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Mastoraki E, Kravvas G, Dear K, Sim S, James M, Watchorn R, Haider A, Ellery P, Freeman A, Basha M, Edmonds E, Bunker CB. Primary vulval melanoma and genital lichen sclerosus. SKIN HEALTH AND DISEASE 2024; 4:e411. [PMID: 39104656 PMCID: PMC11297432 DOI: 10.1002/ski2.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 08/07/2024]
Abstract
Background Lichen sclerosus (LS) is a chronic, inflammatory skin disease with a predilection for the genitalia. Although, the association between squamous cell cancer and genital LS is well established, a link with genital melanoma has not been thoroughly explored. However, we have recently published a case series of penile melanoma where 9/11 (82%) of patients seen over a 10 year period with penile melanoma were retrospectively found to have histological and/or clinical evidence of genital LS on review. Objectives The aim of this study was to illuminate further the relationship between vulval melanoma and genital LS by reviewing all the cases managed by our hospital and undertaking a literature review. Methods We identified all the cases with a diagnosis of vulval melanoma over a 16-year period (2006-2022) where histology was available. The clinical notes were retrospectively reviewed, and the histological features of all cases were reassessed by two independent mutually 'blinded' histopathologists. We also performed a literature review of genital LS in patients with vulval melanoma. Results A total of 11 patients with vulval melanoma were identified for the review. Histopathological review found evidence of genital LS in seven of them (64%). Genital LS was not documented in any of the original histology reports. Clinical notes and letters were available in nine cases. The literature review identified 12 relevant studies with a total of 18 patients. Twelve cases concerned adult women, and six concerned female children. Conclusion The presence of genital LS in as high as 64% of our vulval melanoma cases might indicate a causative relationship between genital LS and vulval melanoma. The pathogenesis of vulval melanoma remains largely unknown. Although ultraviolet radiation is an important pathogenic factor for cutaneous melanoma, it cannot be a factor in vulval melanoma. While possible mechanisms behind this association remain unclear, it is possible that chronic inflammation from genital LS leads to melanocytic distress and increased mutagenesis.
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Affiliation(s)
- Evanthia Mastoraki
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Georgios Kravvas
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Kate Dear
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Sharmaine Sim
- Department of MedicineUniversity College London Medical SchoolLondonUK
| | - Mariel James
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Richard Watchorn
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Aiman Haider
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Peter Ellery
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Alex Freeman
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Mahfooz Basha
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Emma Edmonds
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Christopher B. Bunker
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
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Anitua E, Tierno R, Azkargorta M, Elortza F, Alkhraisat MH. Effect of Health Status and Heat-Induced Inactivation on the Proteomic Profile of Plasma Rich in Growth Factors Obtained from Donors with Chronic Inflammatory Skin Conditions. Biomolecules 2024; 14:763. [PMID: 39062477 PMCID: PMC11275043 DOI: 10.3390/biom14070763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Atopic dermatitis, psoriasis and lichen sclerosus are among the most challenging conditions treated by dermatologists worldwide, with potentially significant physical, social and psychological impacts. Emerging evidence suggests that autologous-platelet-rich plasma could be used to manage skin inflammation. However, the presence of soluble autoimmune components could hinder their therapeutic potential. The aim of this study was to analyze the proteomic profile of plasma rich in growth factors (PRGFs) obtained from donors with inflammatory skin conditions to evaluate the impact of skin health status on the composition and bioactivity of PRGF-based treatments. Venous blood from healthy volunteers and patients with psoriasis, lichen sclerosus and atopic dermatitis was processed to produce PRGF supernatant. Half of the samples were subjected to an additional thermal treatment (56 °C) to inactivate inflammatory and immune molecules. Proteomic analysis was performed to assess the protein profile of PRGFs from healthy and non-healthy patients and the effect of Immunosafe treatment. Differential abundance patterns of several proteins related to key biological processes have been identified, including complement activation, blood coagulation, and glycolysis- and gluconeogenesis-related genes. These results also demonstrate that the thermal treatment (Immunosafe) contributes to the inactivation of the complement system and, as a consequence, reduction in the immunogenic potential of PRGF products.
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Affiliation(s)
- Eduardo Anitua
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), 01007 Vitoria, Spain; (R.T.); (M.H.A.)
- BTI-Biotechnology Institute, 01005 Vitoria, Spain
| | - Roberto Tierno
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), 01007 Vitoria, Spain; (R.T.); (M.H.A.)
- BTI-Biotechnology Institute, 01005 Vitoria, Spain
| | - Mikel Azkargorta
- Proteomics Platform, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), CIBERehd, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Félix Elortza
- Proteomics Platform, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), CIBERehd, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Mohammad H. Alkhraisat
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), 01007 Vitoria, Spain; (R.T.); (M.H.A.)
- BTI-Biotechnology Institute, 01005 Vitoria, Spain
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Fox W, McKenna PH. Treatment algorithm for the comprehensive management of severe lichen sclerosus in boys based on the pathophysiology of the disease. J Pediatr Urol 2024; 20 Suppl 1:S66-S73. [PMID: 38918118 DOI: 10.1016/j.jpurol.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION It is estimated that approximately one out of 200 boys has the diagnosis of lichen sclerosus (LS), previously referred to as BXO (balanitis xerotica obliterans). Severe progressive disease is rare however, mismanagement of urethral tissues may contribute to progression of LS. STUDY DESIGN The current literature regarding the management of severe lichen sclerosus was reviewed alongside our management of seven patients with ages ranging from six to ten years of age with severe lichen sclerosus who required surgical intervention. These patients were identified out of a busy pediatric practice that saw 5507 patients during the four-year span. Based on the pathophysiology of lichen sclerosus, urethral anatomy, and our management an algorithm was developed for medical and surgical management. RESULTS All patients received initial medical treatment with topical steroids. Three patients underwent urethral mobilization and serial biopsy. One of these patients with severe disease required a second distal urethral mobilization. Three patients were treated with circumcision, and one is responding well to topical steroids after complex reconstruction. None developed postoperative urethral disease. DISCUSSION Lichen sclerosus affects squamous epithelium but can extend to unaffected tissue if traumatized via the Koebner phenomenon. There are no randomized control trials for the management of the disease. Thus, appropriate early management with avoidance of urethral dilation or incision may prevent extension down the urethra that can lead to severe stricture disease. Several authors identified this as one of the worst forms of stricture diseases to manage. Based on the pathophysiology of the disease and our 4-year experience treating patients, we propose an algorithm for management of severe lichen sclerosus in boys. The diagnosis of lichen sclerosus in boys requires a high level of suspicion, and early biopsies should be obtained if suspected. If identified before circumcision or meatotomy, initial treatment should be medical. If the patient fails topical steroid therapy, circumcision and biopsy are the initial recommended surgical approach. Optimally, a biopsy with the first meatotomy establishes the diagnosis. If the disease persists, urethral mobilization may represent a curative treatment as it advances healthy urethra and allows complete removal of distal squamous epithelium instead of traumatic repeated dilations or incisions. CONCLUSION This paper summarizes the available literature on the management of severe LS and provides a flow diagram based on the pathophysiology of the disease and our experience sever cases.
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Affiliation(s)
- William Fox
- University of Illinois College of Medicine Rockford, United States.
| | - Patrick H McKenna
- Director of GU Reconstructive Center Mercy Health, Professor of Surgery University of Illinois College of Medicine Rockford, United States.
