1
|
Del Papa J, Pucchio AC, Schneider M, Wang A. Perineural Inflammation as a Novel Feature in Lichen Sclerosus: A Case Series of Histologic and Clinical Features. Am J Dermatopathol 2024; 46:287-291. [PMID: 38457688 DOI: 10.1097/dad.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Lichen sclerosus (LS) is a frequently encountered inflammatory skin disorder characterized by whitened, atrophic patches that can cause pain and pruritus. The underlying cause of this condition remains unknown. Primarily affecting the genital area, this condition carries an increased risk of developing cutaneous cancers and frequently co-occurs with autoimmune disorders. Our retrospective study aimed to explore histologic features of LS, with a particular focus on a newly established finding and its potential implications. We examined 53 histologic cases of LS collected over 2 years. Experienced pathologists evaluated and reached a consensus on the assignment of histologic features. Patient charts were manually reviewed to gather relevant demographic and clinical data. Statistical analysis was performed using IBM SPSS Statistics (2021). Of the 53 total patients identified as meeting criteria for inclusion in this study, only 8 (15%) were male. Eight cases (15%) demonstrated perineural inflammatory infiltrate. Notably, half of all samples from male patients exhibited perineural inflammatory infiltrate. A statistically significant increase ( P < 0.01) in the presence of dermal plasma cells was identified in cases with perineural inflammation versus cases without this feature. The findings of our study highlight the recurrent nature of perineural inflammation in LS, providing valuable insights into this condition. Furthermore, we observed a notable correlation between perineural inflammation, male patients, and the presence of dermal plasma cells. These discoveries contribute to a better understanding of the underlying mechanisms of LS and suggest avenues for future research into the condition.
Collapse
Affiliation(s)
- Joshua Del Papa
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Aine Celestina Pucchio
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Mark Schneider
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
| | - Ami Wang
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
| |
Collapse
|
2
|
Bentivegna K, Grant-Kels JM, Livingston N. Cutaneous Mimics of Child Abuse & Neglect: Part II. J Am Acad Dermatol 2022; 87:519-531. [PMID: 35339589 DOI: 10.1016/j.jaad.2021.12.070] [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: 10/30/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Abstract
Given that some cutaneous mimics of child abuse result from rare disease, they may be more prone to misdiagnosis. For possible child abuse cases in which diagnosis remains uncertain at time of initial dermatologic evaluation, it is important that dermatologists are prepared to distinguish true dermatologic conditions in cases of ambiguous skin findings. Additionally, this review will aid clinicians in recognizing the possibility of concurrent true dermatologic disease and skin findings related to abuse with the acknowledgement that they are not mutually exclusive. Proper recognition of mimics of abuse may prevent unnecessary stress and child protective service investigation.
Collapse
Affiliation(s)
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida.
| | - Nina Livingston
- Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Cigna ST, Goldstein AT, Krapf J. Vulvar lysis of adhesions: surgical treatment of vulvar granuloma fissuratum. Am J Obstet Gynecol 2021; 224:622. [PMID: 33722554 DOI: 10.1016/j.ajog.2021.03.013] [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] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 03/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah T Cigna
- Centers for Vulvovaginal Disorders and the George Washington University, Washington, DC.
| | - Andrew T Goldstein
- Centers for Vulvovaginal Disorders and the George Washington University, Washington, DC
| | - Jill Krapf
- Centers for Vulvovaginal Disorders and the George Washington University, Washington, DC
| |
Collapse
|
5
|
Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne) 2021; 8:649402. [PMID: 33898486 PMCID: PMC8058221 DOI: 10.3389/fmed.2021.649402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023] Open
Abstract
Vulvar pruritus is an unpleasant sensation and frequent symptom associated with many dermatologic conditions, including infectious, inflammatory and neoplastic dermatoses affecting the female genitalia. It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis. We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom.
Collapse
Affiliation(s)
- Haya S Raef
- Tufts University School of Medicine, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | | |
Collapse
|
6
|
Gardner AN, Aschkenazi SO. The short-term efficacy and safety of fractional CO2 laser therapy for vulvovaginal symptoms in menopause, breast cancer, and lichen sclerosus. Menopause 2021; 28:511-516. [PMID: 33399322 DOI: 10.1097/gme.0000000000001727] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the short-term effects and safety of vulvovaginal fractional microablative CO2 laser therapy on atrophy symptoms using validated questionnaires pre- and posttreatment. METHODS This is a retrospective chart review from January, 2016 to December, 2019 on 139 women with vulvovaginal atrophy symptoms, who completed three treatments about 6 weeks apart. All were >18 years old and nonpregnant. As is the practice in our clinic for all women receiving treatment, they were surveyed prior to the 1st and 3rd treatments with validated questionnaires, Female Sexual Function Index (FSFI) and Vulvovaginal Symptoms Questionnaire (VSQ), as well as a visual analog scale (VAS). Paired t test was completed on the pre- and post FSFI and VAS scores. Pre- and postproportions of the VSQ were evaluated by the Fisher's exact test. Means were presented for each study variable. Multivariable regression analysis was completed on continuous and binomial variables for scores predictors. RESULTS Mean age was 62 years with a mean follow-up of 13.8 weeks. Concomitant topical estrogen was reported in 53% (n = 74). Breast cancer diagnosis was documented in 27% (n = 38), and lichen sclerosus in 22% (n = 31). All FSFI scores improved (pre: 12.7, post: 19.0, P < 0.001). The VSQ showed 18 of 21 questions significantly improved (P < 0.05). The VAS showed significant improvement in painful intercourse (pre: 6.6, post: 2.4, P < 0.001), and vulvar dryness (pre: 4.6, post: 1.5, P < 0.001). Posttreatments, 17 additional women became sexually active. No major adverse events were reported. CONCLUSIONS Fractional CO2 laser may be effective and safe for the treatment vulvovaginal atrophy.
Collapse
Affiliation(s)
- Alyssa N Gardner
- Department of Obstetrics and Gynecology, UT Health San Antonio, San Antonio, TX
- Medical College of Wisconsin, Wauwatosa, WI
| | - Sarit O Aschkenazi
- Prohealth Women's Services, Division of Urogynecology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, WI
| |
Collapse
|
7
|
Lauber F, Vaz I, Krebs J, Günthert AR. Outcome of perineoplasty and de-adhesion in patients with vulvar Lichen sclerosus and sexual disorders. Eur J Obstet Gynecol Reprod Biol 2021; 258:38-42. [PMID: 33412460 DOI: 10.1016/j.ejogrb.2020.12.030] [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: 08/31/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Vulvar Lichen sclerosus (LS) is a chronic inflammatory disease in which architectural changes and symptoms like itching, soreness, pain and dyspareunia can affect quality of life and sexual activity. Perineoplasty has been shown to be effective as a supportive surgical treatment in women with refractory dyspareunia in addition to the standard topical immunosuppressive treatment. The aim of this study was to evaluate retrospectively general complaints, patient satisfaction concerning sexual activity, reduction of dyspareunia/apareunia, orgasm ability and recurrence of LS after perineoplasty. STUDY DESIGN This study is a retrospective monocentric observational study, in which patients with vulvar LS who had undergone perineoplasty were invited to fill out a standardized questionnaire during the follow-up time. The main outcome measure is the overall patient satisfaction after surgical therapy of vulvar LS. RESULTS Forty-one of the 70 invited patients with a median age at surgery of 58 years (18-74 years) and a median 60 years (19-76 years) at the last follow-up were evaluated. The median follow-up time was 2.3 years (1-5 years). There was a significant (p < 0.001) reduction in general complaints after surgery. Twenty-two patients were very satisfied, 15 were satisfied and 3 were not satisfied with the outcome of the surgery. Only 2 patients would not recommend the surgery. Although, there was a significant (p = 0.02) reduction in dyspareunia after surgery, 10 patients still felt pain during sexual intercourse. CONCLUSION This is one of the largest studies reporting on long-term results of perineoplasty. It showed that perineoplasty is a safe surgical treatment option with a high satisfaction rate in patients with dyspareunia due to LS and a desire to regain sexual activity. Perineoplasty can improve sexual activity and achieve overall satisfaction in selected patients even though the recurrence rate of LS in sexually active patients remains high.
