further insight into this debilitating and cryptic disease.
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Affiliation(s)
- Davis A Tran
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Xiaohui Tan
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Charles J Macri
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrew T Goldstein
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC.,Center for Vulvovaginal Disorders, Washington, DC
| | - Sidney W Fu
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
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