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Kirtschig G, Kinberger M, Kreuter A, Simpson R, Günthert A, van Hees C, Becker K, Ramakers MJ, Corazza M, Müller S, von Seitzberg S, Boffa MJ, Stein R, Barbagli G, Chi CC, Dauendorffer JN, Fischer B, Gaskins M, Hiltunen-Back E, Höfinger A, Köllmann NH, Kühn H, Larsen HK, Lazzeri M, Mendling W, Nikkels AF, Promm M, Rall KK, Regauer S, Sárdy M, Sepp N, Thune T, Tsiogka A, Vassileva S, Voswinkel L, Wölber L, Werner RN. EuroGuiderm guideline on lichen sclerosus-introduction into lichen sclerosus. J Eur Acad Dermatol Venereol 2024. [PMID: 38822578 DOI: 10.1111/jdv.20082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/21/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness. It may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are redness and oedema, typically followed by whitening of the genital skin; sometimes fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES The guideline intends to provide guidance on the diagnostic of LS, highlight important aspects in the care of LS patients (part 1), generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
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Affiliation(s)
- G Kirtschig
- Medbase Health Centre, Frauenfeld, Switzerland
| | - M Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - R Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Günthert
- Gynäkologisches Tumorzentrum St. Anna, Lucerne, Switzerland
| | - C van Hees
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K Becker
- Office for Paediatric Surgery, Bonn, Germany
| | - M J Ramakers
- CenSeRe (Centre for Psychological, Relational, Sexual Health), Voorschoten, The Netherlands
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - S Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - R Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - C C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J N Dauendorffer
- Department of Dermatology, Centre for Genital and Sexually Transmitted Diseases, University Hospital Saint Louis, Paris, France
| | - B Fischer
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - M Gaskins
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - E Hiltunen-Back
- Department of Dermatovenereology, Helsinki University Hospital, Helsinki, Finland
| | - A Höfinger
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - N H Köllmann
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - H Kühn
- The German Lichen Sclerosus Association, Germany
| | - H K Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - W Mendling
- German Center for Infections in Gynecology and Obstetrics, at Helios University Hospital Wuppertal- University Witten/Herdecke, Wuppertal, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - M Promm
- Department of Paediatric Urology and Clinic St. Hedwig, University Medical Centre of Regensburg, Regensburg, Germany
| | - K K Rall
- Department of Women's Health, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - S Regauer
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - N Sepp
- Department of Dermatology and Venereology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - T Thune
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - A Tsiogka
- National and Kapodistrian University of Athens, Faculty of Medicine, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - S Vassileva
- Department of Dermatology and Venereology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria
| | - L Voswinkel
- The German Lichen Sclerosus Association, Germany
| | - L Wölber
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf and Centre for Colposcopy and Vulvovaginal Disease Jersualem Hospital Hamburg, Hamburg, Germany
| | - R N Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Boero V, Cetera GE, Caia C, Villa S, Montemurro T, Brambilla M, Monti E, Iorio M, Somigliana E, Vercellini P, Prati D. Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study. Arch Gynecol Obstet 2024; 309:2719-2726. [PMID: 38523203 DOI: 10.1007/s00404-024-07424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Owing to the evidence that as many as 30-40% of patients with vulvar lichen sclerosus (VLS) fail to report a remission of symptoms with first-line corticosteroid treatment (TCS), especially as what regards dyspareunia, we aimed to analyze patients' satisfaction following vulvar injection of autologous platelet-rich plasma (PRP). This is intended as an adjunctive treatment, to be used following TCS, and appears to promote tissue repair. It may also possibly have immunomodulatory proprieties. MATERIALS AND METHODS Patients with VLS were considered eligible for this pilot study if, despite having been treated with a 3-month TCS regimen, they reported a persistence of symptoms. PRP was produced in a referral center using a manual method and a standardized protocol. Each patient received three treatments 4 to 6 weeks apart. RESULTS A total of 50 patients with a median age of 53 years [IQR 38-59 years] were included in the study. 6 months after the last injection of PRP all patients were either satisfied or very satisfied with the treatment (100%; 95% CI 93-100%). Median NRS scores for itching, burning, dyspareunia and dysuria were significantly reduced (p < 0.05) and FSFI, HADS and SF-12 questionnaires revealed a significant improvement in sexual function, psychological wellbeing and quality of life (p < 0.05). The number of patients reporting the need for maintenance TCS treatment was reduced by 42% (p < 0.001) and an improvement in vulvar elasticity and color was reported in all patients. CONCLUSION Following standard medical therapy, PRP may be effective not only in improving symptoms, but also in restoring function.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Gynecology Unit, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Villa
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Montemurro
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Service, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Iorio
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Gynecology Unit, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Jerkovic Gulin S, Lundin F, Eriksson O, Seifert O. Lichen Sclerosus-Incidence and Comorbidity: A Nationwide Swedish Register Study. J Clin Med 2024; 13:2761. [PMID: 38792303 PMCID: PMC11122656 DOI: 10.3390/jcm13102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Data on the incidence and comorbidity of Lichen sclerosus (LS), based on validated nationwide population-based registries, remains scarce. Objective: To explore the incidence and association of comorbidities with LS in Sweden, emphasizing its potential links to malignancies and autoimmune disorders. Methods: A population-based retrospective open cohort study was conducted using the National Patient Register to identify all individuals diagnosed with LS (ICD-10 code L90.0) from 1 January 2001 to 1 January 2021. The study included 154,424 LS patients and a sex and age matched control group of 463,273 individuals to assess the incidence and odds ratios for various cancers and premalignant conditions. Results: The incidence of LS in Sweden was 80.9 per 100,000 person per year, with higher incidence in females (114.4) than in males (47.2). LS patients showed an increased odds ratio for vulvar cancer (OR = 8.3; 95% CI = 7.5-9.0), penile cancer (OR = 8.9; 95% CI = 7.3-11.0), prostate cancer (OR = 1.2; 95% CI = 1.1-1.2), testicular cancer (OR = 1.4; 95% CI = 1.1-1.7), bladder cancer (OR = 1.1; 95% CI = 1.1-1.2), breast cancer (OR = 1.4; 95% CI = 1.3-1.4), leukoplakia of the vulva (OR = 253.5; 95% CI = 221.9-289.6), and leukoplakia of the penis (OR = 5.1; 95% CI = 4.9-5.4). Conclusions: This study underscores the significantly increased association of various cancers and premalignant conditions in LS patients, highlighting the critical need for efficacious treatment and diligent follow-up. The association between LS and autoimmune diseases further necessitates comprehensive investigation to understand the underlying mechanisms and clinical management implications. Future research is essential to confirm these findings and elucidate the role of LS in cancer development.