Collapse
Affiliation(s)
- Fabienne Lauber
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Inês Vaz
- gyn-zentrum ag, Lucerne, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | | |
Collapse
|
8
|
Almadori A, Zenner N, Boyle D, Swale V, Reid W, Maclean A, Butler PEM. Development and Validation of a Clinical Grading Scale to Assess the Vulvar Region: The Vulvar Architecture Severity Scale. Aesthet Surg J 2020; 40:1319-1326. [PMID: 32382752 DOI: 10.1093/asj/sjz342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The vulva is composed of aesthetic units that can be affected differently by vulvar conditions. A reliable, comprehensive, and quick-to-use clinical scoring system is required to assess the disease extent in the vulvar area. OBJECTIVES The aim of this study was to develop and validate a grading scale based on the aesthetic unit principle to evaluate the extent of vulvar lichen sclerosus (VLS). METHODS After reviewing photographs of 100 patients affected by VLS, the authors targeted the aesthetic units most frequently affected. The disease signs were recorded and graded in 4 levels of severity (none, mild, moderate, severe) taking into account the vulvar architecture and skin involvement. To validate the scale, 14 observers were asked to apply it to photographs of 25 VLS patients on 2 different occasions. Intra- and inter-observer reliabilities were determined employing Pearson's and intraclass correlation coefficients. RESULTS A 6-region, 4-point grading system was designed and identified as the Vulvar Architecture Severity Scale (VASS). In all 6 areas, the Pearson's r was greater than 0.9 (mean, 0.994; 95% confidence interval [CI] = 0.992), indicating that the intra-observer reliability of the VASS was consistent over time (P < 0.001). Intraclass correlation at time 1 was 0.928 (95% CI = 0.910, 0.943) and at time 2 was 0.944 (95% CI = 0.931, 0.996), indicating a high reliability level among different observers. CONCLUSIONS The VASS is a reliable scale to assess the severity of VLS, and it might be considered as an outcome measure in future VLS trials. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Aurora Almadori
- Centre for Nanotechnology and Regenerative Surgery, University College of London
- Department of Plastic Surgery, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Nicole Zenner
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Deborah Boyle
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Victoria Swale
- Department of Dermatology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Wendy Reid
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Allan Maclean
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Peter E M Butler
- Department of Plastic Surgery, NHS Foundation Trust Royal Free Hospital, London, UK
| |
Collapse
|
9
|
Aboud C, Cristinelli S, Roccaro G, Meningaud JP, Hersant B. Surgical treatment of clitoral phimosis. J Gynecol Obstet Hum Reprod 2020; 50:101919. [PMID: 32971308 DOI: 10.1016/j.jogoh.2020.101919] [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: 07/17/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
The clitoris has a crucial role in the feminine pleasure. Chronic inflammatory dermatosis along with post-menopausal atrophy of the vulva and obstetrical traumas can cause clitoral phimosis, thereby compromising its function. Medical treatments exist depending on the etiology, but when irreversible scarring occur, a surgical treatment can be necessary to regain its function. We present here our surgical technique that achieves excellent functional results with low morbidity and the outcome of our patients in order to improve this sexual dysfunction.
Collapse
Affiliation(s)
- Céline Aboud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Stéphane Cristinelli
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Giovanni Roccaro
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Jean-Paul Meningaud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Barbara Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
| |
Collapse
|
10
|
Shalin SC, Racher LM, Campbell KK. Lichenoid dermatoses involving the vulva: A clinical-pathologic correlation ✰. Semin Diagn Pathol 2020; 38:3-18. [PMID: 32951943 DOI: 10.1053/j.semdp.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
The lichenoid tissue reaction pattern generally signifies cytotoxic damage to the epithelium. When such reaction pattern occurs on vulvar skin or mucosa, the effects can result in considerable morbidity. None of the entities discussed in this review are entirely unique to the vulva, however, some entities may classically occur at this site, while others tend to be widespread diseases that may incidentally affect vulvar skin and mucosa. Given the complex anatomy of the vulva and the bridging of a site showing both keratinizing squamous epithelium and non-keratinizing squamous mucosa, histopathologic features may display variation in presentation. Although identification of a "lichenoid reaction pattern" alone may provide insight into the disease process, understanding of clinical presentation and specific sites of involvement, along with recognition of the nuanced features of the disease entities can help establish a specific diagnosis. Accurate histopathologic diagnoses by pathologists can improve the ability for treating clinicians to implement timely and effective treatment.
Collapse
Affiliation(s)
- Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Luann M Racher
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Katelynn K Campbell
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|
11
|
|
12
|
Fancher K, Gardner JM, Shalin SC. Elastophagocytosis and interstitial granulomatous infiltrate are more common in extragenital vs genital lichen sclerosus. J Cutan Pathol 2020; 47:903-912. [PMID: 32399972 DOI: 10.1111/cup.13741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Genital and extragenital lichen sclerosus (LS) share similar histopathologic features. A recent small series documented elastophagocytosis uniquely in extragenital LS. We evaluated a larger series of LS for elastophagocytosis, elastic fiber loss, and other histopathologic features. We evaluated matrix metalloproteinase (MMP) expression to determine if these proteins play an etiologic role. METHODS Genital (n = 42) and extragenital (n = 41) LS biopsies were examined for histopathologic features, elastic fiber alteration (Verhoeff van Gieson staining), and MMP-2 and MMP-9 expression (immunohistochemistry). RESULTS Elastophagocytosis and an interstitial granulomatous pattern were significantly more common in extragenital LS than genital LS (43.9% vs 4.7% and 56.1% vs 9.5%). Extragenital LS had mild/focal elastic fiber loss (43.9%), while genital LS had moderate (61.9%) or marked (19%) loss. MMP-9 was diffusely expressed in histiocytes in both types of LS (genital 97.5%; extragenital 100%). Weak MMP-2 expression was seen in genital (58%) and extragenital (55%) LS. CONCLUSIONS Extragenital LS, but not genital LS, frequently exhibits elastophagocytosis and interstitial granulomatous infiltrate, and these patterns could contribute to elastic fiber destruction in extragenital LS. While MMP-2 and MMP-9 expression are common in LS, expression did not significantly differ depending on anatomic site and thus is unlikely to explain observed histopathologic differences.
