1
|
Halonen P, Heikinheimo O, Hadkhale K, Gissler M, Pukkala E, Jakobsson M. Risk Factors for Lichen Sclerosus: A Case-Control Study of 43,000 Finnish Women. J Low Genit Tract Dis 2024; 28:164-168. [PMID: 38518214 DOI: 10.1097/lgt.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Lichen sclerosus (LS) is an inflammatory skin disease probably arising from an interplay of genetics, local irritation, and autoimmune processes. We identified potential risk factors for the disease using data from nationwide Finnish registries. METHODS We identified all women diagnosed with LS within specialized health care during 1998-2016 (n = 10,692) and selected 3 age-matched population control women for each case. We calculated odds ratios (ORs) for possible risk factors using conditional logistic regression. RESULTS Dermatological autoimmune conditions were strongly associated with LS (OR = 15.1, 95% confidence interval [CI] = 13.6-16.7 for morphea; OR = 10.3, 95% CI = 5.02-19.0 for lichen planus; OR = 6.86, 95% CI = 5.65-8.33 for alopecia; OR = 2.20, 95% CI = 1.88-2.56 for vitiligo). A diagnosis of Crohn or celiac disease increased the odds of LS (OR = 1.80, 95% CI = 1.71-1.89; OR = 1.49, 95% CI = 1.28-1.73, respectively) as did urge and stress incontinence (OR = 1.79, 95% CI = 1.71-1.87; OR = 1.28, 95% CI = 1.22-1.35, respectively).The odds of LS were lower in women after a diagnosis of type 1 diabetes (OR = 0.43, 95% CI = 0.41-0.45), coronary artery disease (OR = 0.41, 95% CI = 0.38-0.43), and rheumatoid arthritis (OR = 0.38, 95% CI = 0.36-0.41).Parous women had higher odds of LS (OR = 1.11, 95% CI = 1.04-1.17) than nulliparous ones, but increasing number of births decreased the risk. Lichen sclerosus was not associated with socioeconomic status nor the urbanicity level of the place of residence. CONCLUSIONS Certain autoimmune diseases and urinary incontinence were associated with LS.
Collapse
Affiliation(s)
- Pia Halonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kishor Hadkhale
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää Hospital and University of Helsinki, Hyvinkää, Finland
| |
Collapse
|
2
|
Hu N, Zou Y, Deng X, Zhang L, Zhai Z, Yin R. Photodynamic therapy for male genital lichen sclerosus with urethral stricture-Case report. Photodiagnosis Photodyn Ther 2024; 45:103947. [PMID: 38154603 DOI: 10.1016/j.pdpdt.2023.103947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
Male genital lichen sclerosus (MGLSc) typically impacts the external genitalia, resulting in balanitis, erectile pain, urination symptoms, and/or urinary retention. Urethral stricture develops in up to 20 % of these patients, which is usually found in the distal part of the urethra but can, in severe instances, impact the entire urethra and cause structural changes. Patients with skin lesions limited to the foreskin and partially extending to the glans can typically be cured by circumcision, but the recurrence rate of stricture is high when the glans or urethra is extensively involved. In the following case report, we describe a 45-year-old man with a history of MGLSc for 3 years and urethral stricture for 2 years, and these conditions remained untreated after circumcision. We emphasize that treatment with 5-aminolevulinic acid-induced photodynamic therapy (ALA-PDT) may further improve outcomes in such severe cases.
Collapse
Affiliation(s)
- Nan Hu
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xun Deng
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lian Zhang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zhifang Zhai
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
| |
Collapse
|
3
|
Menta N, Nussbaum D, Khilnani A, Dowlut-McElroy T, Habeshian KA. Insights from a joint pediatric dermatology-gynecology vulvar clinic: A retrospective study. Pediatr Dermatol 2024; 41:41-45. [PMID: 38057120 DOI: 10.1111/pde.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND/OBJECTIVES Pediatric vulvar disease has not been widely explored in the medical literature. Few studies focus on vulvar disease in skin of color. The vulvar disease can be distressing for young patients given the sensitive location, and providers may lack experience in diagnosing and managing vulvar dermatoses. We sought to characterize the conditions seen, diagnostic challenges encountered, and the racial and ethnic factors associated with vulvar diseases in our multidisciplinary pediatric dermatology-gynecology vulvar clinic at Children's National. METHODS Medical records of 220 patients who presented to our multidisciplinary pediatric dermatology-gynecology clinic were reviewed retrospectively. RESULTS Lichen sclerosus (LS) (36%, n = 80), inflammatory vulvitis (11%, n = 23), and vitiligo (9%, n = 19) were the three most frequent conditions observed. These conditions were often misdiagnosed as one another. There was a mean delay in diagnosis after symptom onset in LS patients of 16.43 months. CONCLUSIONS LS, inflammatory vulvitis, and vitiligo are common vulvar diseases among pediatric patients. Accurate diagnosis is important because LS must be treated aggressively to prevent sequelae. Further studies are warranted to help differentiate LS and vitiligo with consideration of skin tone.
Collapse
Affiliation(s)
- Nikita Menta
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Dillon Nussbaum
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Aneka Khilnani
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Kaiane A Habeshian
- Pediatric Dermatology, Division of Dermatology, Children's National, Washington, DC, USA
| |
Collapse
|
4
|
Kryshtalskyj MT, Agi J, Ramien ML, Kurek KC, Kherani F. Lichen sclerosus of the upper eyelid in a paediatric patient: a novel presentation. Can J Ophthalmol 2023; 58:e267-e268. [PMID: 37549886 DOI: 10.1016/j.jcjo.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | - Jorge Agi
- Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Kyle C Kurek
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Femida Kherani
- Cumming School of Medicine, University of Calgary, Calgary, AB.; Faculty of Medicine, University of British Columbia, Vancouver, BC
| |
Collapse
|
5
|
Esse I, Rodriguez KH, Kassels A, Shiu J, Kraus CN. Vulvar lichen sclerosus and vitiligo: Overlap and clinical features. J Am Acad Dermatol 2023; 89:839-841. [PMID: 37328003 DOI: 10.1016/j.jaad.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Ilhan Esse
- Department of Dermatology, University of California, Irvine, California
| | | | - Alexa Kassels
- Department of Dermatology, University of California, Irvine, California
| | - Jessica Shiu
- Department of Dermatology, University of California, Irvine, California
| | - Christina N Kraus
- Department of Dermatology, University of California, Irvine, California.