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Affiliation(s)
- Sandra Jerkovic Gulin
- Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, 553 05 Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Filippa Lundin
- Faculty of Medicine and Health Sciences, Linkoping University, 581 83 Linköping, Sweden
| | - Olle Eriksson
- Futurum-Academy for Healthcare, Region Jönköping County, 553 05 Jönköping, Sweden
| | - Oliver Seifert
- Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, 553 05 Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, 581 83 Linköping, Sweden
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Liu L, Zhang Q, Chang J, Yang K. Causal Association Between Diabetes, Body Mass Index and Lichen Sclerosus: A Bidirectional Two-Sample Mendelian Randomization Analysis. Clin Cosmet Investig Dermatol 2024; 17:931-940. [PMID: 38689755 PMCID: PMC11060172 DOI: 10.2147/ccid.s450399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/31/2024] [Indexed: 05/02/2024]
Abstract
Background Previous observational studies have found that lichen sclerosus (LS) is associated with metabolic statuses, such as diabetes mellitus (DM) and body mass index (BMI). However, there are also some studies showing that LS is not related to DM and BMI. The mechanism behind observational results is still unclear. Therefore, the causality of this relationship remains unknown. In this study, a bidirectional two-sample Mendelian randomization (MR) was conducted to investigate the correlation between DM, BMI, and LS. Methods The instrumental variables related to DM (including type 1 and type 2 diabetes), and BMI were identified from genome-wide association studies (GWAS) and a GWAS meta-analysis. The GWAS data for LS was from obtained the eighth edition of the FinnGen biological database released in 2022. Inverse variance weighted (IVW), weighted median, and MR-Egger methods were used to conduct a bidirectional two-sample MR analysis. Thereafter, the heterogeneity and horizontal pleiotropy were examined to determine whether the results were affected by a single-nucleotide polymorphism (SNP). Results We found a lack of evidence for the causal association of DM, and BMI on LS in inverse variance weighted (type 1 diabetes, OR=0.97, 95% CI=0.91-1.04, p=0.429; type 2 diabetes, OR=0.91, 95% CI=0.82-1.00, p=0.0511; BMI, OR=0.92, 95% CI=0.73-1.15, p=0.4554). In the other direction, the results also showed that LS had no significant causal effect on DM and BMI. Conclusion This MR analysis demonstrated no significant causal relationship between DM and BMI with LS in both directions, which contradicts previous observational studies reporting a positive association. Potential confounding factors may contribute to previously observed associations, and further research is necessary.
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Affiliation(s)
- Lin Liu
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Beijing, People’s Republic of China
| | - Qiuli Zhang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jianmin Chang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Beijing, People’s Republic of China
| | - Kun Yang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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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] [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.
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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
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Ghafari-Saravi A, Foster E. Treatment of Refractory Vulvar Lichen Sclerosus With Methotrexate. J Low Genit Tract Dis 2024; 28:202-204. [PMID: 38518219 DOI: 10.1097/lgt.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
We report the successful treatment of severe vulvar lichen sclerosus refractory to topical corticosteroids in 3 adult female patients using low-dose oral methotrexate. All cases reported symptomatic and clinical improvement within 12 weeks.
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10
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Baran W, Woźniak Z, Batycka-Baran A. IL-17: a novel player in the pathogenesis of vulvar lichen sclerosus. Postepy Dermatol Alergol 2024; 41:220-225. [PMID: 38784924 PMCID: PMC11110226 DOI: 10.5114/ada.2024.139142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Vulvar lichen sclerosus (VLS) is a chronic progressive, lymphocyte-mediated inflammatory disease whose pathogenesis is complex and not fully elucidated. Aim In the current study we have investigated for the first time the expression of interleukin-17 (IL-17) and S100A7 in lesional skin obtained from female individuals with histologically confirmed VLS. Material and methods In our study we used skin biopsies obtained from female patients with histologically confirmed VLS (n = 20) and skin samples from healthy age- and gender-matched individuals (plastic surgery procedures) (n = 10) serving as controls. The tissue expressions of IL-17 and S100A7 were assessed with an immunohistochemical method. Results The number of cells showing IL-17 expression was significantly higher in VLS lesional skin as compared to normal skin of healthy controls (p < 0.0001). In VLS lesional skin, IL-17 was expressed in the epidermis and by cells within the inflammatory infiltrate in the upper dermis. The number of cells showing S100A7 expression was significantly higher in VLS lesional skin as compared to normal skin of healthy controls (p < 0.0001). In VLS lesional skin, S100A7 was expressed by suprabasal keratinocytes in epidermis. S100A7 was also expressed by cells within the inflammatory infiltrate in the dermis. Conclusions The results of our study may suggest the involvement of IL-17 and S100A7 in the pathogenesis of VLS. The better understanding of this disease may lead to the development of novel, effective therapeutic strategies e.g. using well-known biologics IL-17 inhibitors class.
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Affiliation(s)
- Wojciech Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Zdzisław Woźniak
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Batycka-Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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11
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Xiong X, Chen R, Wang L, Huang N, Huang L, Wang C, Ke W. Treatment of plasma cell balanitis associated with male genital lichen sclerosus using abrocitinib. JAAD Case Rep 2024; 46:85-88. [PMID: 38577497 PMCID: PMC10992264 DOI: 10.1016/j.jdcr.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Xiaoyu Xiong
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Rongyi Chen
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Liuyuan Wang
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Nanxuan Huang
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Lixia Huang
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Chunmei Wang
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wujian Ke
- Sexually Transmitted Disease Department, Dermatology Hospital of Southern Medical University, Guangzhou, China
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Borghi A, Flacco ME, Pacetti L, Toni G, Corazza M. Topical Corticosteroid Phobia Among Women Affected With Vulvar Lichen Sclerosus: Results From a Cross-sectional Survey. J Low Genit Tract Dis 2024; 28:169-174. [PMID: 38346422 DOI: 10.1097/lgt.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Topical corticosteroid (TC) phobia (TCP) is common in subjects affected with chronic inflammatory skin diseases who need prolonged corticosteroid treatments. The aim of this study was to assess TCP in women affected with vulvar lichen sclerosus (VLS). MATERIALS AND METHODS This observational, cross-sectional study included adult patients with VLS who either started or were undergoing a TC treatment at our vulva unit between May 2022 and May 2023. All patients completed the self-administered TOPICOP questionnaire, which is validated for measuring concerns, worries, and beliefs about TC use. The scores obtained were analyzed in relation to demographic, history, and clinical data. RESULTS The majority of the 165 (92.1%, 66.5 ± 11.9 years) included patients who had previously undergone TC treatments, mostly for VLS; 81.8% of them had received information about TCs, mainly from dermatologists (86.7%). The median global TOPICOP score was 16.7% (interquartile range. 8.3-30.6), corresponding to a raw median value of 6.0 (interquartile range, 3.0-11.0). The median subscores for the 2 TOPICOP domains, namely, mistaken beliefs and worries about TCs, were equal to each other. At multivariate analysis, none of the collected variables showed a significant association with the degree of TCP. CONCLUSIONS In our VLS patients, TCP resulted rather low, probably because of the small skin area being treated and the high percentage of women who had already used TCs and who had received information about them from a dermatologist. This latter point suggests that adequate counseling could be a strong basis for greater awareness and serenity in the long-term use of TCs.
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Affiliation(s)
- Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Lucrezia Pacetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulia Toni
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Xie X, Wu K. Advances in the pathogenesis of vulvar lichen sclerosus. Mol Biol Rep 2024; 51:396. [PMID: 38453810 DOI: 10.1007/s11033-024-09318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
Vulvar lichen sclerosus (VLS) is a chronic non-neoplastic skin lesion characterized by vulvar itching, pain, atrophy, whitening of the skin and mucous membranes, and gradual atrophy and disappearance of the labia minora, which can eventually lead to vulvar scarring, causing functional impairment and seriously affecting the patient's physical and mental health. VLS can occur at any age, however, its pathogenesis and etiology are not fully understood. Considerable progress has been made in related research on genetic susceptibility factors, autoimmune disorders, collagen metabolism abnormalities, and their triggering factors in disease formation and progression. This article reviews the etiology of vulvar lichen sclerosus.
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Affiliation(s)
- Xingkui Xie
- Department of Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Kejia Wu
- Center for Reproductive Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.
