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Ou S, Wang H, Liu W, Zhu H, Zhang W, Li H, Deng H. Combination of high-frequency electrocautery therapy and ALA-PDT in hyperkeratotic vulvar lichen sclerosus: Series of seven cases. Photodiagnosis Photodyn Ther 2024; 45:103924. [PMID: 38061450 DOI: 10.1016/j.pdpdt.2023.103924] [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: 10/10/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
SIGNIFICANCE ALA-PDT effectively treats Vulvar lichen sclerosus et atrophicus (VLSA), but it requires multiple repetitions for satisfactory results. To enhance efficacy, we employed a combination of high-frequency electrocautery therapy and ALA-PDT in treating seven VLSA patients. APPROACH Lesions and leukoplakia in the seven women with VLSA were removed using a high-frequency generator. PDT was administered after wound healing, and it was repeated six times. Follow-up assessments were carried out at 1, 3, and 6 months to evaluate the severity of pruritus and investigate lesion repigmentation. RESULTS Following the combined therapy, the disappearance of pruritus was observed in all patients, and normal color and thickness were restored to their skin. Two patients reported mild pruritus with a score of 2 one month after treatment, which persisted until the 6-month follow-up, while the remaining patients remained free from pruritus. No recurrence of skin lesions was observed in any of the patients. CONCLUSIONS The combined therapy for the treatment of VLSA is found to be convenient, effective, and easily promotable.
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Affiliation(s)
- Shanshan Ou
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China
| | - Huanli Wang
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China
| | - Weiyu Liu
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China
| | - Huilan Zhu
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China
| | - Wenjun Zhang
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China
| | - Huaping Li
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China
| | - Huiyan Deng
- Department of Dermatology, Guangzhou Institute of Dermatology, No.56, Hengfu Road, Guangzhou 510095, China.
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Zhang S, Wang Y, Wang J, Liu J. The efficacy of 5-aminolevulinic acid photodynamic therapy for pediatric vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2024; 45:103986. [PMID: 38272155 DOI: 10.1016/j.pdpdt.2024.103986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Prepubertal girls are one of the vulnerable populations of vulvar lichen sclerosus (VLS), which results in a decreased quality of life and increases risk of vulvar cancer. But the therapeutic effects of traditional topical remedies are unsatisfactory in some pediatric patients. 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) is an effective treatment for refractory VLS patients, but no study has been conducted in child patients. METHODS The patients included in this study underwent three sessions of ALA-PDT at 2-week intervals. All patients were evaluated for objective clinical appearances and subjective symptoms quantitatively. Statistical analysis comparing parameters at baseline and after three-time ALA-PDT was performed. RESULTS A total of seven VLS girl patients were included in this study. Both primary objective appearances (lesion size and depigmentation) and subjective symptoms (itching and burning pain) were improved remarkably after the third treatment. Besides, adverse effects, mainly as pain and post-treatment edema, were mild and could be tolerated. CONCLUSIONS ALA-PDT is an effective and safe therapeutic option for VLS girl patients. Compared with adult patients, the symptoms resolved more quickly in child patients.
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Affiliation(s)
- Shan Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, PR China
| | - Yukun Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, PR China
| | - Juncheng Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, PR China
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, PR China.
