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Burshtein A, Burshtein J, Rekhtman S. Extragenital lichen sclerosus: a comprehensive review of clinical features and treatment. Arch Dermatol Res 2023; 315:339-346. [PMID: 36198917 DOI: 10.1007/s00403-022-02397-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/18/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory skin disease commonly affecting the anogenital area with less frequent extragenital occurrence. Extragenital LS cutaneous manifestations vary and precipitating factors are not well described. Recent evidence for etiology and clinical associations of extragenital LS provide insight into disease recognition and pathogenesis. Novel diagnostic techniques as well as treatment standardization have the potential to improve management of this rare condition. This review details both past and new insights into the pathogenesis, clinical manifestations, and treatment options of extragenital LS.
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Affiliation(s)
- Aaron Burshtein
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA
| | - Joshua Burshtein
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA
| | - Sergey Rekhtman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA.
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2
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Friedland R, Ben-Amitai D, Didkovsky E, Feinmesser M, Zvulunov A. Vascular lesions in genital lichen sclerosus in pediatric patients. Pediatr Dermatol 2020; 37:849-852. [PMID: 32638397 DOI: 10.1111/pde.14277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Lichen sclerosus is a rare, pruritic, mucocutaneous disease affecting mostly the anogenital area. Reports have occasionally associated lichen sclerosus with overlapping vascular lesions. This study explores this association in children. METHODS A retrospective study was conducted in the dermatology unit of a pediatric tertiary care medical center. Electronic medical records were searched for patients diagnosed with lichen sclerosus from 2006 to 2019. Review of the cases was performed to identify overlapping vascular lesions and review the clinical course of overlap cases. RESULTS Of 74 children diagnosed with lichen sclerosus during the study period, five (6.75%) had overlapping vascular lesions and genital lichen sclerosus. Four patients presented with reticular telangiectatic macules and patches (n = 4, 5.4%) that appeared at or shortly after disease onset; resolution occurred a few months after treatment initiation. The fifth patient presented with telangiectases that appeared more than 2 years after the onset of the first symptoms of lichen sclerosus (n = 1, 1.3%). CONCLUSION Vascular lesions in children with genital lichen sclerosus are common and have variable clinical manifestations. Early appearance of reticular macules, patches, and papules is a variant of the disease and is followed by prompt resolution of these lesions. Pathogenesis is attributed to structural changes and repositioning of the papillary vascular plexus. These changes may be alarming to parents and therefore must be recognized by physicians to prevent unnecessary concern and investigations.
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Affiliation(s)
- Rivka Friedland
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Ben-Amitai
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Didkovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Meora Feinmesser
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Alex Zvulunov
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Faculty of Health Sciences, BenGurion University of the Negev, Beer Sheva, Israel
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3
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Robledo-Sierra J, Bäckman K, Öhman J, Jontell M. Oral lichen sclerosus: an overview and report of three cases. Int J Oral Maxillofac Surg 2018; 47:1550-1556. [DOI: 10.1016/j.ijom.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 01/15/2023]
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4
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Meng W, Yang Y, Liu S, Guo W, Xiao H, Zhou H. Lichen sclerosus et atrophicus diagnosed in a child accompanied with local periodontal attachment loss and maxillary deficiency: A rare case report. J Dermatol 2018; 46:e163-e165. [PMID: 30467890 DOI: 10.1111/1346-8138.14699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Wenxia Meng
- Department of Oral Medicine, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Yinshen Yang
- Key Laboratory of Oral Medicine, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuguang Liu
- Department of Surgery, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Wei Guo
- Department of Pathology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Hui Xiao
- Department of Orthodontic, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Hongmei Zhou
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Matela AM, Hagström J, Ruokonen H. Lichen sclerosus of the oral mucosa: clinical and histopathological findings. Review of the literature and a case report. Acta Odontol Scand 2018; 76:364-373. [PMID: 29658796 DOI: 10.1080/00016357.2018.1463452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Lichen sclerosus (LS) is a rare, chronic mucocutaneous disease that most frequently affects the female genital area. Oral manifestations are seldom detected; only 36 well-documented and histopathologically verified oral LS cases have been published. MATERIALS AND METHODS Here we describe one patient affected by oral (LS) and review of the literature 1957-2017. RESULTS Findings in our review suggest a female to male ratio of 1.64:1. It is most commonly diagnosed at the age of 10-29 years (46%). Oral LS can appear as symptomless, irregular-shaped, porcelain-white and flat lesions situated asymmetrically. Lesion is commonly sole, well-demarcated area and its size varies from 2 mm (small macula) to 7 cm (large plaque). The most common sites in the oral cavity include the labial mucosa, lips and gingiva. The histopathological criteria include atrophy and sometimes hyperkeratosis of the epithelium, hydropic degeneration of basal cells, hyalinization of the lamina propria, lymphocyte infiltration beneath the zone of hyalinization and scantiness of elastin. Surgical excision is an effective treatment for small lesions; intralesional triamcinolone or corticosteroid injections are used for larger lesions. CONCLUSIONS Oral LS may be under-recognized due to its asymptomatic nature and rarity.