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Canan S, İnan MA, Erdem A, Demirdağ E, Gündüz Mİ, Erdem Ö, Erdem M. Evaluation of endometrial receptivity in recurrent pregnancy loss and recurrent implantation failure. Turk J Obstet Gynecol 2024; 21:22-27. [PMID: 38440964 PMCID: PMC10920968 DOI: 10.4274/tjod.galenos.2024.42959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Objective The cause of implantation defects in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) has not been clearly established. We aimed to evaluate the immunohistochemical changes in HOXA-11, β1 integrin, focal adhesion kinase (FAK), cluster of differentiation 44 (CD44), and extracellular matrix protein 1 (ECM1) molecules during the receptive endometrial period in patients with RIF and RPL. Materials and Methods This study was retrospectively conducted at a university hospital. After the exclusion of cases with pathology that may cause a change in the level of receptors in the endometrium, biopsies performed during the receptive period were selected, and the patients were categorized into RPL (n=15), RIF (n=16), control (n=16) groups. All preparations were immunohistochemically stained for HOXA-11, β1 integrin, FAK, CD44, and ECM1. Results HOXA-11 and β1 Integrin expression changes were similar between the RIF and control groups. However, FAK expression was significantly increased in the RIF group (p<0.01). Additionally, ECM1 and CD44 expressions were significantly decreased in the RIF group compared with the control group (p<0.01). There was no significant difference in the endometrial staining of HOXA-11, FAK, and ECM1 in patients with a history of RPL. However, β1 Integrin and CD44 levels were significantly decreased in the RPL group compared with the control group (p<0.05). Conclusion Implantation is a complex process, and altered adhesion mechanisms involved in endometrial receptivity may be related to defective implantation in patients with RIF and RPL. Among the adhesion molecules, the expression of CD44, β1 integrin, FAK, and ECM1 molecules varies in inappropriate implantation compared with the normal population.
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Affiliation(s)
- Sultan Canan
- Sakarya Training and Research Hospital, Clinic of Obstetrics and Gynecology, Sakarya, Turkey
| | - Mehmet Arda İnan
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Ahmet Erdem
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Erhan Demirdağ
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Özlem Erdem
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Mehmet Erdem
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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15
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Popa A, Dumitrascu MC, Petca A, Petca RC, Sandru F. Vulvar Lichen Sclerosus: Navigating Sex Hormone Dynamics and Pioneering Personalized Treatment Paradigm. J Pers Med 2024; 14:76. [PMID: 38248777 PMCID: PMC10817476 DOI: 10.3390/jpm14010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Vulvar lichen sclerosus (VLS) is a frequently overlooked inflammatory disorder affecting the skin and mucous membranes of the vulva. With a propensity for atrophy, severe scarring, functional impairment, and malignant evolution, VLS is a disease that recurs frequently; early diagnosis, rapid treatment, and ongoing patient follow-up are essential. Potent topical corticosteroids (TCSs) are now widely recognized as the most effective treatment for achieving remission in VLS, but considering the potential complications of long-term treatment with potent TCSs, understanding the evolution of VLS during puberty becomes particularly crucial in determining the necessity for aggressive or more conservative therapeutic interventions. Emerging treatments, including PRP (platelet-rich plasma), stem cell therapy, and energy-based lasers like fractional CO2 and Nd-YAG, are being investigated to identify more effective VLS treatments than ultrapotent topical corticosteroids. However, more research is needed to assess the efficacy and safety of these new medicines. Topical clobetasol 0.05% ointment daily for 4-12 weeks is the gold standard for treating VLS. This article is a narrative review of the English-language medical literature from 2017 to November 2023, following three main sections concerning VLS: studies of the evolution amid pubertal hormonal changes; studies of the outcomes of personalized conventional therapies; and studies addressing the spectrum of innovative modalities for VLS.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Vladulescu D, Scurtu LG, Simionescu AA, Scurtu F, Popescu MI, Simionescu O. Platelet-Rich Plasma (PRP) in Dermatology: Cellular and Molecular Mechanisms of Action. Biomedicines 2023; 12:7. [PMID: 38275368 PMCID: PMC10813350 DOI: 10.3390/biomedicines12010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Platelet-rich plasma (PRP) therapy has gained attention in the scientific field due to its potential regenerative effects and great benefit-risk ratio. This review extensively explores the most studied mechanisms of this therapy according to the etiopathogenesis of skin diseases: cellular proliferation, matrix formation, regulation of inflammation, angiogenesis, collagen synthesis, and the remodeling of new tissue. Moreover, it draws on newly reported and lesser-known effects of PRP: its anti-apoptotic effects, immunological suppression, decrease in melanin synthesis, anti-microbial effects, overexpression of miR-155, antioxidant effects, and their involved pathways. This work aims to provide a complete update for understanding PRP's benefits and clinical relevance in wound healing, alopecia, pigmentary disorders, scars, rejuvenation, lichen sclerosus, and other inflammatory dermatoses, based on the current evidence. Furthermore, recent reports with novel indications for PRP therapy are highlighted, and new potential pathways correlated with the pathogenesis of skin diseases are explored.
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Affiliation(s)
- Denisa Vladulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
| | - Lucian G. Scurtu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
| | - Anca Angela Simionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Francesca Scurtu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Marco I. Popescu
- Faculty of Medicine, “Titu Maiorescu” University, 040441 Bucharest, Romania
| | - Olga Simionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
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Bao C, Zhao Y, Luo R, Xu Q, Tong Z, Xiao Z, Zhuang Z, Dai W, Gu B, Gong T, Cheng B, Ji C. Application and Comparison of Dermoscopy and Reflectance Confocal Microscopy in the Target Treatment of Genital Lichen Sclerosus: A Single-Arm Prospective Study. Dermatol Ther (Heidelb) 2023; 13:3071-3084. [PMID: 37840118 PMCID: PMC10689603 DOI: 10.1007/s13555-023-01039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION The treatment of genital lichen sclerosus (GLS) remains challenging. Baricitinib has been introduced in the treatment of GLS, but there's no imaging evaluation for GLS patients treated with it. No comparison of dermoscopy and reflectance confocal microscopy (RCM) assessments in GLS has been conducted. We performed this study to evaluate the efficacy and safety of baricitinib for GLS and to compare the value of dermoscopy and RCM assessments in GLS. METHODS Participants were treated with baricitinib for 6 months and assessed at week 0, 2, 4, 6, 8, and every 4 weeks for the next 16 weeks. All patients were evaluated for clinical, dermoscopic, and RCM variables, with numeric scores assigned to each parameter. RESULTS Twenty-six GLS patients were included in this study. All patients achieved Investigator's Global Assessment score ≤ 1 (with ≥ 2-grade improvement) at week 20. The scores of pruritus and pain decreased since week 2 (both P < 0.05). The DLQI and VQLI scores significantly decreased since week 4 (both P < 0.0001). White structureless areas improved at week 2 and white shiny streaks and follicular plugs improved at week 4 under dermoscopic examination. Vessels (P < 0.001) and brown structureless areas (P = 0.003) increased at week 8. In RCM, inflammatory cells count significantly decreased at week 2 (100.03 ± 33.24, P < 0.0001), with substantial regression at week 8 (16.98 ± 5.54, P < 0.0001). Epidermal thickness increased at week 12 (157.44 ± 37.87 μm versus 134.13 ± 36.60 μm, P = 0.0284). Irregular papillae, spongiosis, and fiber structures improved at week 20, week 4, and week 6 (all P < 0.01). Transient hypercholesterolemia (11.54%), thrombocytosis (7.69%), and elevated alanine aminotransferase (7.69%) occurred during treatment. CONCLUSION Both dermoscopy and RCM can be useful and non-invasive adjuvant tools for the evaluation and therapeutic monitoring of GLS. We recommended white structureless areas under dermoscopy and inflammatory cells count under RCM as variables for dermatologic imaging evaluation for GLS. Baricitinib is effective and safe for GLS, while randomized controlled trials are warranted.