Collapse
Affiliation(s)
- Kendall Fancher
- Department of Medicine at Yale, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jerad M Gardner
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sara C Shalin
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Declercq A, Güvenç C, De Haes P. Proposition of standardized protocol for photodynamic therapy for vulvar lichen sclerosus. J DERMATOL TREAT 2020; 33:560-568. [PMID: 32420789 DOI: 10.1080/09546634.2020.1771260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Photodynamic therapy (PDT) is an alternative treatment modality for vulvar lichen sclerosus (VLS) which is a chronic inflammatory mucosal condition. In literature, no consensus of optimal parameters of PDT for VLS is reached so far.Objectives: The aim of this narrative review is to develop a standardized treatment protocol for PDT in VLS.Methods: A systematic literature search was conducted to identify studies reporting on PDT in VLS and used treatment parameters, side-effects, and clinical outcomes were summarized.Results: Thirteen studies used 5-aminolevulinic acid (5-ALA) with concentrations of 20%, 10%, 5% and three studies used methyl aminolevulinate (MAL). Generally, the light source was red light (median 630 nm). Light dose varied between 9 and 180 J/cm2 and light intensity between 40 and 700 mW/cm2. Incubation period with the photosensitizer ranged from 2 to 6 h. All studies showed a substantial improvement in VLS-related pruritus, burning and pain.Conclusions: Based on a literature review, we suggest the following protocol for PDT in VLS: 5% 5-ALA as a photosensitizer applied for 3 h under occlusion before irradiation at the dose of 120 J/cm2 with red light (590-760 nm) and intensity of 204 mW/cm2.
Collapse
Affiliation(s)
- Alicia Declercq
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Canan Güvenç
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Petra De Haes
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
15
|
Woelber L, Prieske K, Mendling W, Schmalfeldt B, Tietz HJ, Jaeger A. Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:126-133. [PMID: 32181734 DOI: 10.3238/arztebl.2020.0126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/16/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND In Germany, 17-23% of the population suffers from chronic itching of the skin; in 5-10% of cases, the female genitalia are affected, specifically, the vulva. Vulvar pruritus is thus a common symptom that often markedly impairs the affected women's quality of life. METHODS This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vul- var pruritus. The search terms were (in German and English) "vulvärer Juckreiz," "pruritus vulvae," and "genital itch," alone and in combination with "Behandlung," "Therapie," or "treat- ment." RESULTS The most common cause of vulvar pruritus is vulvo- vaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. Especially in refractory cases, an invasive or preinvasive lesion such as squamous epithelial dysplasia (VIN, vulvar intraepithelial neoplasia) should be borne in mind in the differential diagnosis. Rarer causes include infection, atrophy, and vulvodynia. The essen- tial elements of treatment are topical/oral antimycotic drugs and high-potency glucocorticoids, along with consistently ap- plied, basic moisturizing care and the avoidance of potential triggering factors. CONCLUSION As vulvar pruritus has multiple causes, standard- ization of its diagnostic evaluation and treatment would be l efficacy and to meet the diverse needs of women who suffer from this condition.
Collapse
Affiliation(s)
- Linn Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infections in Gynecology and Obstetrics, Wuppertal, Germany; Institute of Fungal Disease and Internal Medicine, Mycoclinic Berlin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Chmel R, Nováčková M, Fait T, Zámečník L, Krejčová L, Pastor Z. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2020; 16:257-266. [PMID: 30770072 DOI: 10.1016/j.jsxm.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/06/2018] [Accepted: 12/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgery is the optimal treatment for a severe form of clitoral phimosis (CP) that is initiated by lichen sclerosus (LS) and causes female sexual dysfunction. AIM We aimed to determine the etiology of clitoral phimosis, its influence on sexual function, and outcomes after surgical treatment. METHODS In this prospective cohort study, we observed the occurrence of clitoral phimosis and related changes in a group of 3,650 sexually active heterosexual women with a mean age of 34.8 ± 14.9 years (20-45 years) from September 2014 to September 2016. Ultimately, we compared the changes in sexual function and distress and satisfaction with postoperative genital appearance in 9 patients with severe clitoral phimosis at 12 months after surgical treatment. MAIN OUTCOME MEASURES Sexual function was evaluated using the Female Sexual Distress Scale-Revised and the Female Sexual Function Index, and the patient's genital self-image was evaluated using the Female Genital Self-Image Scale; gynecologic examinations were performed on all patients. RESULTS Various forms of CP were found in 46 of 3,650 patients (1.3%). Severe forms of CP were found in 9 cases, but it was complicated by stenosis of vaginal introitus in only 2 cases. These 9 patients underwent circumcision, and 2 of them underwent perineoplasty. Female sexual dysfunction occurred mainly in those with LS and severe forms of phimosis. Sexual function, as indicated by the total Female Sexual Function Index score, was significantly improved at 12 months after surgery (17.9 ± 0.9 vs 26.6 ± 0.5; P < .001). The Female Genital Self-Image Scale score assessing genital perception was significantly higher after surgery than before in women who underwent clitoral circumcision (20 ± 3.0 vs 12.3 ± 3.3; P < .001). The Female Sexual Distress Scale-Revised score was significantly lower after surgery than before (21.3 ± 6.2 vs 33.8 ± 6.9; P < .001). Sexual function in 2 women with CP and stenosis of vaginal introitus improved after surgery, but the sexual distress level did not decrease significantly. CLINICAL IMPLICATIONS The results of this study will help clinicians to centralize treatment methods and advise patients on the management of clitoral phimosis. STRENGTHS & LIMITATIONS This is a study evaluating postoperative results of sexual function, distress, and satisfaction with genitalia in women with severe CP, using validated questionnaires. However, the small number of patients and the absence of an appropriate control group are limitations. CONCLUSION Surgical treatment of clitoral phimosis can improve sexual function, but because LS-a common underlying cause-is chronic in nature, patients may experience recurrence. Chmel R, M Nováčková, Fait T, et al. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2019;16:257-266.
Collapse
Affiliation(s)
- Roman Chmel
- Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, Prague 5, Czech Republic
| | - Marta Nováčková
- Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, Prague 5, Czech Republic
| | - Tomáš Fait
- Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, Prague 5, Czech Republic
| | - Libor Zámečník
- Department of Urology, 1st Faculty of Medicine, Charles University, Ke Karlovu 6, Prague 2, Czech Republic
| | - Lucie Krejčová
- Institute of Sexology, 1st Medical Faculty, Charles University, Ke Karlovu 460/11, Prague 2, Czech Republic
| | - Zlatko Pastor
- Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, Prague 5, Czech Republic; Institute of Sexology, 1st Medical Faculty, Charles University, Ke Karlovu 460/11, Prague 2, Czech Republic.
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Clarysse K, Grosber M, Ring J, Gutermuth J, Kivlahan C. Skin lesions, differential diagnosis and practical approach to potential survivors of torture. J Eur Acad Dermatol Venereol 2019; 33:1232-1240. [PMID: 30659672 DOI: 10.1111/jdv.15439] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
As the international refugee crisis has reached new proportions (BMJ, 355, 2016 and i5412), survivors of torture increasingly present in treating physicians with an array of acute or chronic skin lesions. Physicians should be aware of common presentations and likely differential diagnoses in order to avoid mislabelling or under-recognizing torture. Survivors of torture also frequently suffer from psychological sequelae, such as post-traumatic stress disorder, and appropriate referrals are essential in order to improve recovery trajectory. Skin sequelae are the most common physical findings of torture. Not all skin lesions seen in tortured survivors are due to perpetrator inflicted injuries, and many dermatological conditions can mimic lesions typical of torture, as can scars as a result of folk remedies or cultural practices specific to geographical regions. Medical documentation of torture includes injury and lesion description. While forensic dermatology and other forensic specialties use an injury description taxonomy, and the standard dermatologic taxonomy uses an anatomic description, they are complementary sciences for lesions inflicted by torture. This results in an opportunity for learning across disciplines in order to improve evidence documentation for survivors of torture. This article describes features of common skin lesions consistent with torture, including their clinical appearances, differential diagnoses, patterns of injury and appropriate clinical descriptions.