| |
Collapse
|
6
|
Day T, Selim MA, Allbritton JI, Scurry J. Nonsclerotic Lichen Sclerosus: Definition of a Concept and Pathologic Description. J Low Genit Tract Dis 2023; 27:358-364. [PMID: 37467474 PMCID: PMC10545066 DOI: 10.1097/lgt.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Nonsclerotic lichen sclerosus (NSLS) refers to the clinicopathologic situation of examination findings consistent with lichen sclerosus (LS) but without dermal sclerosis on microscopy. This review aims to describe the features of NSLS and provide a classification framework. METHODS The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses Committee with development of consensus documents for conditions with problematic histopathology. The Difficult Pathologic Diagnoses Committee reviewed the literature on NSLS and formulated descriptions and diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership. RESULTS Nonsclerotic LS may be categorized into 4 histopathologic subtypes: lichenoid dermatitis, hypertrophic lichenoid dermatitis, dermal fibrosis without acanthosis, and dermal fibrosis with acanthosis. Each has a pathologic differential diagnosis of 1 or more entities, so clinical correlation is required for final diagnosis of LS. There is no evidence to support a reliable association between absent sclerosis and clinical appearance, duration, or oncogenic potential of LS. CONCLUSIONS Pathologists and clinicians should be familiar with the concept of NSLS and its implications for patient management. Use of the term "early LS" to indicate a lack of sclerosis in presumed LS should be abandoned. Clinical correlation is required to confirm LS from among the differential diagnoses.
Collapse
Affiliation(s)
- Tania Day
- University of Newcastle, Newcastle, New South Wales, Australia
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | | | - James Scurry
- University of Newcastle, Newcastle, New South Wales, Australia
- New South Wales Health Pathology, Hunter New England, Newcastle, New South Wales, Australia
| |
Collapse
|
7
|
Lawson A, Wininger M, Wang M, Steger M, Peccerillo K, Vash-Margita A. Premenarchal lichen sclerosus: a multicentre examination of the novel diagnostic tool, the SWIFT model. Br J Dermatol 2023; 189:353-354. [PMID: 37235769 DOI: 10.1093/bjd/ljad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
This is a validating study of a novel diagnostic tool, SWIFT, for rapid and accurate diagnosis of prepubertal lichen sclerosus.
Collapse
Affiliation(s)
- Ashli Lawson
- Division of Pediatric & Adolescent Gynecology, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Michael Wininger
- Departments of Biostatistics, Yale University, New Haven, CT, USA
| | - Melinda Wang
- Obstetrics & Gynecology, Yale University, New Haven, CT, USA
| | - Makenna Steger
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | |
Collapse
|
8
|
Bizon MA, Ostrowska A, Wieczorek A, Sawicki W. The impact of limited access of photodynamic therapy during COVID-19 pandemic on patients with vulvar lichen sclerosus. Ginekol Pol 2023; 94:959-966. [PMID: 37417382 DOI: 10.5603/gp.a2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/28/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES Stressful situations have an impact on progression of lichen sclerosus. The aim of the study was to investigate fears and complaints of patients with vulvar lichen sclerosus and progression of disease at the beginning of the COVID-19 pandemic. MATERIAL AND METHODS The analysis was based on 103 women with mean age was 64.81 ± 11.36 years divided into two groups. The first one comprised of patients with stabilization of disease during the pandemic with mean age 66.02 ± 10.01 (32-87), while the second one with progression of vulvar symptoms with mean age 63.49 ± 12.66 (25-87). RESULTS Delay of diagnosis was reported to be a problem for respectively 25.93% of women from both groups. Fear about COVID-19 was described respectively by 57.4% and 55.1%. Stabilization of disease was more frequent in patients after photodynamic therapy before pandemic. Progression of vulvar symptoms and features were observed more in patients who did not conduct PDT previously. All patients from the second group who underwent photodynamic therapy reported disappointment because of no access for continuation of treatment. On the other hand, 81.4% (43 women) regret that have no chance for trying photodynamic therapy. CONCLUSIONS Photodynamic therapy seems to be a method of treatment with longer survival without progression of lichen sclerosus in times of pandemics. There has been no investigation until now about concerns of patients with vulvar lichen sclerosus. Better understanding of problems connected with the pandemic can help medical personnel in taking care of patients with vulvar lichen sclerosus.
Collapse
Affiliation(s)
- Magdalena A Bizon
- LUX-MED Oncology Hospital, Warsaw, Poland.
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland.
| | - Aleksandra Ostrowska
- Scientific Students' Group of Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland
| | - Anna Wieczorek
- Scientific Students' Group of Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland
| | - Wlodzimierz Sawicki
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland
| |
Collapse
|
9
|
Lim S, Daddario S, Afvari S, Goldman N, Yang K, Kassamali B, Shahriari N, LaChance AH. Clinical practice gaps in patients with extragenital lichen sclerosus: A retrospective review. J Am Acad Dermatol 2023; 89:182-184. [PMID: 36918083 DOI: 10.1016/j.jaad.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Subin Lim
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Eastern Virginia Medical School, Norfolk, Virginia
| | - Salvatore Daddario
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Shawn Afvari
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; New York Medical College School of Medicine, Valhalla, New York
| | - Nathaniel Goldman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; New York Medical College School of Medicine, Valhalla, New York
| | - Kevin Yang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neda Shahriari
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Avery H LaChance
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
10
|
Rees S, Owen C, Baumhauer C, Hillman S. Vulval lichen sclerosus in primary care: thinking beyond thrush and genitourinary symptoms of the menopause. Br J Gen Pract 2023; 73:234-236. [PMID: 37105742 PMCID: PMC10147430 DOI: 10.3399/bjgp23x732861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/10/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol
| | | | | | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry
| |
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
12
|
Vuković D, Ogorevc M, Tripković I, Puizina-Ivić N, Saraga-Babić M, Mardešić S. The Distribution of Innervation and Immune Cell Infiltration Is Different in Genital and Extragenital Variants of Lichen Sclerosus. Biomolecules 2022; 12:biom12121767. [PMID: 36551194 PMCID: PMC9775107 DOI: 10.3390/biom12121767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Lichen sclerosus (LS) is a progressive skin disease that is characterized by chronic inflammation of either genital or extragenital skin, and it disproportionately affects women. We analyzed the distribution of nerve fibers, vanilloid receptors, cell proliferation, mast cells and macrophages in genital and extragenital LS samples, as well as in healthy skin, by using immunohistochemistry. The total amount of intraepidermal nerve fibers was lower in LS samples compared to healthy controls, while the total amount of subepidermal nerve fibers and calcitonin gene-related peptide (CGRP) positive fibers was higher in genital LS samples compared to both extragenital LS and healthy controls. Cell proliferation, macrophage and mast cell density were increased in LS samples compared to healthy controls. Genital LS had a higher macrophage density compared to the extragenital variant. Mast cell distribution significantly differed between genital and extragenital LS samples, even though their total mast cell densities were similar. These findings could explain the differences between pruritic symptoms of genital and extragenital LS and provide targets for the research of novel therapeutic strategies for LS management.