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Affiliation(s)
- Chengbei Bao
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Yan Zhao
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Renwei Luo
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Qiuyun Xu
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Zequn Tong
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Zhixun Xiao
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Zheyu Zhuang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Wenjia Dai
- Nanjing Medical University, Nanjing, 035599, Jiangsu, China
| | - Bohan Gu
- Soochow University, Suzhou, 215000, Jiangsu, China
| | - Ting Gong
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Central Laboratory, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China
| | - Bo Cheng
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China.
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China.
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China.
| | - Chao Ji
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China.
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China.
- Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China.
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Borghi A, Ferretti S, Pacetti L, Falcini F, Corazza M. Incidence of Vulvar Lichen Sclerosus and of Cancer Among Vulvar Lichen Sclerosus Patients: Does Socioeconomic Status Have a Role? J Low Genit Tract Dis 2023; 27:373-377. [PMID: 37729046 DOI: 10.1097/lgt.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Socioeconomic status (SES) impacts on the incidence of many inflammatory diseases and cancers, but there is no evidence on its implication in vulvar lichen sclerosus (VLS). The authors aimed to assess possible associations between SES and both occurrence of VLS and cancer occurrence among VLS patients. MATERIALS AND METHODS A retrospective cohort of women resident in the province of Ferrara, Italy, affected with VLS diagnosed between 2001 and 2020, was investigated for assessing any association of SES with VLS and cancer incidence. The SES was expressed through an ecological-based deprivation index identifying 5 subgroups. RESULT Four-hundred women were diagnosed with VLS during the study period, with double the number of cases in the second decade (2011-2020) compared with the first (2001-2010). More VLS patients belonged to the high rather than the low SES groups (p = .032). From VLS diagnosis to 2018 (1,958.4 total person*years at risk), 22 patients received their first diagnosis of cancer, mainly the skin, breast, and vulva. No significant differences in cancer incidence were found between high/medium-high and low/medium-low SES subjects. CONCLUSIONS The fact that more VLS patients belonged to the highest socioeconomic classes may be due to a more frequent diagnosis in those with greater health seeking behavior and resources. An involvement of SES-related factors in VLS pathophysiological background can also be taken into consideration. Both the lack of marked social and economic differences in the study area and the availability of free visits and screening may account for the lack of association between SES and cancer development.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | | | - Lucrezia Pacetti
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | | | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
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Huisman BW, Pagan L, Ulrich M, Rissmann R, Damman J, Piek JMJ, Niemeyer-van der Kolk T, van Poelgeest MIE. Reflectance confocal microscopy as a non-invasive imaging tool in vulvar high-grade squamous intraepithelial lesions and lichen sclerosus: A descriptive morphological study in patients and healthy volunteers. Exp Dermatol 2023; 32:1734-1743. [PMID: 37486173 DOI: 10.1111/exd.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
Incorrect and delayed diagnosis of vulvar high-grade squamous intraepithelial neoplasia (vHSIL) and lichen sclerosus (LS) increases malignant progression risks and negatively impacts prognosis and quality of life. There is a need to improve diagnosis and monitoring. Reflectance confocal microscopy is a non-invasive imaging tool that visualizes skin structures at cellular resolution. The objectives were to explore feasibility and patient acceptability of vulvar RCM imaging and to identify RCM characteristics that are discriminative for vulvar HSIL and LS. This was a prospective, cross-sectional, observational clinical trial in patients with vHSIL and LS compared to healthy volunteers. RCM images and vulvar tissue samples were obtained. Five (5) patients with vHSIL, 10 patients with LS and 10 healthy volunteers were enrolled. In total, 100 image series of vulvar skin were obtained, including lesional and nonlesional sites. The RCM technique was considered acceptable for application by patients and healthy controls. Healthy vulvar skin was characterized by a homogenous, normal honeycomb patterned epidermis and a clear epidermal-dermal junctions. Vulvar HSIL and LS displayed an atypical honeycomb pattern of the epidermis and lymphocytic influx with presence of melanophages. Distinct features specifically observed in LS included the presence of hyalinised vessels and sclerotic areas in the dermis. RCM is a non-invasive imaging technique that is feasible and clinically acceptable to apply on vulvar skin, both in patients with premalignant lesions and healthy controls. Recognition and validation of disease-specific characteristics could make reflectance confocal microscopy a clinical tool to non-invasively aid identification of vulvar premalignancies.
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Affiliation(s)
- Bertine W Huisman
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Pagan
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martina Ulrich
- CMB Collegium Medicum Berlin GmbH/Dermatology Office, Berlin, Germany
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | | | - Mariette I E van Poelgeest
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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20
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Potapov A, Matveev L, Moiseev A, Sedova E, Loginova M, Karabut M, Kuznetsova I, Levchenko V, Grebenkina E, Gamayunov S, Radenska-Lopovok S, Sirotkina M, Gladkova N. Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study. Int J Mol Sci 2023; 24:13967. [PMID: 37762270 PMCID: PMC10531024 DOI: 10.3390/ijms241813967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Photodynamic therapy (PDT) is a modern treatment for severe or treatment-resistant vulvar lichen sclerosus (VLS). The chronic and recurrent nature of VLS requires control of recurrences at an early stage. In this paper, a non-invasive multimodal optical coherence tomography (OCT) method was used to control for early histological signs of VLS recurrence after systemic PDT using Photodithazine®. To interpret the OCT data, a histological examination was performed before PDT and 3 months after PDT. Two groups of patients were identified: with early histological signs of VLS recurrence (Group I, n = 5) and without histological signs of VLS recurrence (Group II, n = 6). We use structural OCT, OCT angiography, and OCT lymphangiography throughout 6 months after PDT to visually assess the skin components and to quantitatively assess the dermis by calculating the depth-resolved attenuation coefficient and the density of blood and lymphatic vessels. The OCT data assessment showed a statistically significant difference between the patient groups 3 months after PDT. In Group II, all the studied OCT parameters reached maximum values by the 3rd month after PDT, which indicated recovery of the skin structure. At the same time, in Group I, the values of OCT parameters did not approach the values those in Group II even after 6 months. The obtained results of multimodal OCT can be used for non-invasive control of early histological recurrence of VLS after systemic PDT and for adjusting treatment tactics in advance, without waiting for new clinical manifestations of the disease.
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Affiliation(s)
- Arseniy Potapov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Lev Matveev
- Institute of Applied Physics Russian Academy of Sciences, 603950 Nizhny Novgorod, Russia; (L.M.); (A.M.)
| | - Alexander Moiseev
- Institute of Applied Physics Russian Academy of Sciences, 603950 Nizhny Novgorod, Russia; (L.M.); (A.M.)