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Popa A, Dumitrascu MC, Petca A, Petca RC, Sandru F. Vulvar Lichen Sclerosus: Navigating Sex Hormone Dynamics and Pioneering Personalized Treatment Paradigm. J Pers Med 2024; 14:76. [PMID: 38248777 PMCID: PMC10817476 DOI: 10.3390/jpm14010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Vulvar lichen sclerosus (VLS) is a frequently overlooked inflammatory disorder affecting the skin and mucous membranes of the vulva. With a propensity for atrophy, severe scarring, functional impairment, and malignant evolution, VLS is a disease that recurs frequently; early diagnosis, rapid treatment, and ongoing patient follow-up are essential. Potent topical corticosteroids (TCSs) are now widely recognized as the most effective treatment for achieving remission in VLS, but considering the potential complications of long-term treatment with potent TCSs, understanding the evolution of VLS during puberty becomes particularly crucial in determining the necessity for aggressive or more conservative therapeutic interventions. Emerging treatments, including PRP (platelet-rich plasma), stem cell therapy, and energy-based lasers like fractional CO2 and Nd-YAG, are being investigated to identify more effective VLS treatments than ultrapotent topical corticosteroids. However, more research is needed to assess the efficacy and safety of these new medicines. Topical clobetasol 0.05% ointment daily for 4-12 weeks is the gold standard for treating VLS. This article is a narrative review of the English-language medical literature from 2017 to November 2023, following three main sections concerning VLS: studies of the evolution amid pubertal hormonal changes; studies of the outcomes of personalized conventional therapies; and studies addressing the spectrum of innovative modalities for VLS.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Shang X, Chen C, Ma H, Zhao P, Mao Y, Liu H, Wang C, Mao K, Luo Z, Li Y, Zhou G, Tan H. Application of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma injection + chemexfoliation in vulvar lichen sclerosus. Front Pediatr 2023; 11:1276786. [PMID: 38111623 PMCID: PMC10725975 DOI: 10.3389/fped.2023.1276786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction To investigate the therapeutic effect of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma (PRP) injection + chemexfoliation on vulvar lichen sclerosus (VLS). Methods Twenty children with VLS (under 14 years old) at our hospital from July 2020 to November 2022 were enrolled and treated with clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation. Additionally, symptomatic changes and improvements in signs were recorded. Results Significant therapeutic effects were achieved in all children enrolled in this study. The Cattanco score was 8.02 ± 1.22 points before surgery, 2.21 ± 0.70 points 3 months after surgery, and 2.61 ± 0.59 points 6 months after surgery, demonstrating that the score after surgery was significantly lower than that before surgery (p < 0.05). Mild complications (one case of mild vulvar swelling, one case of minor bleeding, and one case of superficial ulcer) were observed in three children after surgery, with an overall complication incidence of 15%; all complications were improved after the intervention, and no severe adverse reactions were observed. Recurrence was observed in one child (5%) 6 months after surgery. Conclusion Clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation is an effective approach for the treatment of VLS. Systematic Review Registration https://www.chictr.org.cn/searchproj.html, identifier: ChiCTR2100054787.
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Affiliation(s)
- Xianhui Shang
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Changmei Chen
- Department of Physiology, Basic Medical College, Medicine & Technology College of Zunyi Medical University, Zunyi, China
| | - Hong Ma
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Peng Zhao
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuchen Mao
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Liu
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Cao Wang
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kaiyi Mao
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhen Luo
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yingbo Li
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangxu Zhou
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongyang Tan
- Department of Pediatric Surgery, Guizhou Children’s Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Potapov A, Matveev L, Moiseev A, Sedova E, Loginova M, Karabut M, Kuznetsova I, Levchenko V, Grebenkina E, Gamayunov S, Radenska-Lopovok S, Sirotkina M, Gladkova N. Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study. Int J Mol Sci 2023; 24:13967. [PMID: 37762270 PMCID: PMC10531024 DOI: 10.3390/ijms241813967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Photodynamic therapy (PDT) is a modern treatment for severe or treatment-resistant vulvar lichen sclerosus (VLS). The chronic and recurrent nature of VLS requires control of recurrences at an early stage. In this paper, a non-invasive multimodal optical coherence tomography (OCT) method was used to control for early histological signs of VLS recurrence after systemic PDT using Photodithazine®. To interpret the OCT data, a histological examination was performed before PDT and 3 months after PDT. Two groups of patients were identified: with early histological signs of VLS recurrence (Group I, n = 5) and without histological signs of VLS recurrence (Group II, n = 6). We use structural OCT, OCT angiography, and OCT lymphangiography throughout 6 months after PDT to visually assess the skin components and to quantitatively assess the dermis by calculating the depth-resolved attenuation coefficient and the density of blood and lymphatic vessels. The OCT data assessment showed a statistically significant difference between the patient groups 3 months after PDT. In Group II, all the studied OCT parameters reached maximum values by the 3rd month after PDT, which indicated recovery of the skin structure. At the same time, in Group I, the values of OCT parameters did not approach the values those in Group II even after 6 months. The obtained results of multimodal OCT can be used for non-invasive control of early histological recurrence of VLS after systemic PDT and for adjusting treatment tactics in advance, without waiting for new clinical manifestations of the disease.