Collapse
Affiliation(s)
- K Clarysse
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Grosber
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Ring
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - J Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Kivlahan
- University of California San Francisco Health System, San Francisco, CA, USA
| |
Collapse
|
19
|
Nguyen Y, Bradford J, Fischer G. Lichen sclerosus in pregnancy: A review of 33 cases. Aust N Z J Obstet Gynaecol 2018; 58:686-689. [DOI: 10.1111/ajo.12812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yvonne Nguyen
- Discipline of DermatologySydney Medical School CentralThe University of Sydney Sydney New South Wales Australia
- Department of DermatologyRoyal Prince Alfred Hospital Camperdown New South Wales Australia
| | | | - Gayle Fischer
- Discipline of DermatologySydney Medical School NorthernThe University of Sydney Sydney New South Wales Australia
- Department of DermatologyRoyal North Shore Hospital St Leonards New South Wales Australia
| |
Collapse
|
20
|
|
21
|
Lewis F, Tatnall F, Velangi S, Bunker C, Kumar A, Brackenbury F, Mohd Mustapa M, Exton L, McHenry P, Leslie T, Wakelin S, Hunasehally R, Cork M, Johnston G, Chiang N, Worsnop F, Buckley D, Petrof G, Salin A, Callachand N, Saunders C, Salad A. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol 2018; 178:839-853. [DOI: 10.1111/bjd.16241] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/18/2022]
Affiliation(s)
- F.M. Lewis
- Frimley Health NHS Foundation Trust Slough SL2 4HL U.K
- St John's Institute of Dermatology Guy's & St Thomas’ NHS Foundation Trust London SE1 9RT U.K
| | - F.M. Tatnall
- West Hertfordshire NHS Trust Watford WD18 0HB U.K
| | - S.S. Velangi
- University Hospitals Birmingham NHS Foundation Trust Birmingham B15 2TH U.K
| | - C.B. Bunker
- University College London Hospitals NHS Foundation Trust University College Hospital London NW1 2BU U.K
- Chelsea & Westminster NHS Foundation Trust London SW10 9NH U.K
| | - A. Kumar
- King's College London London SE1 3ER U.K
| | - F. Brackenbury
- Association for Lichen Sclerosus and Vulval Health Brighton U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev 2018; 6:558-571. [PMID: 29631981 DOI: 10.1016/j.sxmr.2018.03.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Genitourinary conditions in women increase in prevalence with age. Androgens are prerequisite hormones of estrogen biosynthesis, are produced in larger amounts than estrogens in women, and decrease throughout adulthood. However, research and treatment for genitourinary complaints have traditionally focused on estrogens to the exclusion of other potential hormonal influences. AIM To summarize and evaluate the evidence that androgens are important for maintaining genitourinary health in women and that lack of androgenic activity can contribute to the development of symptoms of the genitourinary syndrome of menopause. METHODS The role of androgens in the pathophysiology, diagnosis, and treatment of genitourinary syndrome of menopause was discussed by an international and multidisciplinary panel during a consensus conference organized by the International Society for the Study of Women's Sexual Health. A subgroup further examined publications from the PubMed database, giving preference to clinical studies or to basic science studies in human tissues. MAIN OUTCOME MEASURES Expert opinion evaluating trophic and functional effects of androgens, their differences from estrogenic effects, and regulation of androgen and estrogen receptor expression in female genitourinary tissues. RESULTS Androgen receptors have been detected throughout the genitourinary system using immunohistochemical, western blot, ligand binding, and gene expression analyses. Lower circulating testosterone and estradiol concentrations and various genitourinary conditions have been associated with differential expression of androgen and estrogen receptors. Supplementation of androgen and/or estrogen in postmenopausal women (local administration) or in ovariectomized animals (systemic administration) induces tissue-specific responses that include changes in androgen and estrogen receptor expression, cell growth, mucin production, collagen turnover, increased perfusion, and neurotransmitter synthesis. CONCLUSION Androgens contribute to the maintenance of genitourinary tissue structure and function. The effects of androgens can be distinct from those of estrogens or can complement estrogenic action. Androgen-mediated processes might be involved in the full or partial resolution of genitourinary syndrome of menopause symptoms in women. Traish AM, Vignozzi L, Simon JA, et al. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev 2018;6:558-571.
Collapse
Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
| | - Linda Vignozzi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - James A Simon
- Women's Health & Research Consultants, Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA.
| |
Collapse
|
23
|
Clarysse K, Kivlahan C, Beyer I, Gutermuth J. Signs of physical abuse and neglect in the mature patient. Clin Dermatol 2018; 36:264-270. [PMID: 29566931 DOI: 10.1016/j.clindermatol.2017.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neglect and physical abuse of elderly are worrisome health problems, which are expected to grow even further, considering the aging of the population. By 2060, the number of people aged above 65 years is expected to double, whereas birth rates are low. This trend will cause a significant imbalance between different age groups and put more senior adults at risk for abuse. Risk factors, associated with abuse and neglect, are well established and can be categorized in sociodemographic-, victim-, or perpetrator-related risk factors. The effects of these risk factors depend mainly on the setting, which can be community-dwelling or institutionalized older adults. In community-based settings, 90% of perpetrators are family members. In each setting, suspicious physical injuries should be recognized and addressed promptly. This can be very challenging in elderly, among others, due to the age-related skin changes, which can mimic abuse; however, there are some cutaneous clues that should always raise suspicion of abuse, such as patterned shape or distribution, different healing stages of wounds, parallel injuries, signs of blunt trauma, and irregular patches of alopecia. General awareness is needed, and the advice of dermatologists, who are best trained to differentiate between those lesions, should be systematically sought, to reduce false-positive and false-negative interpretations.