Collapse
Affiliation(s)
- Dubravka Vuković
- Department of Dermatovenerology, University Hospital Split, 21000 Split, Croatia
| | - Marin Ogorevc
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia
| | - Ivo Tripković
- Department of Plastic Surgery, University Hospital Split, 21000 Split, Croatia
| | - Neira Puizina-Ivić
- Department of Dermatovenerology, University Hospital Split, 21000 Split, Croatia
| | - Mirna Saraga-Babić
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia
| | - Snježana Mardešić
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence:
| |
Collapse
|
13
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
14
|
Guo W, Zeng J, Shen J. [Oral lichen sclerosus et atrophicus: a case report]. Zhonghua Kou Qiang Yi Xue Za Zhi 2022; 57:1065-1067. [PMID: 36266081 DOI: 10.3760/cma.j.cn112144-20220225-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- W Guo
- Department of Pathology, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - J Zeng
- Department of Comprehensive Clinic, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - J Shen
- Department of VIP Service Center, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| |
Collapse
|
15
|
Madsen EP, Bonefeld RE, Petersen CD. [Lichen sclerosus in women]. Ugeskr Laeger 2022; 184:V03220171. [PMID: 36178192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This review investigates women suffering from chronic vulval pruritus who may suffer from lichen sclerosus (LS). LS is a chronic inflammatory skin condition involving the vulva and anogenital regions. Treatment may be initiated upon suspicion, although the diagnosis is predominantly clinical and at times a skin biopsy is needed to confirm the diagnosis. LS is treated with potent to very potent topical steroids initially for three months. Prophylactic lifelong treatment is recommended to avoid long term scarring, sexual dysfunction, improve quality of life and to prevent cancer. Mild cases can be managed in general practice.
Collapse
|
16
|
Aziz Filho AM, de Azevedo LMS, Rochael MC, de Jesus LE. Frequency of lichen sclerosus in children presenting with phimosis: A systematic histological study. J Pediatr Urol 2022; 18:529.e1-529.e6. [PMID: 35864046 DOI: 10.1016/j.jpurol.2022.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of preputial lichen sclerosus (PLS) among children presenting with phimosis varies from 10 to 95%, depending on the age, the protocol for the treatment of pediatric phimosis, the method of diagnosis (clinical versus histological), and case mix (congenital versus acquired phimosis). OBJECTIVE PLS may not be clinically obvious. Our aim is to show that a systematic histological examination of the prepuce may diagnose PLS in clinically unsuspected cases. METHODS Prospective observational study of the histology of all prepuces resected from boys undergoing circumcision for phimosis but not clinically suspected to have PLS. RESULTS PLS was diagnosed histologically in 22 boys (32%). Boys with PLS were significantly older (mean 8.4 versus 4.7 years old). Diagnosis of PLS was not related to the degree of phimosis (summary figure). In three patients (grade 4 phimosis) glans discoloration was observed during surgery, and all had PLS. Follow up for boys found to have PLS ranged from 1 to 10 years. One patient developed recurrent phimosis, attributed to inappropriate conservative resection, and required further surgery. There were no cases of meatal stenosis. DISCUSSION Subtle cases of PLS may be difficult to detect clinically. Children are frequently asymptomatic, except for being unable to retract the prepuce. Physical examination has a low negative predictive value for the diagnosis of PLS. Complete removal of the prepuce with permanent glans exposure is regarded as essential to cure PLS and to avoid recurrent phimosis, but our patients were treated with partial circumcisions for cultural reasons. Only one needed reoperation for recurrent phimosis. CONCLUSION Histological PLS was present in approximately 1/3 of boys with phimosis, frequently without typical manifestations. Those patients may be cured with partial circumcisions.
Collapse
Affiliation(s)
| | | | | | - Lisieux Eyer de Jesus
- Antônio Pedro University Hospital, UFF, Niterói, Rio de Janeiro, Brazil; Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
| |
Collapse
|
17
|
Abstract
This case-control study uses data from the National Institutes of Health All of Us Research Program to investigate whether depression and anxiety are associated with lichen sclerosus among women.
Collapse
Affiliation(s)
- Ryan Fan
- Yale School of Medicine, New Haven, Connecticut
| | | | - Fahrisa I. Maisha
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Alicia J. Little
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey M. Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
18
|
Vieira-Baptista P, Pérez-López FR, López-Baena MT, Stockdale CK, Preti M, Bornstein J. Risk of Development of Vulvar Cancer in Women With Lichen Sclerosus or Lichen Planus: A Systematic Review. J Low Genit Tract Dis 2022; 26:250-257. [PMID: 35285455 DOI: 10.1097/lgt.0000000000000673] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vulvar lichen sclerosus (VLS) and possibly vulvar lichen planus (VLP) are associated with an increased vulvar cancer (VC) risk. We analyzed the risk of VC and its precursors after a diagnosis of VLS or VLP. MATERIALS AND METHODS A search was performed to identify articles describing the development of vulvar neoplasia in women with VLS or VLP. This systematic review was registered with the PROSPERO database. RESULTS Fourteen studies on VLS included 14,030 women without a history of vulvar neoplasia. Vulvar cancer, differentiated vulvar intraepithelial neoplasia (dVIN), and vulvar high-grade squamous intraepithelial lesion occurred in 2.2% (314/14,030), 1.2% (50/4,175), and 0.4% (2/460), respectively. Considering women with previous or current VC, the rate was 4.0% (580/14,372). In one study, dVIN preceded VC in 52.0% of the cases. Progression of dVIN to VC was 18.1% (2/11).The risk was significantly higher in the first 1-3 years after a biopsy of VLS and with advancing age; it significantly decreased with ultrapotent topical steroid use.For the 14,268 women with VLP (8 studies), the rates of VC, dVIN, and vulvar high-grade squamous intraepithelial lesion were 0.3% (38/14,268), 2.5% (17/689), and 1.4% (10/711), respectively. CONCLUSIONS Vulvar lichen sclerosus is associated with an increased risk of VC, especially in the presence of dVIN and with advancing age. Ultrapotent topical steroids seem to reduce this risk. An increased risk of developing VC has been suggested for VLP. Hence, treatment and regular life-long follow-up should be offered to women with VLS or VLP.