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Affiliation(s)
- Arseniy Potapov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Lev Matveev
- Institute of Applied Physics Russian Academy of Sciences, 603950 Nizhny Novgorod, Russia; (L.M.); (A.M.)
| | - Alexander Moiseev
- Institute of Applied Physics Russian Academy of Sciences, 603950 Nizhny Novgorod, Russia; (L.M.); (A.M.)
| | - Elena Sedova
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
| | - Maria Loginova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
- Center of Photonics, Lobachevsky State University of Nizhny Novgorod, 603022 Nizhny Novgorod, Russia
| | - Maria Karabut
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Irina Kuznetsova
- Department of Obstetrics and Gynecology, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, 603126 Nizhny Novgorod, Russia
| | | | - Elena Grebenkina
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
- Kstovo Central District Hospital, 607650 Kstovo, Russia
| | - Sergey Gamayunov
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
| | - Stefka Radenska-Lopovok
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Marina Sirotkina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
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6
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He L, Xu F, Li Y, Jin H, Lo PC. Cupric-ion-promoted fabrication of oxygen-replenishing nanotherapeutics for synergistic chemo and photodynamic therapy against tumor hypoxia. Acta Biomater 2023; 162:57-71. [PMID: 36944404 DOI: 10.1016/j.actbio.2023.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
Mixing a glutathione (GSH)-responsive carboxy zinc(II) phthalocyanine (ZnPc*) and CuSO4·5H2O in water with or without the presence of the anticancer drug SN38 resulted in the formation of self-assembled nanotherapeutics labeled as ZnPc*/Cu/SN38@NP and ZnPc*/Cu@NP, respectively. The Cu2+ ions not only promoted the self-assembly of the carboxy phthalocyanine through metal complexation, but also catalyzed the transformation of H2O2 to oxygen via a catalase-like reaction, rendering an oxygen-replenishing property to the nanosystems. Both nanosystems exhibited high stability in aqueous media, but the nanoparticles disassembled gradually in an acidic or GSH-enriched environment and inside human colorectal adenocarcinoma HT29 cells, releasing the encapsulated therapeutic components. The disassembly process together with the activation by the intracellular GSH led to relaxation of the intrinsic quenching of the nanophotosensitizers and restoration of the photoactivities of ZnPc*. Under a hypoxic condition, ZnPc*/Cu/SN38@NP could attenuate the intracellular hypoxia level and maintain the photodynamic activity due to its Cu2+-promoted oxygen-replenishing ability. The photodynamic effect of ZnPc* and the anticancer effect of SN38 worked cooperatively, causing substantial apoptotic cell death. The dual therapeutic actions could also effectively inhibit the tumor growth in HT29 tumor-bearing nude mice without initiating notable adverse effects to the mice. STATEMENT OF SIGNIFICANCE: The oxygen-dependent nature of photodynamic therapy generally reduces its efficacy against tumor hypoxia, which is a common characteristic of advanced solid tumors and usually leads to resistance toward various anticancer therapies. We report herein a facile approach to assemble a glutathione-responsive carboxy phthalocyanine-based photosensitizer and an anticancer drug in aqueous media, in which Cu(II) ions were used to promote the self-assembly through metal complexation and catalyze the conversion of H2O2 to oxygen through a catalase-like reaction, making the resulting nanoparticles possessing an oxygen-replenishing property that could promote the photodynamic effect against hypoxic cancer cells and tumors. The use of Cu(II) ions to achieve the aforementioned dual functions in the fabrication of advanced nano-photosensitizing systems has not been reported.
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Affiliation(s)
- Lin He
- Department of Biomedical Sciences and Tung Biomedical Sciences Centre, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
| | - Feijie Xu
- Department of Biomedical Sciences and Tung Biomedical Sciences Centre, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
| | - Yongxin Li
- Department of Biomedical Sciences and Tung Biomedical Sciences Centre, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
| | - Honglin Jin
- College of Biomedicine and Health and College of Life Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Pui-Chi Lo
- Department of Biomedical Sciences and Tung Biomedical Sciences Centre, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China.