| | - Elena Sedova
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
| | - Maria Loginova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
- Center of Photonics, Lobachevsky State University of Nizhny Novgorod, 603022 Nizhny Novgorod, Russia
| | - Maria Karabut
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Irina Kuznetsova
- Department of Obstetrics and Gynecology, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, 603126 Nizhny Novgorod, Russia
| | | | - Elena Grebenkina
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
- Kstovo Central District Hospital, 607650 Kstovo, Russia
| | - Sergey Gamayunov
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
| | - Stefka Radenska-Lopovok
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Marina Sirotkina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
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21
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Gulin SJ, Lundin F, Seifert O. Comorbidity in patients with Lichen sclerosus: a retrospective cohort study. Eur J Med Res 2023; 28:338. [PMID: 37697418 PMCID: PMC10494448 DOI: 10.1186/s40001-023-01335-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
Lichen sclerosus (LS) is a chronic lymphocyte mediated inflammatory mucocutaneous disease of unknown aetiology with a predilection for the anogenital region, and affecting both sexes. The disease is characterized by pain, intolerable itching and scarring. In late stages of LS, disfiguring scarring can drastically alter the structural anatomical architecture of the genitals. The association between genital LS and different malignant tumours is a concern that needs to be further investigated. An association between LS and several autoimmune diseases has been confirmed in recent studies. All registered citizens of Region Jönköping, Sweden were included in the present study. Patients diagnosed with LS (n = 5680) between 2001 and 2021 were identified using ICD-10 code L90.0 and selected as cases. All other individuals (n = 362 568) served as controls. Odds ratios (ORs) for the selected comorbidity were calculated and adjusted for age and sex. The cumulative incidence of LS for the entire population over a 20-year period was 1.54% (15.4 per 1000 people). The cumulative incidences over a 20-year period for females and males were 2.13% and 0.97%, respectively. This study confirmed the association between LS and vulvar cancer (OR = 17.4; 95% CI 12.1-25.3), penis cancer (OR = 9.1; 95% CI 4.3-18.9), prostate cancer (OR = 2.0; 95% CI 1.6-2.4) and breast cancer (OR = 1.6; 95% CI 1.4-1.8). LS was also associated with Crohn´s disease (OR = 2.0; 95% CI 1.6-2.6) and diabetes mellitus type 1 (OR = 1.9; 95% CI 1.6-2.1). The present study revealed novel important data regarding the association of LS with cancer and autoimmune diseases, emphasising the importance of sufficient treatment and follow-up of patients with LS. However, future studies are needed to confirm these results and the potential role of LS in the development of cancer.
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Affiliation(s)
- Sandra Jerkovic Gulin
- Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, 553 05, Jönköping, Sweden.
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, The Faculty of Medicine and Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Filippa Lundin
- The Faculty of Medicine and Health Sciences, Linkoping University, 581 83, Linköping, Sweden
| | - Oliver Seifert
- Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, 553 05, Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, The Faculty of Medicine and Health Sciences, Linköping University, 581 83, Linköping, Sweden
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22
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Arena S, Ieni A, Currò M, Vaccaro M, Di Fabrizio D, Cassaro F, Bonfiglio R, Montalto AS, Tuccari G, Alibrandi A, Impellizzeri P, Romeo C. Immunohistological Analysis of Lichen Sclerosus of the Foreskin in Pediatric Age: Could It Be Considered a Premalignant Lesion? Biomedicines 2023; 11:1986. [PMID: 37509626 PMCID: PMC10377095 DOI: 10.3390/biomedicines11071986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND A major worry of juvenile penile LS is potential malignant degeneration to spinocellular carcinoma (SCC) in adulthood. LS is characterized by increased CD8+ and CD57+ cells, dermal sclerosis, epidermal atrophy, and hyperkeratosis. p53 and Ki67 are reliable premalignant markers. Our aim was to define the LS immunohistochemical profile of foreskin in children, focusing on tissue immune response and cell proliferation. METHODS Thirty specimens of foreskins removed from pediatric patients during circumcision were included: six from ritual operation (A), twelve from phimosis (B), and twelve from phimosis with LS (C). Formalin-fixed paraffin-embedded sections were stained for histomorphology and immunohistochemistry. A quantitative evaluation for CD8, CD57, p53, and Ki-67 and a statistical analysis were performed. RESULTS As compared to groups A and B, the samples from group C patients showed an acanthotic epidermis, a dermal band of lymphoid infiltrate with a significant enhancement of CD8+ CD57+ lymphocytes, and a keratinocytic hyperplasia with an overexpression of Ki67+ and p53+ cells. CONCLUSIONS Immunohistological findings confirmed an immune reaction and proliferative behavior in juvenile LS of foreskin. We believe that radical circumcision should be the first treatment of choice in pediatric patients with clinical suspicious of LS for the potential risk of transformation to SCC in adulthood.
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Affiliation(s)
- Salvatore Arena
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Antonio Ieni
- Unit of Human Pathology, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Monica Currò
- Department of Biochemical, Physiological and Nutritional Sciences, University of Messina, 98121 Messina, Italy
| | - Mario Vaccaro
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy
| | - Donatella Di Fabrizio
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Fabiola Cassaro
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Roberta Bonfiglio
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Angela Simona Montalto
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Giovanni Tuccari
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98121 Messina, Italy
| | - Pietro Impellizzeri
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, 98121 Messina, Italy
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23
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Bao C, Xu Q, Xiao Z, Wang H, Luo R, Cheng B, Ji C, Gong T. Abrocitinib as a novel treatment for lichen sclerosus. Br J Dermatol 2023; 189:136-138. [PMID: 37093680 DOI: 10.1093/bjd/ljad129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/13/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023]
Abstract
Ten patients were recruited to evaluate the efficacy and safety of abrocitinib for the treatment of lichen sclerosus (LS). All patients reported rapid control of pruritus at week 2 and achieved Investigator’s Global Assessment 0 or 1 at week 12. This study suggests that the abrocitinib could be an effective and safe treatment option for LS, based on the significant improvements seen in investigator evaluations, patient-reported outcomes and skin imaging findings.
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Affiliation(s)
- Chengbei Bao
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Qiuyun Xu
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Zhixun Xiao
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Haiqing Wang
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Renwei Luo
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Bo Cheng
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Chao Ji
- Department of Dermatology
- Fujian Dermatology and Venereology Research Institute
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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24
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Kolesnikova EV, Zharov AV, Todorov SS, Penzhoyan GA, Mingaleva NV. Morphological features of various variants of the course of scleroatrophic lichen of the vulva. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-17-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Relevance. Most of the scientific papers presented in the literature indicate morphological features of the stages of development of sclerotic lichen of the vulva, or in comparison with other vulvar skin lesions. At the same time, data on the features of morphological examination of vulvar biopsies, depending on the clinical variants of the course of sclerotic lichen of the vulva, is currently insufficient. The aim of the study - to determine the presence or absence of distinctive morphological features of the sclerotic lichen of the vulva, depending on the clinical variants of its course. Materials and Methods. The study included 292 patients with sclerotic lichen of the vulva (20-70 years old). Based on the scale of assessment of objective and subjective clinical signs of sclerotic lichen of the vulva developed by us, 3 clinical groups: 101 patients with an atrophic variant of the course, 154 with a sclerosing variant and 37 patients with a scleroatrophic variant of the course of sclerotic lichen of the vulva. In addition to clinical laboratory, instrumental and immunological studies, all patients underwent incisional biopsy of the vulva followed by morphological examination of biopsies. Results and Discussion. The features of the results of morphological examination of various clinical variants of the course of sclerotic lichen of the vulva are described and presented in the form of images. The characteristic morphological signs for each clinical group, as well as common signs characteristic of all variants of the course of this pathology, were revealed. Morphological examination of vulvar tissues is informative only to confirm the diagnosis of «Sclerotic lichen of the vulva», to determine the stage of the disease, as well as to exclude the malignant process, while for a clear differentiation of variants of the clinical course of sclerotic lichen of the vulva, conventional morphological examination is not enough, which requires further studies using immunohistochemical and molecular genetic methods. Conclusion. The revealed differences in morphological parameters of various variants of the course of sclerotic lichen of the vulva are insufficiently specific, which excludes the possibility of accurate morphological verification of the variants of the course of sclerotic lichen of the vulva and confirms the expediency of using clinical classification of variants of the course of sclerotic lichen of the vulva based on objective and subjective clinical signs.