Collapse
Affiliation(s)
- Karlijn Clarysse
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Coleen Kivlahan
- University of California-San Francisco Health System, San Francisco, California
| | - Ingo Beyer
- Geriatric Department/Frailty in Ageing Research Group, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jan Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| |
Collapse
|
24
|
Lan T, Zou Y, Hamblin MR, Yin R. 5-Aminolevulinic acid photodynamic therapy in refractory vulvar lichen sclerosus et atrophicus: Series of ten cases. Photodiagnosis Photodyn Ther 2018; 21:234-238. [PMID: 29258952 PMCID: PMC5922423 DOI: 10.1016/j.pdpdt.2017.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Vulvar lichen sclerosus et atrophicus (VLSA) is a chronic inflammatory skin disease of unknown etiology that mainly affects postmenopausal and perimenopausal women. The primary clinical symptoms of VLSA are itching, burning pain, and dyspareunia that can results in decreased quality of life. Existing therapies including topical corticosteroid ointment, topical calcineurin inhibitors, estrogens, are not very effective for treatment of VLSA. OBJECTIVE To evaluate the effectiveness and safety of 5-aminolevulinic acid mediated photodynamic therapy (ALA-PDT) in the treatment of VLSA. MATERIALS AND METHODS Ten patients with VLSA who had failed conventional treatment received ALA-PDT. 10% 5-ALA in an oil-in-water emulsion was applied to the lesions and occluded with plastic film for 3 h, when the lesions were irradiated with 100 mW/cm2, 635 ± 15 nm red light for 20 min. Treatments were repeated three times at 2-week intervals. Objective and subjective symptoms and signs of the vulvar lesions based on horizontal visual analogue scales were recorded at each treatment and 1, 3, and 6 months after the last session. The quality of life was assessed using dermatology life quality index (DLQI) questionnaire. RESULTS All patients completed three ALA-PDT treatments and the follow-up visits. Clinical symptoms of itching disappeared completely in nine patients, one patient had itching decreased from severe to mild. All subjects showed objective improvement in lesions. The DLQI of all cases improved after treatment. The main side-effects of ALA-PDT were pain, erythema, and swelling. Side-effects were transient and tolerable. All patients reported being "satisfied" or "very satisfied" with their outcomes. CONCLUSIONS ALA-PDT is an effective and safe approach for the treatment of VLSA.
Collapse
Affiliation(s)
- Ting Lan
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA02114, United States; Department of Dermatology, Harvard Medical School, Boston, MA 02115, United States; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| |
Collapse
|
25
|
Lewin MR, Hick RW, Selim MA. Lichenoid Dermatitis of the Vulva: Diagnosis and Differential Diagnosis for the Gynecologic Pathologist. Adv Anat Pathol 2017; 24:278-293. [PMID: 28654444 DOI: 10.1097/pap.0000000000000160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inflammatory processes affecting the vulva may present a unique challenge due to location specific changes. Different factors are behind the intricacy in the presentation of vulvar dermatoses. First, the vulva is lined by different epithelia (hair-bearing keratinized epithelium, modified mucosa, and mucosa). Furthermore, among other factors, this organ is exposed to friction, occlusion, and trauma. Lastly, as there is a tendency to look for health care advice at an advanced stage of the disease, the lesion may be modified by secondary changes due to self-treatment. This article describes the clinical presentation and pathologic features of vulvar dermatoses with a lichenoid pattern and highlights practical points for their diagnoses.
Collapse
|
26
|
Agarwal MD, Resnick EL, Mhuircheartaigh JN, Mortele KJ. MR Imaging of the Female Perineum. Magn Reson Imaging Clin N Am 2017; 25:435-455. [DOI: 10.1016/j.mric.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, Calligaro A, Elias JA, Gambaciani M, Gaviria JE, Iglesia CB, Selih-Martinec K, Mwesigwa PL, Ogrinc UB, Salvatore S, Scollo P, Zerbinati N, Nelson JS. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017; 49:137-159. [PMID: 28220946 DOI: 10.1002/lsm.22637] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/09/2022]
Abstract
Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yona Tadir
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Adrian Gaspar
- Department of Laser Surgery, Mendoza Hospital, Mendoza, Argentina
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Macrene Alexiades
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Red Alinsod
- South Coast Urogynecology, Laguna Beach, California
| | - Alex Bader
- Reconstruction & Cosmetic Gynecology, London, UK
| | - Alberto Calligaro
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Jorge A Elias
- Urogynecology and Aesthetic Gynecology Clinic, Boenos Aires, Argentina
| | - Marco Gambaciani
- Department of Obstetrics and Gynecology, University Hospital Pisa, Pisa, Italy
| | - Jorge E Gaviria
- Aesthetics and Laser Medical Educational Center, Korpo Laser, Caracas, Venezuela
| | - Cheryl B Iglesia
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Patricia L Mwesigwa
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Stefano Salvatore
- Department of Obstetrics and Gynecology, San Raffaele University, Milan, Italy
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Nicola Zerbinati
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - John Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| |
Collapse
|
28
|
Haidopoulos D, Bakolas G, Michala L. Turner syndrome: don't forget the vulva. Endocrinol Diabetes Metab Case Rep 2016; 2016:160016. [PMID: 27252865 PMCID: PMC4870723 DOI: 10.1530/edm-16-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/29/2016] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED Turner syndrome (TS) has been linked to a number of autoimmune conditions, including lichen sclerosus (LS), at an estimated prevalence of 17%. LS is a known precursor to vulvar cancer. We present a case of vulvar cancer in a 44-year-old woman, who had previously complained of pruritus in the area, a known symptom of LS. Histology confirmed a squamous cell carcinoma with underlying LS. Vulvar assessment for the presence of LS should be undertaken regularly as part of the routine assessments proposed for adult TS women. If LS is identified, then the patient should be warned of the increased risk of vulvar cancer progression and should be monitored closely for signs of the condition. LEARNING POINTS Patients with TS are at increased risk of developing LS.LS is a known precursor to vulvar cancer.TS women with LS may be at risk of developing vulvar cancer and should be offered annual vulvar screening and also be aware of signs and symptoms of early vulvar cancer.
Collapse
Affiliation(s)
| | | | - Lina Michala
- Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, 80 Vas Sofias Avenue, Athens, Greece
| |
Collapse
|
29
|
Borghi A, Corazza M, Minghetti S, Bianchini E, Virgili A. Dermoscopic Features of Vulvar Lichen Sclerosus in the Setting of a Prospective Cohort of Patients: New Observations. Dermatology 2015; 232:71-7. [DOI: 10.1159/000439198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/31/2015] [Indexed: 11/19/2022] Open
|
30
|
Flynn AN, King M, Rieff M, Krapf J, Goldstein AT. Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus. Sex Med 2015; 3:251-5. [PMID: 26797058 PMCID: PMC4721030 DOI: 10.1002/sm2.90] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Lichen sclerosus (LS) is a chronic inflammatory dermatosis, usually affecting the anogenital skin in women. This chronic inflammation can cause scarring of genitalia including narrowing of the introitus and phimosis of the clitoris. These architectural changes can lead to recurrent tearing during intercourse (vulvar granuloma fissuratum) and decreased clitoral sensation. Surgical correction of vulvar granuloma fissuratum (VGF) and clitoral phimosis can be performed, but there is little data on the patient satisfaction and complications following these surgical procedures. Aim To evaluate patient experience and outcomes in women undergoing surgical correction of scarring caused by anogenital LS. Methods A retrospective chart review of patients at a vulvar disorders clinic was performed to identify women who had undergone surgical correction of clitoral phimosis or lysis of vulvar adhesions for VGF due to LS. Twenty‐eight women were contacted via telephone between 4 and 130 months postoperatively. An eight‐question survey was used to determine patient experience and outcomes. Main Outcome Measures All participants completed an eight‐question survey to evaluate patient satisfaction with the surgery, effects on clitoral sensation, orgasm and pain with intercourse, postoperative symptoms or complications, and the presence of recurrent vulvar scarring. Results Participants reported that they were either very satisfied (44%) or satisfied (40%) with the procedure. Of the women who experienced decreased clitoral sensation prior to surgery, 75% endorsed increased clitoral sensitivity postoperatively. Of the women who had dyspareunia prior to surgery, the majority of women reported having pain‐free sex (33%) or improved but not completely pain‐free sex (58%) after surgery. There were no complications or symptoms made worse by the surgical procedures. Conclusions This study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS. Flynn AN, King M, Rieff M, Krapf J, and Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med 2015;3:251–255.