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Li Y, Hua C, Zhang M. Efficacy of non-invasive photodynamic therapy for female lower reproductive tract diseases associated with HPV infection: a comprehensive meta-analysis. Lasers Med Sci 2023; 38:42. [PMID: 36652121 DOI: 10.1007/s10103-023-03713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
Photodynamic therapy (PDT) is a proposed non-invasive, highly effective, and fertility-preserving method for the treatment of lower reproductive tract diseases in women. We aim to evaluate the effect of PDT on complete remission, recurrence, and HPV clearance in diseases of the female lower reproductive tract associated with the human papillomavirus (HPV) infection in this meta-analysis. PubMed, EMBASE, Scopus, Cochrane Library, and China National Knowledge Infrastructure databases were searched to compare PDT with other treatments for complete remission, recurrence, and HPV clearance in women with lower genital tract disease. Fixed or random effect models were performed to assess the pooled effect size. Sensitivity analysis was performed to detect heterogeneity in the included studies. The Begg and Egger test assessed publication bias. There were 12 studies qualified for inclusion; compared to other treatments, PDT had a significant advantage in complete remission (OR=2.97, 95%CI, 2.18-4.04, I2=0, P<0. 001) and recurrence (OR, 0.21; 95%CI, 0.11-0.39; I2=34.9%, P<0. 001). Furthermore, PDT clears HPV quickly and lastingly compared to other therapies (OR, 2.65; 95% CI, 1.41-4.95; I2=71.0%, P=0.002). In addition, the heterogeneity test of sensitivity analysis suggested that the results were robust. Begg test (P=0.73) and Egger test (P=0.71) showed no publication bias. PDT treats diseases of the female lower reproductive tract associated with HPV infection: high complete remission, low recurrence, and rapid and lasting HPV clearance. The PDT seems to be a non-invasive, effective, and promising treatment of female lower reproductive tract diseases associated with HPV infection.
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Affiliation(s)
- Yanhui Li
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, 107 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China.
| | - Cuiju Hua
- Yiyuan People's Hospital, Zibo City, Shandong Province, China
| | - Mengyao Zhang
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, 107 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China
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8
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Wang Y, Hao J, Liu J. High-frequency ultrasound assessment of vulvar lichen sclerosus treated with photodynamic therapy. Photodiagnosis Photodyn Ther 2023; 41:103277. [PMID: 36621633 DOI: 10.1016/j.pdpdt.2023.103277] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with vulvar lichen sclerosus (VLS) are faced with a decreased quality of life and an increased risk of vulvar malignancy. 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) can serve as an alternative for refractory VLS patients. However, high-frequency ultrasound (HFUS) has never been introduced in the ALA-PDT outcome assessment for VLS patients. METHODS A prospective study was conducted. Refractory VLS patients received two treatment courses of ALA-PDT (3 times of remedies at 2-week intervals for each course), and underwent clinical, HFUS and histopathological assessment. Statistical analysis comparing parameters at baseline and after ALA-PDT was performed. RESULTS Thirty-one VLS patients were included. Both subjective symptoms (itch and burning pain) and objective severity (lesion size and hypopigmentation) were relieved significantly after ALA-PDT treatment. Hypoechoic dermal band (HDB) thickness revealed by HFUS decreased progressively with successive ALA-PDT treatment, and the reduction value had a positive correlation with the reduction of inflammatory infiltration depth in histopathology. Collagen homogenization depth decrease was also noticed. Besides, adverse effects were recorded, mainly as mild and transient post-treatment edema and pain. CONCLUSIONS ALA-PDT is an effective and safe therapeutic option for refractory VLS patients. HFUS can act as a complement to the non-invasive treatment monitoring for its objectivity, quantifiability and precision in the distinct vertical perspective.
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Affiliation(s)
- Yukun Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Center for Translational Medicine, Beijing 100730, China
| | - Jianchun Hao
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing 100022, China
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Center for Translational Medicine, Beijing 100730, China.