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25
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Lichen Sclerosus. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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26
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Rao M, Young K, Jackson-Cowan L, Kourosh A, Theodosakis N. Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options. J Clin Med 2023; 12:jcm12031243. [PMID: 36769891 PMCID: PMC9917556 DOI: 10.3390/jcm12031243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.
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Affiliation(s)
- Medha Rao
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | | | - Ladonya Jackson-Cowan
- The Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Arianne Kourosh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nicholas Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +617-724-2919
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27
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Jia R, Wu C, Tang X, He M, Liu X, Su C, Li C. Comparison of the efficacy of focused ultrasound at different focal depths in treating vulvar lichen sclerosus. Int J Hyperthermia 2023; 40:2172220. [PMID: 36710083 DOI: 10.1080/02656736.2023.2172220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of focused ultrasound (FU) at different focal depths in treating vulvar lichen sclerosus (VLS). METHODS A retrospective study was conducted on 84 patients with VLS. Among them, 43 cases were treated with FU at a focal depth of 2.5 mm and 41 cases at a focal depth of 4.0 mm. Therapeutic time, treatment energy, postoperative efficacy, complications and recurrence rates were compared. RESULTS No statistically substantially differences in age, disease course, history of immune system diseases, lesion size and severity of symptoms were found between the two groups. All patients successfully received FU therapy. No significant difference in curative rate was observed between the two groups at 3, 6 and 12 months after FU therapy. At 12 months after FU therapy, the recurrence rate of the experimental group (FU treatment at 2.5 mm focal depth) was lower than the control group (FU treatment at 4.0 mm focal depth) (7.0% vs 24.4%, p = 0.027). The experimental group was treated for a shorter period of time [22.69 ± 0.64 (min) vs 24.93 ± 0.72(min), p = 0.022] and at a lower dose[5,026.05 ± 148.00(J) vs 5,484.26 ± 160.60(J) p = 0.039]. CONCLUSION Compared with that at the routine focal depth (4.0 mm), FU therapy at a low treatment depth (2.5 mm) can achieve a similar therapeutic effect but lower recurrence rate, therapeutic time and treatment energy. This work provides insight into the optimization of clinical protocols.
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Affiliation(s)
- Ru Jia
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Can Wu
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Xiaoxu Tang
- Chongqing Ronghai Engineering Research Center of Ultrasound Medicine Co., Ltd., Chongqing, China
| | - Miaomiao He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xinglin Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chang Su
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chengzhi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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28
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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: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.
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Affiliation(s)
- David A De Luca
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Cristian Papara
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Hernán Staiger
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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29
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Bellei B, Migliano E, Picardo M. Therapeutic potential of adipose tissue-derivatives in modern dermatology. Exp Dermatol 2022; 31:1837-1852. [PMID: 35102608 DOI: 10.1111/exd.14532] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022]
Abstract
Stem cell-mediated therapies in combination with biomaterial and growth factor-based approaches in regenerative medicine are rapidly evolving with increasing application beyond the dermatologic field. Adipose-derived stem cells (ADSCs) are the more frequently used adult stem cells due to their abundance and easy access. In the case of volumetric defects, adipose tissue can take the shape of defects, restoring the volume and enhancing the regeneration of receiving tissue. When regenerative purposes prevail on volume restoration, the stromal vascular fraction (SVF) rich in staminal cells, purified mesenchymal stem cells (MSCs) or their cell-free derivatives grafting are favoured. The therapeutic efficacy of acellular approaches is explained by the fact that a significant part of the natural propensity of stem cells to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines and extracellular matrix components. Therefore, the secretome's ability to modulate multiple targets simultaneously demonstrated preclinical and clinical efficacy in reversing pathological mechanisms of complex conditions such atopic dermatitis (AD), vitiligo, psoriasis, acne and Lichen sclerosus (LS), non-resolving wounds and alopecia. This review analysing both in vivo and in vitro models gives an overview of the clinical relevance of adipose tissue-derivatives such as autologous fat graft, stromal vascular fraction, purified stem cells and secretome for skin disorders application. Finally, we highlighted the major disease-specific limitations and the future perspective in this field.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Emilia Migliano
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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30
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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] [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.
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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:
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31
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Torres A, Zaborek-Łyczba M, Łyczba J, Mertowska P, Mertowski S, Grywalska E. The Importance of Immunological Disorders in the Pathogenesis of Lichen Sclerosus in Pediatric Patients: A Systematic Review. Int J Mol Sci 2022; 23:ijms232214212. [PMID: 36430687 PMCID: PMC9697898 DOI: 10.3390/ijms232214212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Lichen sclerosus (LS) is defined as a chronic mucocutaneous inflammatory disease with a localization predominantly to the anus and genitals (vulvar sclerosus (VLS)). Pediatric lichen sclerosus (LS) is a chronic inflammatory skin condition with predilection for the anogenital area that if untreated can lead to scarring. Vulvar LS is characterized by two peaks in incidence: it occurs in prepubertal girls and in postmenopausal women. To date, several mechanisms and risk factors have been proposed in the pathogenesis of pediatric vulvar LS; however, the etiology of this condition is still not fully understood and constitutes a challenge for scientists and clinicians. The presented research aimed to systematically review the existing literature on the pathogenesis of pediatric LS and to identify possible underlying autoimmune mechanisms and molecular networks. The clinical presentation of pediatric lichen sclerosus and available treatment modalities are also presented to acquaint a broader audience with this underdiagnosed and undertreated condition. As a result of our review, we discuss several potential mechanisms, molecules, and pathways that have been recognized in this disease. The purpose of our review was also to summarize what we can induce in further studies, which will ultimately help to identify the mechanism responsible for the disease and aid in the development of new, more effective treatment strategies for diagnosis and treatment by clinicians and researchers.
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Affiliation(s)
- Anna Torres
- Department of Pediatric and Adolescent Gynecology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Monika Zaborek-Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jakub Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence:
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
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32
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Zhang J, Qi F, Zhang X, Dong J, Tong C, Zhang X, Liu F. Sjögren’s Syndrome with Lichen Sclerosus: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:2535-2539. [DOI: 10.2147/ccid.s389809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
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33
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Potapov AL, Sirotkina MA, Matveev LA, Dudenkova VV, Elagin VV, Kuznetsov SS, Karabut MM, Komarova AD, Vagapova NN, Safonov IK, Kuznetsova IA, Radenska-Lopovok SG, Zagaynova EV, Gladkova ND. Multiphoton microscopy assessment of the structure and variability changes of dermal connective tissue in vulvar lichen sclerosus: A pilot study. JOURNAL OF BIOPHOTONICS 2022; 15:e202200036. [PMID: 35652856 DOI: 10.1002/jbio.202200036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/17/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
In this article, we offer a novel classification of progressive changes in the connective tissue of dermis in vulvar lichen sclerosus (VLS) relying on quantitative assessment of the second harmonic generation (SHG) signal received from formalin fixed and deparaffinized tissue sections. We formulate criteria for distinguishing four degrees of VLS development: Initial-Mild-Moderate-Severe. Five quantitative characteristics (length and thickness type I Collagen fibers, Mean SHG signal intensity, Skewness and Coherence SHG signal) are used to describe the sequential degradation of connective tissue (changes in the structure, orientation, shape and density of collagen fibers) up to the formation of specific homogeneous masses. Each of the degrees has a characteristic set of quantitatively expressed features. We focus on the identification and description of early, initial changes of the dermis as the least specific. The results obtained by us and the proposed classification of the degrees of the disease can be used to objectify the dynamics of tissue changes during treatment.
