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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bonfill-Ortí M, Martínez-Molina L, Penín R, Marcoval J. Liquen escleroso extragenital inducido por radioterapia. Actas Dermo-Sifiliográficas 2019; 110:69-71. [DOI: 10.1016/j.ad.2017.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/30/2017] [Indexed: 10/17/2022] Open
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Bonfill-ortí M, Martínez-molina L, Penín R, Marcoval J. Extragenital Lichen Sclerosus Induced by Radiotherapy. Actas Dermo-Sifiliográficas (English Edition) 2019; 110:69-71. [DOI: 10.1016/j.adengl.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Edwards LR, Privette ED, Patterson JW, Tchernev G, Chokoeva AA, Wollina U, Lotti T, Wilson BB. Radiation-induced lichen sclerosus of the vulva. Wien Med Wochenschr 2016; 167:74-77. [DOI: 10.1007/s10354-016-0525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/09/2016] [Indexed: 11/29/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Sepčić J, Ristić S, Perković O, Brinar V, Lipozenčić J, Crnić-Martinović M, Čizmarević NS, Labinac DJ, Kapović M, Peterlin B. A Case of Lichen Ruber Planus in a Patient with Familial Multiple Sclerosis. J Int Med Res 2010; 38:1856-60. [DOI: 10.1177/147323001003800533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Multiple sclerosis and lichen ruber planus are clinically and histologically distinct complex disorders of putative autoimmune aetiology that are fairly commonly observed in isolation but rarely found in combination. Only two previous reports have described lichen skin disorders in association with multiple sclerosis. The present report describes the case of a 51-year old Caucasian woman exhibiting both familial multiple sclerosis and lichen ruber planus. This combination may have occurred by chance or it might imply that these disorders share common mechanisms in their pathogenesis.
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Affiliation(s)
- J Sepčić
- Department of Neurology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - S Ristić
- Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - O Perković
- Department of Neurology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - V Brinar
- Department of Neurology School of Medicine, University of Zagreb, Zagreb, Croatia
| | - J Lipozenčić
- Department of Dermatology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - M Crnić-Martinović
- Department of Transfusion Medicine, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - N Starčević Čizmarević
- Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - D Janko Labinac
- Department of Neurology, General Hospital Pula, Pula, Croatia
| | - M Kapović
- Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - B Peterlin
- Division of Medical Genetics, Department of Obstetrics and Gynaecology, University of Ljubljana, Ljubljana, Slovenia
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