Collapse
Affiliation(s)
- Anne N. Flynn
- The George Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Michelle King
- The Centers for Vulvovaginal DisordersWashingtonDCUSA
| | - Mollie Rieff
- The Centers for Vulvovaginal DisordersWashingtonDCUSA
| | - Jill Krapf
- The George Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | | |
Collapse
|
31
|
Borghi A, Corazza M, Minghetti S, Toni G, Virgili A. Continuous vs. tapering application of the potent topical corticosteroid mometasone furoate in the treatment of vulvar lichen sclerosus: results of a randomized trial. Br J Dermatol 2015; 173:1381-6. [DOI: 10.1111/bjd.14074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A. Borghi
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - M. Corazza
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - S. Minghetti
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - G. Toni
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - A. Virgili
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| |
Collapse
|
32
|
Abstract
Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis of unknown etiology. Extragenital involvement is uncommon and commonly affects the neck, shoulders, and upper portion of the trunk. It is predominant in women with a male-to-female ratio of 1:6 and occurs at any age. Linear pattern along the lines of Blaschko are seen. There is no cure for LSA. Topical corticosteroids and calcineurin inhibitors, such as tacrolimus, pimecrolimus, PUVA antimalarial agents, and topical retinoids have been tried with varying results. A case of a 33-year-old man with LSA over right lower limb along the lines of Blasckho is reported here.
Collapse
Affiliation(s)
- Nilofar G Diwan
- Department of Dermatology and Venereology, Pramukshwami Medical College, Karamsad, Gujarat, India
| | - Pragya A Nair
- Department of Dermatology and Venereology, Pramukshwami Medical College, Karamsad, Gujarat, India
| |
Collapse
|
33
|
Tong LX, Sun GS, Teng JMC. Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options. Pediatr Dermatol 2015; 32:593-9. [PMID: 25940739 DOI: 10.1111/pde.12615] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lichen sclerosus (LS) is a rare, chronic, inflammatory disease of the skin that primarily affects postmenopausal women but may occur in men and children as well. Approximately 7% to 15% of cases are believed to occur in children. The epidemiologic data for LS have been limited and treatment options are not well studied, particularly in children. We reviewed new developments available in the current literature on the epidemiology and management of LS for children.
Collapse
Affiliation(s)
- Lana X Tong
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Grace S Sun
- Department of Dermatology, Stanford University, Palo Alto, California
| | - Joyce M C Teng
- Department of Dermatology, Stanford University, Palo Alto, California
| |
Collapse
|
34
|
Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper S, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2015. [PMID: 26202852 DOI: 10.1111/jdv.13136] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lichen sclerosus (LS) is an inflammatory skin disease that usually involves the anogenital area. All patients with symptoms or signs suspicious of lichen sclerosus should be seen at least once initially by a physician with a special interest in the disease in order to avoid delay in diagnosis, as early treatment may cure the disease in some and reduce or prevent scarring. The diagnosis is made clinically in most cases. Biopsies should only be performed under certain circumstances. The gold standard for treatment remains potent to very potent topical steroids; however, mild and moderate disease in boys and men may be cured by circumcision. Certain triggers should be avoided. http://www.euroderm.org/images/stories/guidelines/2014/S3-Guideline-on-Lichen-sclerosus.pdf http://www.awmf.org/fachgesellschaften/mitgliedsgesellschaften/visitenkarte/fg/deutsche-gesellschaft-fuer-gynaekologie-und-geburtshilfe-dggg.html.
Collapse
Affiliation(s)
- G Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.,Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - K Becker
- (representing the Deutsche Gesellschaft für Kinderchirurgie), Office for Paediatric surgery, Bonn, Germany
| | - A Günthert
- (representing the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG), Deptartment of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - D Jasaitiene
- (representing the Lithuanian Association of Dermatovenereologists), Department of Skin and Venereal Diseases of Republican Hospital of Panevezys, Panevezys, Lithuania
| | - S Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - K K Rall
- Research Centre and Department for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S Riechardt
- (representing the Deutsche Gesellschaft für Urologie), Department of Urology and paediatric Urology, University of Hamburg, Hamburg, Germany
| | - F Casabona
- Dirigente Medico, S. C. Chirurgia Plastica, Chirurgia Plastica Rigenerativa, Ospedale Andrea Gallino, Genova-Pontedecimo, Italy
| | - J Powell
- Department of Dermatology, Hampshire Hospitals foundation Trust, Hampshire, UK
| | - F Brackenbury
- (patient representative) www.lichensclerosus.org, Association for Lichen Sclerosus and Vulval Health, Oxford, UK
| | - R Erdmann
- (development of the search strategy and performance of the literature search), Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - M Lazzeri
- Centro Chirurgico Toscano, Arezzo, Italy
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - F Wojnarowska
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
35
|
Abstract
Vaginal and vulvar disorders are among the leading causes for women to visit a health care professional. Therefore, it is important to have a basic understanding of these diseases. Although rarely life threatening, these disorders can impact significantly a woman's sexual function and sense of well-being.
Collapse
Affiliation(s)
- Andrea Prabhu
- Division of Women's Health, Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA.
| | - Carolyn Gardella
- Division of Women's Health, Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA; Department of Gynecology, VA Puget Sound Medical Center, 1600 South Columbian Way, Seattle, WA 98108, USA
| |
Collapse
|
36
|
Karadag AS, Kavala M, Ozlu E, Zindancı İ, Ozkanlı S, Turkoglu Z, Zemheri E. The co-occurrence of lichen sclerosus et atrophicus and celiac disease. Indian Dermatol Online J 2015; 5:S106-8. [PMID: 25593796 PMCID: PMC4290169 DOI: 10.4103/2229-5178.146172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 53-year-old female patient was admitted to our clinic for generalized hypo/hyper-pigmented, partially firm and sclerotic plaques with undefined borders. As the skin biopsy taken from the lesion was compatible with lichen sclerosus et atrophicus (LSA), the patient was treated with ultraviolet A1 (UVA1) treatment. Upon follow-up, she developed abdominal pain and diarrhea. Further investigation (including endoscopic and laboratory tests) showed signs consistent with celiac disease. After 30 sessions of UVA1 treatment, the skin lesions partially regressed. We present this case because the co-occurrence of LSA and celiac disease is very rare.