Collapse
Affiliation(s)
| | | | | | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mario Preti
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Jacob Bornstein
- Research Institute of the Azrieli Faculty of Medicine, Bar-Ilan University, Galilee Medical Center, Safed, Israel
| |
Collapse
|
19
|
Simms-Cendan J, Hoover K, Marathe K, Tyler K. NASPAG Clinical Opinion: Diagnosis and Management of Lichen Sclerosis in Pediatric and Adolescent Patients. J Pediatr Adolesc Gynecol 2022; 35:112-120. [PMID: 34610442 DOI: 10.1016/j.jpag.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022]
Abstract
This Clinical Opinion replaces the NASPAG Clinical Recommendation: Pediatric Lichen Sclerosus published in 2014. The objective of this document is to provide guidance in the diagnosis and management of vulvar lichen sclerosus (LS) in the pediatric and adolescent patient in order to treat patient symptoms and reduce long-term sequelae. LS is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, loss of pigmentation and vulvar adhesions with loss of normal vulvar architecture. Management includes topical agents for induction and maintenance therapy, as well as long-term follow-up for identification and treatment of recurrence and sequelae. This document is intended for use by both primary and specialty pediatric and adolescent gynecology (PAG) providers, including specialists in pediatrics, gynecology, adolescent medicine, and dermatology.
Collapse
Affiliation(s)
- Judith Simms-Cendan
- Division of Pediatric Adolescent Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Kimberly Hoover
- Division of Pediatric Adolescent Gynecology, Department of Women's Reproductive Health, University of Alabama, Birmingham, Alabama
| | - Kalyani Marathe
- Division of Dermatology, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Kelly Tyler
- Departments of Dermatology and Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
20
|
Yalici-Armagan B, Bostan E, Akdogan N, Ersoy-Evans S. Paediatric lichen sclerosus et atrophicus: A retrospective analysis of 38 paediatric patients. Int J Clin Pract 2021; 75:e14661. [PMID: 34322973 DOI: 10.1111/ijcp.14661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory cutaneous disease. AIM To evaluate the characteristics of paediatric LSA patients in Turkey. MATERIAL AND METHODS Data for patients aged <18 years who were diagnosed with LSA by a paediatric dermatologist were retrospectively reviewed. Patient demographic characteristics, clinical features, disease duration, the vitamin D level, accompanying diseases, presence of atopy, therapeutic approach and treatment response were recorded. RESULTS The study included 38 patients, of whom 35 (92.1%) were female and 3 (7.9%) were male. Mean age at onset of disease was 6.4 ± 3.3 years in females versus 3.1 ± 2.6 years in males. Mean diagnostic delay was 20.6 ± 28.9 months in females and 2 ± 1.7 months in males. In 28 (80%) patients the time from onset of lesions to diagnosis was ≥3 months. The majority (76.3%) of the patients were asymptomatic, whereas five had itching, two had itching and burning, and two had pain. Among the females, 12 (34.3%) and 23 (65.7%) presented with isolated extragenital and anogenital involvement + extragenital lesions, respectively. All three males had isolated extragenital involvement. The most commonly recommended treatments were topical calcineurin inhibitors and calcipotriol/betamethasone ointment. Accompanying diseases were as follows: alopecia areata (n = 2); atopic dermatitis (n = 2); vitiligo (n = 2); ulcerative colitis and juvenile idiopathic arthritis (n = 1); Hashimoto's thyroiditis (n = 1). Among the 28 patients whose vitamin D level was measured, 24 (85.7%) had vitamin D deficiency. CONCLUSION LSA can be asymptomatic in the majority of affected children. Diagnostic delay was noted in 80% of the study's LSA patients, highlighting the lack of awareness of the condition among parents and clinicians.
Collapse
Affiliation(s)
- Basak Yalici-Armagan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ecem Bostan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Neslihan Akdogan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel Ersoy-Evans
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
21
|
Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, Helios St Elisabeth Hospital Oberhausen, Oberhausen, University Witten/Herdecke, Germany
| | - Bijan Koushk-Jalali
- Department of Dermatology, Venereology, and Allergology, Helios St Elisabeth Hospital Oberhausen, Oberhausen, University Witten/Herdecke, Germany
| |
Collapse
|
22
|
Sharma P, Ramesh V. Hypopigmented atrophic plaques in a young woman. BMJ 2021; 373:n1012. [PMID: 33952444 DOI: 10.1136/bmj.n1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Prateek Sharma
- Department of Dermatology, Safdarjung Hospital, New Delhi, India
| | - V Ramesh
- Department of Dermatology, Safdarjung Hospital, New Delhi, India
| |
Collapse
|
23
|
Ringel NE, Iglesia C. Common Benign Chronic Vulvar Disorders. Am Fam Physician 2020; 102:550-557. [PMID: 33118795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Common benign chronic vulvar conditions include genitourinary syndrome of menopause (formerly called vulvovaginal atrophy), lichen sclerosus, lichen planus, lichen simplex chronicus, and vulvodynia. Genitourinary syndrome of menopause results from the hypoestrogenic state that leads to atrophy of normal vulvar and vaginal tissues. It is typically treated with lubricants, moisturizers, and intravaginal estrogen. Lichen sclerosus is an inflammatory condition characterized by intense vulvar itching. It is treated with topical steroids or, in some cases, topical calcineurin inhibitors. Patients with lichen sclerosus are at risk of vulvar squamous cell carcinoma and should be monitored closely for malignancy. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and vagina in addition to other skin and mucosal surfaces. The first-line treatment is topical steroids, and significant scarring can occur if left untreated. Lichen simplex chronicus manifests as persistent itching and scratching of the vulvar skin that leads to thickened epithelium. Breaking the itch-scratch cycle, often with topical steroids, is the key to treatment. Vulvodynia is a common vulvar pain disorder and is a diagnosis of exclusion. A multimodal treatment approach typically includes vulvar hygiene, physical therapy, psychosocial interventions, and antineuropathy medications.