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Affiliation(s)
- Anna-Maija Matela
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, Oral and Maxillofacial Diseases, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Hellevi Ruokonen
- Head and Neck Center, Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
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Katsoulas N, Prodromidis G, Nikitakis NG. Lichen Sclerosus of the Upper Lip: Report of a Case, Utilizing Shikata's Modified Orcein Stain, and Review of the Literature. J Oral Maxillofac Res 2018; 9:e5. [PMID: 29707184 PMCID: PMC5913418 DOI: 10.5037/jomr.2018.9105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022]
Abstract
Background Lichen sclerosus is a rare chronic inflammatory disorder, affecting mainly the skin and the anogenital mucosa, while oral lesions can be the primary or the only manifestation of the disease. A rare case of oral lichen sclerosus, assessed histopathologically and histochemically, is presented, along with a thorough review of the English language literature. Methods A 32-year-old female presented an asymptomatic white patch affecting the skin and the mucosa of the upper lip, without other mucocutaneous involvement. A partial biopsy of the lesion was performed, along with the histochemical Shikata’s modified orcein stain for elastin fibres detection. A literature review was also performed, discussing the epidemiological data, clinical presentation, and treatment modalities of all published cases with oral involvement. Results The histopathological evaluation revealed the presence of acellular zone underneath the basal layer of the epithelium, accompanied by deep band-like chronic inflammation. Shikata’s modified orcein stain exhibited scarcity or loss of elastin fibres in the acellular subepithelial area. The diagnosis of lichen sclerosus was made. Topical application of corticosteroids was prescribed and resolution of the lesion was observed. Literature review revealed that oral lichen sclerosus is predominantly presented in females, as asymptomatic lesions of the lips and buccal mucosa; few cases have extraoral manifestations and topical corticosteroids are the main treatment intervention. Conclusions Despite its rarity, lichen sclerosus should be considered in the clinical and histopathological differential diagnosis of white patches of the oral mucosa. For rendering proper diagnosis, the histochemical Shikata’s modified orcein stain is a useful assessment tool.
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Affiliation(s)
- Nikolaos Katsoulas
- Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, AthensGreece
| | - Georgios Prodromidis
- Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, AthensGreece
| | - Nikolaos G Nikitakis
- Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, AthensGreece
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Kakko T, Salo T, Siponen MK. Oral lichen sclerosus: a systematic review of reported cases and two new cases. Int J Dermatol 2018; 57:521-528. [DOI: 10.1111/ijd.13870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/11/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Tuomas Kakko
- Institute of Dentistry; Faculty of Medicine; University of Oulu; Oulu Finland
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit; Faculty of Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
- Department of Oral and Maxillofacial Diseases; University of Helsinki; Oulu Finland
- Medical Research Center; Oulu University Hospital; Oulu Finland
| | - Maria K. Siponen
- Cancer and Translational Medicine Research Unit; Faculty of Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
- Department of Oral and Maxillofacial Diseases; Kuopio University Hospital; Kuopio Finland
- Institute of Dentistry; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
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Bevans SL, Keeley JM, Sami N. Oral lichen sclerosus—a review of clinical presentation, treatment, and clinical outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e243-e248. [DOI: 10.1016/j.oooo.2017.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
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Tomo S, Santos IS, de Queiroz SA, Bernabé DG, Simonato LE, Miyahara GI. Uncommon oral manifestation of lichen sclerosus: critical analysis of cases reported from 1957 to 2016. Med Oral Patol Oral Cir Bucal 2017; 22:e410-e416. [PMID: 28578370 PMCID: PMC5549513 DOI: 10.4317/medoral.21606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 04/22/2017] [Indexed: 12/24/2022] Open
Abstract