Collapse
Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Mukaddes Kavala
- Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Emin Ozlu
- Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - İlkin Zindancı
- Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Seyma Ozkanlı
- Department of Pathology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Zafer Turkoglu
- Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Ebru Zemheri
- Department of Pathology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
37
|
King M, Rubin R, Goldstein AT. Current Uses of Surgery in the Treatment of Genital Pain. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0032-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
|
39
|
Haefner HK, Aldrich NZ, Dalton VK, Gagné HM, Marcus SB, Patel DA, Berger MB. The impact of vulvar lichen sclerosus on sexual dysfunction. J Womens Health (Larchmt) 2014; 23:765-70. [PMID: 25162790 DOI: 10.1089/jwh.2014.4805] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory condition that is known to arise on the vulva. Many women with LS report vulvar pain, often affecting a patient's quality of life. In this study, the sexual function of LS patients, with and without pain, was compared to control populations. MATERIALS AND METHODS A case-control study to examine the relationship between LS and sexual dysfunction was conducted. A total of 335 women presenting to the gynecology clinic were included in the study: 197 women with biopsy confirmed LS were compared to two control groups (95 asymptomatic women were "healthy" controls and 43 women had vulvovaginal candidiasis) on self-reported current health complaints, medical and surgical history and current symptoms such as pain and itching, type and frequency of sexual activity, and satisfaction with sexual activity. RESULTS Women with LS reported less frequent sexual activity than healthy controls (p=0.007) and Candida controls (p=0.04). Currently sexually active women with LS were significantly less likely to report vaginal intercourse (71.6%) than healthy controls (89.0%, p=0.003) or Candida controls (100%, p=0.0003), even though similar proportions of all three groups reported that vaginal intercourse was important. Satisfaction towards the quality of current sexual activity was significantly lower among women with LS compared with both the healthy and Candida control groups. 23.7% of women with LS reported that sexual activity was rarely or never satisfactory as compared with 0% of healthy controls (p<0.0001) and 6.5% of Candida controls (p=0.03). CONCLUSION Women with LS have less frequent sexual activity and less satisfying sexual activity when compared with controls.
Collapse
Affiliation(s)
- Hope K Haefner
- 1 Department of Obstetrics and Gynecology, The University of Michigan Health System , Ann Arbor, Michigan
| | | | | | | | | | | | | |
Collapse
|
40
|
Virgili A, Borghi A, Toni G, Minghetti S, Corazza M. First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability. Br J Dermatol 2014; 171:388-96. [DOI: 10.1111/bjd.12910] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Virgili
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - A. Borghi
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - G. Toni
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - S. Minghetti
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| | - M. Corazza
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Via Savonarola 9 44100 Ferrara Italy
| |
Collapse
|
41
|
Heinzelmann-Schwarz VA, Nixdorf S, Valadan M, Diczbalis M, Olivier J, Otton G, Fedier A, Hacker NF, Scurry JP. A clinicopathological review of 33 patients with vulvar melanoma identifies c-KIT as a prognostic marker. Int J Mol Med 2014; 33:784-94. [PMID: 24535703 PMCID: PMC3976128 DOI: 10.3892/ijmm.2014.1659] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/21/2014] [Indexed: 01/19/2023] Open
Abstract
Vulvar melanoma is the second most common vulvar cancer. Patients with vulvar melanoma usually present with the disease at a late stage and have a poor prognosis. The prognostic predictors reported in the literature are not unequivocal and the role of lichen sclerosus and c-KIT mutations in the aetiology of vulvar melanoma is unclear. Breslow staging currently seems to be the most adequate predictor of prognosis. We thus performed a clinicopathological and literature review to identify suitable predictors of prognosis and survival and investigated the expression of c-KIT (by immunohistochemistry) in patients with vulvar melanoma (n=33) from the Gynaecological Cancer Centres of the Royal Hospital for Women (Sydney, Australia) and John Hunter Hospital (Newcastle, Australia). Our series of 33 patients fitted the expected clinical profile of older women: delayed presentation, high stage, limited response to treatment and poor prognosis. We identified 3 patients (9.1%) with lichen sclerosus associated with melanoma in situ, although no lichen sclerosus was found in the areas of invasive melanoma. No patient had vulvar nevi. We identified a) Breslow's depth, b) an absence of any of the pathological risk factors, such as satellitosis, in-transit metastasis, lymphovascular space invasion (LVSI) and dermal mitosis, c) removal of inguino-femoral lymph nodes, d) lateral margin of >1 cm, and e) c-KIT expression as valuable prognostic predictors for disease-free survival. We conclude that c-KIT expression is, apart from Breslow's depth, another valuable predictor of prognosis and survival. Lichen sclerosus may be associated with vulvar melanoma.
Collapse
Affiliation(s)
- Viola A Heinzelmann-Schwarz
- Ovarian Cancer Group, Lowy Cancer Research Centre, School of Women's and Children's Health and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sheri Nixdorf
- Ovarian Cancer Group, Lowy Cancer Research Centre, School of Women's and Children's Health and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mehrnaz Valadan
- Gynaecological Cancer Centre, Royal Hospital for Women, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia
| | - Monica Diczbalis
- Hunter Area Pathology Service and University of Newcastle, John Hunter Hospital, Newcastle, NSW 2310, Australia
| | - Jake Olivier
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia
| | - Geoff Otton
- Hunter Centre for Gynaecological Cancer, John Hunter Hospital, Newcastle, NSW 2310, Australia
| | - André Fedier
- Gynecological Research Group, Department of Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Neville F Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia
| | - James P Scurry
- Hunter Area Pathology Service and University of Newcastle, John Hunter Hospital, Newcastle, NSW 2310, Australia
| |
Collapse
|
42
|
Origoni M, Gelardi C, Salvatore S, Candiani M. Lichen sclerosus of the vulva. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
43
|
van den Einden LCG, van der Avoort IAM, de Hullu JA. Prevention, identification and treatment of vulvar squamous (pre)malignancies: a review focusing on quality of care. Expert Rev Anticancer Ther 2014; 13:845-59. [DOI: 10.1586/14737140.2013.811059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
44
|
Khatu S, Vasani R. Isolated, localised extragenital bullous lichen sclerosus et atrophicus: a rare entity. Indian J Dermatol 2013; 58:409. [PMID: 24082218 PMCID: PMC3778813 DOI: 10.4103/0019-5154.117351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Lichen sclerosus et atrophicus (LSA) is a rare, chronic, mucocutaneous disease of unknown cause. Onset can occur in subjects of any age but more prevalent in adult females around the time of menopause. In both the sexes anogenital involvement is more common. Extragenital cases are rare, and common localizations are neck and shoulders, axilla, upper arms, flexor aspects of wrists and around the umbilicus. Bullous LSA is an unusual manifestation of the disease. Isolated extragenital bullous LSA is a distinctly rare event with very few cases reported till date.
Collapse
Affiliation(s)
- Swapna Khatu
- Dr. R.C. Shah's Clinic, Kalyan, Phoenix Polyclinic, Dombivli, Thane, Maharashtra, India
| | | |
Collapse
|
45
|
Li Y, Xiao Y, Wang H, Li H, Luo X. Low-concentration topical tacrolimus for the treatment of anogenital lichen sclerosus in childhood: maintenance treatment to reduce recurrence. J Pediatr Adolesc Gynecol 2013; 26:239-42. [PMID: 24049806 DOI: 10.1016/j.jpag.2012.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory skin disorder that is commonly found in the anogenital area, especially in females. Ultra-potent topical corticosteroids are first line for the treatment of LS, but their atrophic side effects and the recurrence of the disease restrict their use. An equally effective, safer, tolerant therapeutic option is required, especially in the treatment and preventing relapse of children. METHODS Fourteen prepubertal girls (range of age: 4 to 11 years) with anogenital lichen sclerosus were treated with 0.03% tacrolimus ointment twice daily for 16 weeks, then 9 of the 14 patients adhered to 2 times weekly for further 6 months (a total of 10 months). The therapeutic effects were evaluated according to 3 grades: complete response (O75% improvement, partial response (30%-75% improvement),or no response (!30% improvement). RESULTS Clinical improvement occurred in all patients (100%). Complete response of symptoms and signs was achieved in 5 (36%), 9 (64%) and 11 (79%) patients at week 8, week 16, and month 10 respectively. During the follow-up period of 1 year, 4 patients (4/5, 80%) who treated with tacrolimus ointment for 16 weeks had a recurrence of symptoms, while only 2 of 9 (22%) patients who insisted on maintenance therapy developed recurrence of disease. No severe side effects were observed. CONCLUSIONS Low-concentration topical tacrolimus appears to be an effective and safe treatment for children with anogenital lichen sclerosus. Maintenance therapy (2 times a week for 6 months) can reduce the relapse of the disease.