Collapse
|
24
|
García-Arpa M, Franco-Muñoz M, Ramos-Rodríguez C, Sánchez-Caminero MP. Lichen Sclerosus on the Eyelids. Actas Dermosifiliogr (Engl Ed) 2020; 112:179. [PMID: 32986974 DOI: 10.1016/j.ad.2019.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/17/2018] [Accepted: 01/01/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- M García-Arpa
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - M Franco-Muñoz
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - C Ramos-Rodríguez
- Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M P Sánchez-Caminero
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| |
Collapse
|
25
|
Tonin B, Catenaro R, Girolomoni G, Ghimenton C, Gisondi P. Pseudoepitheliomatous, keratotic, and micaceous balanitis mimicking lichen sclerosus et atrophicus. Dermatol Online J 2020; 26:13030/qt7c33g14w. [PMID: 33054948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023] Open
Abstract
We present a man in his 70s with a hyperkeratotic whitish plaque over the internal prepuce and glans. The lesion was slowly growing for four years prior to presentation and was resistant to several topical treatments. The histological examination of the lesion revealed marked hyperkeratosis and pseudoepitheliomatous hyperplasia, supporting the diagnosis of pseudoepitheliomatous, keratotic, and micaceous balanitis. It is important to be aware of this uncommon but potentially malignant condition affecting elderly men.
Collapse
Affiliation(s)
- Beatrice Tonin
- Section of Dermatology, Department of Medicine, University of Verona, Verona.
| | | | | | | | | |
Collapse
|
26
|
Kuraitis D, Stumpf B, Murina A. Discrepancies by dermatology resident gender in diagnostic confidence and management of female and male genital lichen sclerosus. Dermatol Online J 2020; 26:13030/qt09r2d0n3. [PMID: 32898408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023] Open
Abstract
Physician gender may impact their exposure to genital dermatoses during residency. The purpose of this study was to survey current dermatology residents regarding their comfort in diagnosing and managing lichen sclerosus. As residents progress through training, confidence improves in diagnosing and managing both male and female lichen sclerosus. However, residents overall feel less comfortable with male genital lichen sclerosus, with female residents displaying the greatest confidence discrepancy. This study highlights gender discrepancies with dermatology resident confidence and practice habits and may serve to further guide curricula to address these disparities.
Collapse
Affiliation(s)
- Drew Kuraitis
- Department of Dermatology, Tulane University, New Orleans, LA.
| | | | | |
Collapse
|
27
|
Cheng HS, Kerckhoffs C, Perkins N, Eva L. Demographics of New Zealand women with vulval lichen sclerosus: is specialist care equitable? N Z Med J 2020; 133:24-31. [PMID: 32595219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM Vulval lichen sclerosus is an inflammatory genital skin condition associated with poor quality of life, sexual dysfunction and risk of squamous cell carcinoma. The aim of this study was to document the demographics of women with lichen sclerosus seen at specialist vulval clinics. METHOD We performed a retrospective review of women with lichen sclerosus seen at a tertiary combined gynaecology/dermatology vulval clinic over 12 months and Auckland Regional sexual health vulval clinics over five years. Data were collected for age, ethnicity, skin biopsy, treatment, referral source and time from symptom onset to diagnosis. Ethnicity was compared with Census data for the Auckland region. DISCUSSION Three hundred and thirty-five women were included; 273 from the gynaecology/dermatology clinic and 62 from sexual health. Women seen at sexual health were younger than those seen by gynaecology/dermatology (mean age 45 and 64, respectively; p<0.0001). Most referrals were from general practitioners (54%), although self-referrals made up 42% of sexual health consultations. The most common ethnicity was European (82%) followed by Asian (10%), Māori (4%) and Pacific Peoples (3%). Compared with Census data, European women were over-represented and Māori, Pacific and Asian women were under-represented. CONCLUSION We found inequitable ethnic representation of women with vulval lichen sclerosus seen at our institution. Causes may include sociocultural beliefs, variations in access to care or ethnic differences in the prevalence of lichen sclerosus. A deeper understanding of underlying issues would enable planning of initiatives to ensure equitable access to specialist care for all New Zealand women with vulval conditions.
Collapse
Affiliation(s)
- Harriet S Cheng
- Dermatologist, Department of Dermatology and National Women's Health, Auckland District Health Board, Auckland
| | | | - Nicky Perkins
- Sexual Health Physician, Auckland Regional Sexual Health Service, Auckland District Health Boards, Auckland
| | - Lois Eva
- Gynaecological Oncologist, National Women's Health, Auckland District Health Board, Auckland
| |
Collapse
|
28
|
Meijerink AM, van Altena AM. [A girl who was suddenly unable to urinate]. Ned Tijdschr Geneeskd 2020; 164:D4469. [PMID: 32395963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We saw a 15-year-old girl with a sudden inability to urinate. She was diagnosed with an obliterated vulva, due to an uncommon first presentation of lichen sclerosus.
Collapse
|
29
|
Abstract
The pathogenesis of vulvar squamous neoplasia has 2 pathways: human papillomavirus (HPV)-dependent and HPV-independent. The HPV-dependent pathway in the vulva follows the same progression as HPV-dependent lesions elsewhere in the gynecologic tract-HPV infection results in high-grade squamous intraepithelial lesion with subsequent progression to basaloid squamous cell carcinoma. The HPV-independent pathway is more complex, with a variety of precursor lesions and molecular alterations. Although the most recognized form of HPV-independent vulvar lesion is differentiated vulvar intraepithelial neoplasia, recent explorations have elucidated new precursors. This review provides an update on HPV-independent risk factors and precursor lesions for squamous cell carcinoma of the vulva.
