Lichen sclerosus et atrophicus

Pseudoepitheliomatous, Keratotic and Micaceous Balanitis: A Case Report

Pseudoepitheliomatous, keratotic and micaceous balanitis (KPMB) is a rare condition affecting glans penis of elderly men. It is characterized by thick hyperkeratotic plaque with micaceous scaling often leading to phimosis. Here we are reporting a rare case of pseudoepitheliomatous, keratotic, and micaceous balanitis in 50-year-old man who has undergone circumcision 16 years back. Till date only a handful cases have been reported in world literature.

Pseudoepitheliomatous keratotic and micaceous balanitis

Many premalignant and malignant lesions affect the genitalia of elderly men. These include conditions like erythroplasia of Queyret, giant condyloma acuminata, verrucous carcinoma, invasive squamous cell carcinoma (SCC), which are relatively common. We report a case of a 65-year-old male with pseudoepitheliomatous keratotic and micaceous balanitis which is a rare penile condition affecting the elderly. It is considered as a distinct clinical entity by some, while others consider it as a condition that overlaps with verrucous carcinoma. It can also be considered a premalignant condition, as progression to invasive SCC has been noted.

Pseudoepitheliomatous keratotic and micaceous balanitis

Many premalignant and malignant lesions affect the genitalia of elderly men. These include conditions like erythroplasia of Queyret, giant condyloma acuminata, verrucous carcinoma, invasive squamous cell carcinoma (SCC), which are relatively common. We report a case of a 65-year-old male with pseudoepitheliomatous keratotic and micaceous balanitis which is a rare penile condition affecting the elderly. It is considered as a distinct clinical entity by some, while others consider it as a condition that overlaps with verrucous carcinoma. It can also be considered a premalignant condition, as progression to invasive SCC has been noted.

Lichen sclerosus et atrophicus and sexual abuse

AIMS

The aetiology of lichen sclerosus et atrophicus (LSA) is unknown. A series of 42 cases of this uncommon condition is reported. The aim of this study was to identify associations of LSA and document the association with sexual abuse.

METHODS

Information about the patients was obtained by retrospective case note review and some patients were contacted by telephone for further information.

RESULTS

In 12 cases there was evidence of sexual abuse. The abused group were slightly older than the non-abused group but were similar in all other respects. All three patients who presented over the age of 12 years had evidence of sexual abuse. Genital trauma was recalled by the patient or found at examination in 17 cases. Evidence of autoimmunity was present in five cases. Positive microbiological isolates were obtained in 18 cases. In only 11 cases were there no associated factors. The symptoms of LSA started between the ages of 3 and 7 years in most patients. The usual symptoms were related to genital skin involvement, and symptoms related to bladder and bowel function were common (50%).

CONCLUSION

In this large series of paediatric LSA, associations with trauma, autoimmunity, and infection were noted. There was a high rate of coexisting sexual abuse with LSA, possibly due to genital trauma.

Surgical treatment of vulvar lichen sclerosus: a review

Surgical therapy of lichen sclerosus of the vulva consists of three main operations: vulvectomy (with or without a skin graft), cryosurgery, and laser ablation. It is indicated in two conditions, either when malignant transformation is present or is likely to occur, or when medical treatment has failed. The overall risk for malignant transformation of vulvar lichen sclerosus is low, ranging between 0 and 9 percent. However, specific histological criteria, such as mixed dystrophy, have recently been associated with higher malignancy rates. Vulvectomy is indicated only when these criteria are met. Both skinning and simple vulvectomies are associated with recurrence rates as high as 50 percent. However, better sexual function and cosmetic results have been reported in the former, especially with concomitant split skin grafting. Cryosurgery also has high recurrence rates, although short-term results are favorable. Although only small series have been reported, laser therapy seems to carry better long-term results than other modes of treatment. Convalescence is complete within 6 weeks posttreatment, and remission rates are as high as 85 percent at 3 years of follow-up. The high recurrence rate of all surgical modalities makes surgical treatment suitable only for patients who failed to respond to multiple medical treatments such as topical high potent steroid ointments, testosterone, and retinoids.

Risk factors for vulvar lichen sclerosus

To assess risk factors for vulvar lichen sclerosus data were collected in a case-control study of 75 cases and 225 age-matched control subjects. Questions concerned personal characteristics and habits, gynecologic and obstetric data, general indicators of sexual habits, and selected dietary habits. The risk of vulvar lichen sclerosus was greater in parous women than nulliparous women, but there was little tendency for the risk to increase with number of births; the finding was not significant when only married women were considered. There was no material difference between cases and control subjects in relation to major indicators of sexual habits (age at first intercourse and number of sexual partners). A smaller proportion of cases was married, but no difference was observed in the distribution of cases and controls with reference to education, smoking habits, body mass index, and previous history of diabetes. There was no association between retinoids and risk of vulvar lichen sclerosus, but intake of carotenoids was inversely and strongly associated with vulvar lichen sclerosus. This apparent protection did not materially change after adjustment for socioeconomic status and other potential confounding factors.