Background Lichen sclerosus is a mucocutaneous autoimmune disease which might be initiated by infectious pathogens as Borrelia Bugrdorferi and HPV. This disease shows destructive potential and is rarely diagnosed in oral mucosa. The purpose of this paper is to evaluate the characteristics of cases described in literature from 1957 to 2016, looking to provide valuable evidence about clinicopathologic features of this disease. Material and Methods A MedLine search was performed aiming to find oral lichen sclerosus cases in literature and discuss its demographical and pathological characteristics as well as treatment methods performed for these cases. Results 34 oral lichen sclerosus cases with histological confirmation and one clinicopathologic study linked with this disease were found in literature. Oral lichen sclerosus affected most commonly female patients, were asymptomatic and not associated to skin or genital lesions. Furthermore, affected patients in a range of 7 – 70-years old (Average age = 31.81). Conclusions Oral lichen sclerosus is a rare pathologic process with slight predilection for prepubertal girls, for which topical corticosterois have demonstrated satisfactory therapeutic value. Key words:Lichen sclerosus et atrophicous, skin diseases, mouth disease, autoimmune diseases, mouth.
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Affiliation(s)
- S Tomo
- Oral Oncology Center and Department of Pathology and Clinical Propedeutics, Araçatuba Dental School, São Paulo State University - UNESP 1193 José Bonifácio St. Araçatuba, São Paulo, Brazil, 16015-050,
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Marangon Júnior H, Souza PEA, Soares RV, Gomez RS, Pereira GHDM, Horta MCR. Oral Lichen Sclerosus: A Rare Case Report and Review of the Literature. Head Neck Pathol 2016; 11:212-218. [PMID: 27807761 PMCID: PMC5429284 DOI: 10.1007/s12105-016-0766-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area and causes significant discomfort and morbidity. Oral mucosal lesions in LS are extremely rare and might be associated with genital and/or skin manifestations. As a unique manifestation of LS, oral lesions are even more rare, with only 20 cases reported in English-language literature. In reviewing that literature in this paper, we present the case of a 44-year-old white man who sought dental assistance with a complaint of a white spot on his upper lip. Extraoral clinical examination revealed a slight white macule on the left upper lip vermilion next to the labial commissure. Intraoral examination revealed that the macule was approximately 3.5 × 2.0 cm, extended to the upper left labial mucosa, and presented an ivory-white color. Following an incisional biopsy and microscopy, the lesion was shown to be covered by a stratified squamous epithelium showing hyperkeratosis and atrophy. The superficial lamina propria revealed a well-marked band of subepithelial hyalinization and, below it, a band-like mononuclear inflammatory infiltrate. Sections stained by Verhoeff's technique revealed a scantiness of elastic fibers in the superficial lamina propria. The diagnosis of LS was then established. The patient was referred for dermatologic evaluation, which identified no skin or genital lesions, and no treatment was employed. After 6 years, no significant changes in clinical features were observed. Altogether, this rare case makes an important contribution to knowledge on this uncommon condition.
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Affiliation(s)
- Helvécio Marangon Júnior
- 0000 0001 2155 6671grid.412520.0Oral Pathology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom José Gaspar, 500, Prédio 46, Sala 101, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
| | - Paulo Eduardo Alencar Souza
- 0000 0001 2155 6671grid.412520.0Oral Pathology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom José Gaspar, 500, Prédio 46, Sala 101, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
| | - Rodrigo Villamarim Soares
- 0000 0001 2155 6671grid.412520.0Periodontology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Ricardo Santiago Gomez
- 0000 0001 2181 4888grid.8430.fDepartment of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | | | - Martinho Campolina Rebello Horta
- 0000 0001 2155 6671grid.412520.0Oral Pathology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom José Gaspar, 500, Prédio 46, Sala 101, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
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George AA, Hixson CD, Peckham SJ, Tyler D, Zelger B. A case of oral lichen sclerosus with gingival involvement and Borrelia identification. Histopathology 2014; 65:146-8. [PMID: 24387701 DOI: 10.1111/his.12363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alan A George
- Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Abstract
Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.
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