Collapse
Affiliation(s)
- Jaclyn C Watkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, MCN C-3306A, 1161 21st Avenue South, Nashville, TN 37232-2582, USA.
| |
Collapse
|
30
|
Alaniz VI, Rosen M, Mohr B, Markman L, Quint EH. 4-year-old girl · genital discomfort and dysuria · clitoral hood swelling · Blood blister on the labia minora · Dx? J Fam Pract 2019; 68:E8-E10. [PMID: 31287448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Veronica I Alaniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA
| | - Monica Rosen
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA
| | - Bethany Mohr
- Department of Pediatrics and Communicable Diseases, Child Protection Team, University of Michigan, Ann Arbor, USA
| | - Lisa Markman
- Department of Pediatrics and Communicable Diseases, Child Protection Team, University of Michigan, Ann Arbor, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA
| |
Collapse
|
31
|
Farmer C, Patel D, Pimentel JD, Shwayder T. Large hemorrhagic plaque with central crusting. Cutis 2019; 103:68-80. [PMID: 30893389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Caitlin Farmer
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Devika Patel
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason D Pimentel
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
32
|
Ljubojević Hadžavdić S, Krtanjek J, Đurinec P, Žele-Starčević L, Skerlev M, Bartenjev I. Coexistence of genital lichen sclerosus and genital warts. Acta Dermatovenerol Alp Pannonica Adriat 2018; 27:221-223. [PMID: 30564837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of the genital and extragenital skin. Anogenital warts are benign proliferative lesions caused by human papillomavirus (HPV), which is found in > 95% of lesions. We present two cases of the coexistence of LS and genital warts: one patient with and one without a previous history of genital warts. According to our knowledge and a literature search, only a few cases of the coexistence of LS and genital warts have been reported.
Collapse
Affiliation(s)
- Suzana Ljubojević Hadžavdić
- Department of Dermatology and Venereology, Zagreb University Hospital Center, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Jelena Krtanjek
- Division of Dermatology and Venereology, Varaždin General Hospital, Varaždin, Croatia
| | - Paola Đurinec
- Department of Dermatology and Venereology, Zagreb University Hospital Center, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Lidija Žele-Starčević
- Department of Clinical and Molecular Microbiology, Zagreb Clinical Hospital Center, Zagreb, Croatia
| | - Mihael Skerlev
- Department of Dermatology and Venereology, Zagreb University Hospital Center, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Igor Bartenjev
- Department of Dermatology and Venereology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
33
|
Hasegawa M, Ishikawa O, Asano Y, Sato S, Jinnin M, Takehara K, Fujimoto M, Yamamoto T, Ihn H. Diagnostic criteria, severity classification and guidelines of lichen sclerosus et atrophicus. J Dermatol 2018; 45:891-897. [PMID: 29265410 DOI: 10.1111/1346-8138.14171] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
Abstract
We established diagnostic criteria and severity classification of lichen sclerosus et atrophicus, because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there is no clinical guideline for lichen sclerosus et atrophicus in Japan, so we proposed its clinical guideline. The clinical guidelines were formulated by clinical questions and recommendations on the basis of evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guidelines easy to use and reliable including the newest evidence, and to present guidance for various clinical problems in treatment of lichen sclerosus et atrophicus.
Collapse
Affiliation(s)
- Minoru Hasegawa
- Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshihide Asano
- Department of Dermatology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hironobu Ihn
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
34
|
Rafiei R, Eftekhari H, Granmayeh S, Nickhah N, Rafiee B. Extramammary Paget's Disease Associated With Genital Wart and Lichen Sclerosus. Acta Med Iran 2017; 55:591-593. [PMID: 29202553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 06/07/2023] Open
Abstract
Extramammary Paget's disease is an uncommon intraepithelial adenocarcinoma in genital and perianal regions. Genital wart is the most common sexually transmitted disease caused by human papilloma viruses and vulval lichen sclerosus is chronic pruritic dermatitis in genital area which could be able to change to invasive squamous cell carcinoma. We report a patient who had simultaneous lichen sclerosus, genital wart and extramammary Paget's disease of the vulva. We could not find any significant association between them in literature.
Collapse
Affiliation(s)
- Rana Rafiei
- Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hojat Eftekhari
- Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Siamak Granmayeh
- Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nahid Nickhah
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Rafiee
- Department of Pathology, NYU Winthrop Hospital, Mineola, NY, USA
| |
Collapse
|
35
|
Ambrifi M, Dona' MG, Tedesco M, Latini A, Cota C, Giuliani M, Benevolo M, Gheit T, Tommasino M, Cristaudo A. Lichen Sclerosus in stable sexual partners: etiologic correlation or mere coincidence? GIORN ITAL DERMAT V 2017; 152:92-94. [PMID: 27978615 DOI: 10.23736/s0392-0488.16.05238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marina Ambrifi
- Infectious Dermatology and Allergology Unit (STI/HIV Unit), San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Maria G Dona'
- Infectious Dermatology and Allergology Unit (STI/HIV Unit), San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Marinella Tedesco
- Plastic Surgery Department, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit (STI/HIV Unit), San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Carlo Cota
- Dermatopathology Division, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Massimo Giuliani
- Infectious Dermatology and Allergology Unit (STI/HIV Unit), San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Antonio Cristaudo
- Infectious Dermatology and Allergology Unit (STI/HIV Unit), San Gallicano Dermatologic Institute, IRCCS, Rome, Italy -
| |
Collapse
|
36
|
Abstract
A wide range of genital infections and skin conditions may present with vulval pruritus. Lichen sclerosus is one cause. This is often associated with visible skin changes which include atrophy, resorption or fusion of the labia, sclerosis and excoriation. Ulceration may indicate malignant transformation and requires urgent biopsy. Many experienced clinicians diagnose lichen sclerosus on clinical appearance, however we recommend a low threshold for biopsy, especially for non-responding or odd looking lesions. We report a patient whose vulval skin biopsy for clinically suspected lichen sclerosus revealed extramammary Paget's disease of the vulva. We review the pathology, prognosis and treatment of this condition.