Collapse
Affiliation(s)
- Yongmei Li
- Department of Dermatology, Children’s Hospital of Chongqing Medical University, and Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | | | | | | | | |
Collapse
|
46
|
Virgili A, Borghi A, Minghetti S, Corazza M. Mometasone fuoroate 0.1% ointment in the treatment of vulvar lichen sclerosus: a study of efficacy and safety on a large cohort of patients. J Eur Acad Dermatol Venereol 2013; 28:943-8. [DOI: 10.1111/jdv.12219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Virgili
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Ferrara Italy
| | - A. Borghi
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Ferrara Italy
| | - S. Minghetti
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Ferrara Italy
| | - M. Corazza
- Department of Medical Sciences; Section of Dermatology; University of Ferrara; Ferrara Italy
| |
Collapse
|
47
|
Virgili A, Minghetti S, Borghi A, Corazza M. Proactive maintenance therapy with a topical corticosteroid for vulvar lichen sclerosus: preliminary results of a randomized study. Br J Dermatol 2013; 168:1316-24. [DOI: 10.1111/bjd.12273] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A. Virgili
- Department of Clinical and Experimental Medicine; Section of Dermatology; University of Ferrara; Via Savonarola 9; 44121; Ferrara; Italy
| | - S. Minghetti
- Department of Clinical and Experimental Medicine; Section of Dermatology; University of Ferrara; Via Savonarola 9; 44121; Ferrara; Italy
| | - A. Borghi
- Department of Clinical and Experimental Medicine; Section of Dermatology; University of Ferrara; Via Savonarola 9; 44121; Ferrara; Italy
| | - M. Corazza
- Department of Clinical and Experimental Medicine; Section of Dermatology; University of Ferrara; Via Savonarola 9; 44121; Ferrara; Italy
| |
Collapse
|
48
|
Squamous cell carcinoma of the vulva: a comparison between women 35 years or younger and 90 years or older. J Low Genit Tract Dis 2013; 17:267-72. [PMID: 23733164 DOI: 10.1097/lgt.0b013e31827527cb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare clinical features, diagnosis, management, and outcomes between women 35 years or younger and 90 years or older with vulvar squamous cell carcinoma referred to Queensland Centre for Gynaecological Cancer between 1983 and 2010. MATERIALS AND METHODS Fifty-seven case records, including pathology reports for these 2 groups were reviewed and analyzed using the computer software SPSS 11.0. RESULTS Of the cases, 34 were 35 years or younger (mean = 31.6 years), and 23 90 years or older (mean = 92.6 years). International Federation of Gynecology and Obstetrics classification showed grade 1 for 74% in the younger group and 55% for the older group. Patient status showed 22 alive (65%) in the younger group and 4 alive (17%) in the older group. Three younger patients (9%) were dead of disease and 8 (35%) in the older group. Three patients (9%) died of another disease in the younger group and 10 patients (43%) in the older group. Initial treatment was surgical in 30 younger cases (88%) and 18 older cases (78%). CONCLUSIONS We demonstrated a trend toward younger women presenting with vulvar squamous cell carcinoma and a history of human papillomavirus and vulvar intraepithelial neoplasia. Immune deficiency diseases occurred in 23% of the younger group, but none occurred in the older group, where Alzheimer disease, heart disease, and renal failure (57%) were present. Poorly differentiated tumors and an International Federation of Gynecology and Obstetrics classification of 2 or more resulted in a worse outcome than did better differentiated lesions, irrespective of additional medical conditions.
Collapse
|
49
|
Kyriakou A, Patsialas C, Patsatsi A, Sotiriadis D. Treatment of male genital lichen sclerosus with clobetasol propionate and maintenance with either methylprednisolone aceponate or tacrolimus: a retrospective study. J DERMATOL TREAT 2013; 24:431-4. [PMID: 23472631 DOI: 10.3109/09546634.2013.782385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the efficacy of clobetasol propionate 0.05% cream in male patients suffering from genital lichen sclerosus (GLS), as well as the efficacy of methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment as maintenance therapy. METHODS The study was conducted retrospectively. At baseline, male patients with GLS (n = 41) were treated with clobetasol propionate 0.05% cream applied twice daily for 8 weeks. Visual Analog Scale (VAS) score for pruritus, Investigator's Global Assessment (IGA) score and Dermatology Life Quality Index (DLQI) were recorded at baseline, week 8 and week 20. At week 8, patients responsive to treatment (n = 37) were further treated with methylprednisolone aceponate 0.1% cream twice weekly (n = 17) or tacrolimus 0.1% ointment once daily (n = 20), as maintenance therapy until week 20. RESULTS VAS, IGA and DLQI median scores were significantly decreased from baseline to week 8 (p < 0.001). At week 20, patients treated with methylprednisolone aceponate 0.1% cream presented no significant difference in median IGA score (p = 0.865), median DLQI score (p = 0.853) or median VAS score (p = 0.474) compared with patients treated with tacrolimus 0.1% ointment. CONCLUSIONS Clobetasol propionate 0.05% cream is effective as first-line treatment in male GLS. The data suggest that there is no difference between methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment in preventing the relapses.
Collapse
Affiliation(s)
- Aikaterini Kyriakou
- 2nd Department of Dermatology and Venereology, Aristotle University School of Medicine , Thessaloniki , Greece
| | | | | | | |
Collapse
|
50
|
Potter JE, Moore KA. Lichen sclerosus in a breast cancer survivor on an aromatase inhibitor: a case report. J Gen Intern Med 2013; 28:592-5. [PMID: 22956445 PMCID: PMC3599029 DOI: 10.1007/s11606-012-2209-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/02/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
Lichen sclerosus is a commonly misdiagnosed disease that is characterized by thinned, hypopigmented, crinkled skin that often forms a figure-eight shape around the vaginal and anal openings. We present a case of advanced lichen sclerosus in a 53-year-old female patient prescribed a nonsteroidal aromatase inhibitor after the excision of a breast cancer tumor. We present a diagnostic approach to lichen sclerosus by recognizing its common figure-eight pattern, and we review the known causes and treatment of lichen sclerosus. Research has shown that lichen sclerosus is more common in low estrogen states, and thus it is logical that aromatase inhibitors could increase a patient's risk for developing this disease. We therefore propose that all patients prescribed aromatase inhibitors undergo regular vulvo-vaginal exams to rule out lichen sclerosus and other hypoestrogen-related vulvo-vaginal problems.
Collapse
Affiliation(s)
- Jennifer E Potter
- Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Women's Health Team, Fenway Health, Boston, MA, USA.
| | | |
Collapse
|