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9
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De Luca DA, Papara C, Vorobyev A, Staiger H, Bieber K, Thaçi D, Ludwig RJ. Lichen sclerosus: The 2023 update. Front Med (Lausanne) 2023; 10:1106318. [PMID: 36873861 PMCID: PMC9978401 DOI: 10.3389/fmed.2023.1106318] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.
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Affiliation(s)
- David A De Luca
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Cristian Papara
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Hernán Staiger
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Torres A, Zaborek-Łyczba M, Łyczba J, Mertowska P, Mertowski S, Grywalska E. The Importance of Immunological Disorders in the Pathogenesis of Lichen Sclerosus in Pediatric Patients: A Systematic Review. Int J Mol Sci 2022; 23:ijms232214212. [PMID: 36430687 PMCID: PMC9697898 DOI: 10.3390/ijms232214212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Lichen sclerosus (LS) is defined as a chronic mucocutaneous inflammatory disease with a localization predominantly to the anus and genitals (vulvar sclerosus (VLS)). Pediatric lichen sclerosus (LS) is a chronic inflammatory skin condition with predilection for the anogenital area that if untreated can lead to scarring. Vulvar LS is characterized by two peaks in incidence: it occurs in prepubertal girls and in postmenopausal women. To date, several mechanisms and risk factors have been proposed in the pathogenesis of pediatric vulvar LS; however, the etiology of this condition is still not fully understood and constitutes a challenge for scientists and clinicians. The presented research aimed to systematically review the existing literature on the pathogenesis of pediatric LS and to identify possible underlying autoimmune mechanisms and molecular networks. The clinical presentation of pediatric lichen sclerosus and available treatment modalities are also presented to acquaint a broader audience with this underdiagnosed and undertreated condition. As a result of our review, we discuss several potential mechanisms, molecules, and pathways that have been recognized in this disease. The purpose of our review was also to summarize what we can induce in further studies, which will ultimately help to identify the mechanism responsible for the disease and aid in the development of new, more effective treatment strategies for diagnosis and treatment by clinicians and researchers.
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Affiliation(s)
- Anna Torres
- Department of Pediatric and Adolescent Gynecology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Monika Zaborek-Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jakub Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence:
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
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Di Bartolomeo L, Altavilla D, Vaccaro M, Vaccaro F, Squadrito V, Squadrito F, Borgia F. Photodynamic therapy in pediatric age: Current applications and future trends. Front Pharmacol 2022; 13:879380. [PMID: 36052131 PMCID: PMC9424823 DOI: 10.3389/fphar.2022.879380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Photodynamic therapy (PDT) is a photochemotherapy based on local application of a photosensitive compound and subsequent exposure to a light source of adequate wavelength. It is a non-invasive therapeutic procedure widely used in oncodermatology for treatment of numerous skin cancers, but in the last years its use has been gradually extended to an increasing list of skin diseases of both infectious and inflammatory nature. Although PDT is proven as a safe and effective therapeutic option in adults, its use is not well standardized in the pediatric population. In this review, we will focus on clinical applications, mechanisms of action, protocols, and adverse events in children and adolescents. Most of pediatric experiences concerned treatment of skin cancers in Gorlin syndrome and xeroderma pigmentosum, acne vulgaris, and viral warts, but other applications emerged, such as cutaneous lymphoma and pseudo-lymphomas, necrobiosis lipoidica, hidradenitis suppurativa, dissecting cellulitis, leishmaniasis, angiofibromas, verrucous epidermal nevus, and linear porokeratosis. In these pediatric diseases, PDT appeared as an effective therapeutic alternative. The results on vitiligo were limited and not fully encouraging. Although highly versatile, PDT is not a therapy for all skin diseases, and a deeper knowledge of its mechanisms of action is required to better define its spectrum of action and safety in pediatric patients.
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Affiliation(s)
- Luca Di Bartolomeo
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
- *Correspondence: Luca Di Bartolomeo,
| | - Domenica Altavilla
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federico Vaccaro
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Violetta Squadrito
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi, Pediatryˮ, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
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