Collapse
Affiliation(s)
- D Bansal
- Department of Genitourinary Medicine, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
| | | |
Collapse
|
37
|
Osterberg EC, Gaither TW, Awad MA, Alwaal A, Erickson BA, McAninch JW, Breyer BN. Current Practice Patterns Among Members of the American Urological Association for Male Genitourinary Lichen Sclerosus. Urology 2016; 92:127-31. [PMID: 26948526 PMCID: PMC4896157 DOI: 10.1016/j.urology.2016.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the practice patterns of urologists who treat male genitourinary lichen sclerosus (MGU-LS) via a national web-based survey distributed to American Urological Association members. METHODS A 20-question survey was collected from a random sample of American Urological Association members. Respondents answered questions on their practice patterns for MGU-LS diagnosis, treatment of symptomatic urethral stricture disease, surveillance, and follow-up. RESULTS In total, 309 urologists completed the survey. The majority of respondents reported practicing more than 20+ years (37.5%) within an academic (31.7%) or group practice (31.1%) setting. The majority of respondents saw 3-5 men with MGU-LS per year (32.7%). The most common locations of MGU-LS involvement included the glans penis (66.2%), foreskin (26.3%), and/or the urethra (5.8%). Respondent first-line treatment for urethral stricture disease was direct visual internal urethrotomy (26.6%) and second-line treatment was referral to subspecialist (38.4%). After controlling for the number of patients evaluated with MGU-LS per year, those with reconstructive training were more likely to perform a primary urethroplasty for men with symptomatic urethral stricture disease (adjusted odds ratio 13.1, 95% confidence interval 5.1-33.8, P < .001). They were also more likely to counsel men on the associated penile cancer risks (adjusted odds ratio 4.6, 95% confidence interval 1.7-12.5, P < .01). CONCLUSION Reconstructive urologists evaluate the most number of patients with MGU-LS and are more likely to perform primary urethroplasty for urethral stricture disease. Men with MGU-LS should be referred to a reconstructive urologist to understand the full gamut of treatment options.
Collapse
Affiliation(s)
- E Charles Osterberg
- Department of Urology, University of California-San Francisco, San Francisco, CA.
| | - Thomas W Gaither
- Department of Urology, University of California-San Francisco, San Francisco, CA
| | - Mohannad A Awad
- Department of Urology, University of California-San Francisco, San Francisco, CA
| | - Amjad Alwaal
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Jack W McAninch
- Department of Urology, University of California-San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA
| |
Collapse
|
38
|
Moser A, Lautenschlager S. [CME Dermatology. Pruritus and white lesions of the trunk. Lichen sclerosus]. Praxis (Bern 1994) 2015; 104:760-761. [PMID: 26135730 DOI: 10.1024/1661-8157/a002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Andreas Moser
- 1 Dermatologisches Ambulatorium, Stadtspital Triemli, Zürich
| | | |
Collapse
|
39
|
Le Lievre H, Baker L. A young boy with an interesting skin condition: a case study. Aust Fam Physician 2015; 44:223-224. [PMID: 25901407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Hugh Le Lievre
- GP MBBS (Hons), Procedural Registrar, Orange Health Service, Orange, NSW
| | | |
Collapse
|
40
|
Patsatsi A, Kyriakou A, Mantas A, Vavilis D, Patsialas C, Sotiriadis D. Circulating anti-BP180 NC16a and anti-BP230 autoantibodies in patients with genital lichen sclerosus do not correlate with disease activity and pruritus. Acta Derm Venereol 2014; 94:711-2. [PMID: 24676719 DOI: 10.2340/00015555-1851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aikaterini Patsatsi
- 2nd Dermatology Department, Aristotle University School of Medicine, GR-57500 Thessaloniki,, Greece
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Lichen sclerosus most commonly affects the anogenital region. Spreading into the extragenital regions is rare, and its course is most commonly asymptomatic. Women have been reported to be affected 6 to 10 times more often than men. The etiology of lichen sclerosus is still unknown. The disease is characterized by ivory-white atrophic plaques, and no treatment ensuring complete recovery is available. T-cells are also involved in its pathogenesis. Pimecrolimus is a topical inhibitor of T-cells. In the present paper, we present a male patient with lichen sclerosus located only in extragenital regions and report an unsuccessful outcome of treatment with pimecrolimus 1% cream administered topically twice a day for 16 weeks.
Collapse
Affiliation(s)
- Ozer Arican
- Department of Dermatology, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | | | | |
Collapse
|
42
|
Chen HC, Kadono T, Mimura Y, Saeki H, Tamaki K. High-Frequency Ultrasound as a Useful Device in the Preliminary Differentiation of Lichen Sclerosus et Atrophicus from Morphea. J Dermatol 2014; 31:556-9. [PMID: 15492421 DOI: 10.1111/j.1346-8138.2004.tb00554.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Accepted: 03/09/2004] [Indexed: 11/30/2022]
Abstract
High-frequency ultrasound diagnostic equipment (HFUS) using probes with frequencies above 15-MHz has been utilized conventionally in preoperative assessments and postoperative follow-up of skin tumors. The advent of probes with even higher frequencies (up to 30-MHz) has widened the clinical applications of HFUS to inflammatory dermatoses which are histologically confined to the epidermis and upper dermis, such as psoriasis and atopic dermatitis. Ultrasound imaging has the advantage of being a noninvasive and relatively inexpensive technology that is quick and easy to perform. In addition, information obtained from HFUS is unique and useful for clinical diagnosis and evaluation for various skin disorders. We believe that HFUS has the potential to become a powerful tool for either clinical or investigative dermatology. Herein, we present a case of lichen sclerosus et atrophicus (LSA) to which we applied HFUS before skin biopsy and obtained substantial information for the differential diagnosis from morphea, and we reemphasize the usefulness of HFUS in studying the inflammatory skin disorders.
Collapse
Affiliation(s)
- Hsin-Chi Chen
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | | | | | | | | |
Collapse
|
43
|
Al-Dawsari NA, Croke J, Yaar M. Sclerotic atrophic plaques associated with a tattoo. Dermatol Online J 2014; 20:13030/qt6f78p4ht. [PMID: 25046469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 06/03/2023] Open
Abstract
Lichen sclerosus is a chronic inflammatory disease, usually of the anogenital area, that causes intractable itching and soreness. Less commonly, it may have extragenital involvement in 15 to 20% of cases. Lichen sclerosus has been reported at sites of injury as a Koebner phenomenon. We report a case of lichen sclerosus at the site of a tattoo with simultaneous genital involvement.
Collapse
|
44
|
Lü J, Huang XD. [Current diagnosis and treatment of male genital lichen sclerosus]. Zhonghua Nan Ke Xue 2014; 20:579-585. [PMID: 25095613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Male genital lichen sclerosus (MGLSc) is a chronically relapsing disease characterized by a long course, gradual aggravation, and a tendency towards malignancy. Once called balanitis xerotica obliterans, MGLSc has a distinct predilection for the prepuce and glans, involving the urethra when aggravating, forming scarring tissues, and causing urethral stricture, which may seriously affect the patients'quality of life with such symptoms as urinary stream narrowing, dysuria, and painful penile erection. The etiology and pathogenesis of MGLSc have not yet been adequately explained though it is generally thought to be associated with autoimmune mechanism, genetic factors, infections, local trauma, and chronic urinary irritation. MGLSc can be fairly easily diagnosed according to its clinical manifestations and histopathological results, but can be hardly cured. Early diagnosis and prompt treatment are the most important approaches, which may relieve its symptoms, check its progression, and prevent its long-term sequelae. Ultrapotent topical corticosteroids are the choice for the treatment of MGLSc. For those who fail to respond to expectant medication or have dysuria due to urethral stricture and painful erection, rational surgery may be resorted to, with importance attached to long-term follow-up. This article presents an update of the diagnosis and treatment of MGLSc and MGLSc-induced urethral stricture.
Collapse
|
45
|
Abstract
Morphea (localized scleroderma) is a rare fibrosing disorder of the skin and underlying tissues characterized by skin thickening and hardening due to increased collagen deposition. The significance of the disease depends on the extent of the lesions, potential for functional disability or cosmetic disfigurement, and presence or absence of extracutaneous manifestations. Treatment is tailored; circumscribed forms may require only topical treatment, while forms causing functional impairment or severe cosmetic change may require systemic treatment. Although localized scleroderma has a good prognosis, some clinical subtypes can be deforming and irreversibly disabling, especially when affecting the extremities or the face.
Collapse
Affiliation(s)
- Elena Pope
- Section of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Ronald M Laxer
- Departments of Paediatrics and Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| |
Collapse
|
46
|
Pranteda G, Muscianese M, Grimaldi M, Fidanza L, Pranteda G, Narcisi A, Nistico S, Bottoni U. Lichen sclerosus et atrophicus induced by carbamazepine: a case report. Int J Immunopathol Pharmacol 2014; 26:791-4. [PMID: 24067479 DOI: 10.1177/039463201302600326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of Lichen Sclerosus in a 73-year-old man who had been treated for epilepsy with carbamazepine. Lichen sclerosus et atrophicus (LSA), also called lichen sclerosus (LS), is a chronic inflammatory cutaneous condition characterized by white plaques with epidermal atrophy and scarring. To date no cases of LSA has been linked to carbamazepine, although in a few cases lichenoid eruptions but without sclero-atrophy have been described after exposure to this drug. Therefore, to our knowledge, this is the first report of a Lichen sclerosus et atrophicus induced by carbamazepine.
Collapse
Affiliation(s)
- G Pranteda
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, S. Andrea Hospital, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Kumar P, Jha AK, Mallik SK, Raihan M. Bilateral zosteriform extragenital lichen sclerosus. Skinmed 2014; 12:123-125. [PMID: 24933856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 35-year-old man presented with asymptomatic eruption on both forearms and lower aspects of the legs for 6 months. The lesions first appeared on his inner aspects of the wrist, the dorsal surface of the hands, and legs and progressed to involve proximal aspects of the extremities. There was no significant past history. On examination, multiple pearly white papules and depigmented atrophic plaques were found bilaterally on the flexors of the arms and the extensors of the legs. The lesions were arranged in a linear manner, following the lines of Blaschko (Figures 1 and 2). The surface of the atrophic plaques was notable for prominent telangiectasia, giving an erythematous appearance. The genitalia, oral cavity, palms, and soles were spared. Systemic examination was noncontributory. Lichen striatus and extragenital lichen sclerosus (ELS) were considered the differential diagnosis. Clinically, the age of the patient, the absence of scaling, and the presence of atrophic plaques and telangiectasia were in favor of ELS. A punch biopsy from an atrophic plaque was performed, and it revealed hyperkeratosis, atrophic epidermis, basal layer vacuolar degeneration, mild lymphocytic infiltration in the dermis, edema, and homogenization of collagen of the upper portion of the dermis (Figures 3 and Figure 4). Histopathologic findings were consistent with lichen sclerosus. A diagnosis of bilateral zosteriform ELS was made.
Collapse
|
48
|
Abstract
Vulvar dermatologic disorders are common among women, and prevalence increases with age. Treatment can provide women with symptomatic relief and can halt further progression of disease. Numerous therapies are available, and nurses who work with women across the life span should have an understanding of vulvar dermatologic disorders and therapeutic modalities. We provide an overview of general vulvar care, four vulvar dermatologic disorders, and common treatment modalities including topical and systemic pharmacologic management.
Collapse
|
49
|
Noonan V, Woo SB, Kabani S. Lichen sclerosus. J Mass Dent Soc 2014; 63:51. [PMID: 25509505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
50
|
Ganovska A, Kovachev S, Nikolov A. [Diagnosis and treatment of lichen sclerosus--review]. Akush Ginekol (Sofiia) 2014; 53:32-39. [PMID: 25510069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Lichen sclerosus (LS) is a chronic skin disease of the vulva which affects mostly women in the postmenopausal period. The disease affects also men and children. Its frequency is from 1/70 up to 1/1000, whereas for women it is 10 times more frequently. The disease has unknown etiology. Due to the high frequency of accompanying, autoimmune diseases, it is presumed that this disease is a result of immunological processes. Some of patients diagnosed with LS have vulvar intraepithelial neoplasia, while 0.3% - 4.9% of them have squamous cell carcinoma. The aim of this review is to summarize our knowledge regarding the frequency, clinical features, diagnosis and therapy of LS in view of the prevention of the complications that may occur. MATERIAL AND METHODS We researched the available literature and Medline on the topic for the period of 1971 until 2014 year. We summarized the most interesting, contemporary and scientifically substantiated facts regarding this disease. DISCUSSION Early diagnosis, the proper and timely treatment, as well as the continuous follow up the patients with LS is mandatory due to the fact that the spontaneous remission is extremely rare and the complications may lead to significant deterioration of the quality of life.
Collapse
|