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Affiliation(s)
| | | | - Lev A Matveev
- Institute of Applied Physics Russian Academy of Sciences, Nizhny Novgorod, Russia
| | | | - Vadim V Elagin
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Sergey S Kuznetsov
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - Maria M Karabut
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Anastasia D Komarova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - Nailya N Vagapova
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - Ivan K Safonov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Irina A Kuznetsova
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | | | - Elena V Zagaynova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
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Dong Z, Geng Y, Zhang P, Tang J, Cao Z, Zheng H, Guo J, Zhang C, Liu B, Liu WJ. Identification of molecular mechanism and key biomarkers in membranous nephropathy by bioinformatics analysis. Am J Transl Res 2022; 14:5833-5847. [PMID: 36105034 PMCID: PMC9452341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Membranous nephropathy (MN) is an autoimmune nephropathy. The incidence of MN is increasing gradually in recent years. Previous studies focused on antibody production, complement activation and podocyte injury in MN. However, the etiology and underlying mechanism of MN remain to be further studied. METHODS GSE104948 and GSE108109 of glomerular expression profile were downloaded from Gene Expression Omnibus (GEO) database, GSE47184, GSE99325, GSE104954, GSE108112, GSE133288 of renal tubule expression profile, and GSE73953 of peripheral blood mononuclear cells (PBMCs) expression profile. After data integration by Networkanalyst, differentially expressed genes (DEGs) between MN and healthy samples were obtained. DEGs were enriched in gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG), and protein-protein interaction (PPI) networks of these genes were constructed through Metascape, etc. We further understood the function of hub genes through gene set enrichment analysis (GSEA). The diagnostic value of DEGs in MN was evaluated by receiver operating characteristic (ROC) analysis. RESULTS A total of 3 genes (TP53, HDAC5, and SLC2A3) were screened out. Among them, the up-regulated TP53 expression may be closely related to MN renal pathological changes. However, the expression of MN podocyte target antigen was not significantly different from that of healthy controls. In addition, the changes of Wnt signaling pathway in PBMCs and the effects of SLC2A3 on the differentiation of M2 monocyte need further study. CONCLUSION It is difficult to unify a specific mechanism for the changes of glomerulus, renal tubules and PBMCs in MN patients. This may be related to the pathogenesis, pathology and immune characteristics of MN. MN podocyte target antigen may not be the root cause of the disease, but a stage result in the pathogenesis process.
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Affiliation(s)
- Zhaocheng Dong
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Yunling Geng
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Pingna Zhang
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Jingyi Tang
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Zijing Cao
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Huijuan Zheng
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Jing Guo
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Chao Zhang
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
| | - Baoli Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical UniversityBeijing, China
| | - Wei Jing Liu
- Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing, China
- Renal Research Institution of Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing, China
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35
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Miracco C, DE Piano E, Marruganti C, Baldino G, Sorrentino E, Batsikosta A, Rubegni P, Angotti R, Messina M, Cinotti E. Folliculosebaceous units are a frequent finding in early lichen sclerosus of the foreskin. Ital J Dermatol Venerol 2022; 157:342-347. [PMID: 35666664 DOI: 10.23736/s2784-8671.22.07301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
BACKGROUND Folliculosebaceous units (FSU) has been considered an early target of inflammation in vulvar lichen sclerosus (VLS). This diagnostic clue is not reported in lichen sclerosus (LS) of the foreskin (FLS) that is normally hairless. We evaluated the presence and inflammation of FSU and sebaceous glands (SG) in LS of the foreskin. METHODS Histological specimens from therapeutic circumcision were assessed in order to evaluate the frequency and inflammation of FSU and SG in LS. RESULTS Ninety-eight cases, grouped into 46 early (group 1) and 52 overt (group 2) FLS were included in the study. SG-FSU were found in 95.7% of group 1, and 65.4% of group 2 cases. Their density was inversely correlated with patient age (P=0.0014). We observed perifollicular inflammation in all cases with visible SG-FSU and frequent FSU abnormalities. CONCLUSIONS SG and FSU were frequent in early FLS and decreased in advanced disease and adults. We hypothesize that SG and FSU are involved in the inflammatory process leading to FLS. These data, which need further investigation, could help to better understand the pathogenesis of FLS.
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Affiliation(s)
- Clelia Miracco
- Section of Pathological Anatomy, Department of Medicine, Surgery and Neuroscience, University Hospital of Siena, Siena, Italy
| | - Ernesto DE Piano
- Department of Medicine, Surgery and Neuroscience, Dermatosurgery, University Hospital of Siena, Siena, Italy
| | - Crystal Marruganti
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gennaro Baldino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Ester Sorrentino
- Section of Pathological Anatomy, Department of Medicine, Surgery and Neuroscience, University Hospital of Siena, Siena, Italy
| | - Anastasia Batsikosta
- Section of Pathological Anatomy, Department of Medicine, Surgery and Neuroscience, University Hospital of Siena, Siena, Italy
| | - Pietro Rubegni
- Department of Medicine, Surgery and Neuroscience, Dermatosurgery, University Hospital of Siena, Siena, Italy
| | - Rossella Angotti
- Department of Medicine, Surgery and Neuroscience, Pediatric Surgery, University Hospital of Siena, Siena, Italy
| | - Mario Messina
- Department of Medicine, Surgery and Neuroscience, Pediatric Surgery, University Hospital of Siena, Siena, Italy
| | - Elisa Cinotti
- Department of Medicine, Surgery and Neuroscience, Dermatosurgery, University Hospital of Siena, Siena, Italy -
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36
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Krapf JM, Smith AB, Cigna ST, Goldstein AT. Presenting Symptoms and Diagnosis of Vulvar Lichen Sclerosus in Premenopausal Women: A Cross-Sectional Study. J Low Genit Tract Dis 2022; 26:271-275. [PMID: 35533256 DOI: 10.1097/lgt.0000000000000679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/PURPOSE Presenting symptoms of vulvar lichen sclerosus (LS) specific to premenopausal women are not well reported in the literature and may differ from those in postmenopausal women. This study aimed to characterize the presentation of vulvar LS among premenopausal women. MATERIALS AND METHODS An observational web-based study was conducted in premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50 years. Participants completed a 28-question survey evaluating characteristics of symptoms, timing of diagnosis, alternate diagnoses, and presence of concomitant autoimmune conditions. RESULTS Of the 956 responses received, 503 met inclusion criteria of biopsy-confirmed LS and premenopausal status. Average age of symptom onset was 27 years, and average age of diagnosis was 32 years, with a 4-year delay in diagnosis. Symptoms most present were dyspareunia (68%) and tearing with intercourse or vaginal insertion (63%). Symptoms that affect the individual most were also dyspareunia (44%) and tearing with intercourse or vaginal insertion (39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%) and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulvar fissures (72%), and labial resorption (60%), with fissures affecting the individual the most (48%). Sixty-six percent of the respondents initially received an alternative diagnosis, most commonly vulvovaginal yeast infection (49%). Hypothyroidism was the most common concurrent autoimmune condition (10%). CONCLUSIONS Vulvar LS affects premenopausal women, commonly presenting with dyspareunia and tearing with intercourse. This condition should be considered and evaluated in premenopausal women presenting with vulvar symptoms and sexual pain.
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Affiliation(s)
| | - Alyssa B Smith
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sarah T Cigna
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
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37
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Wang L, Lv Q, Guo J, Wang J, Pan J. Transcriptome Profiling and Network Analysis Provide Insights Into the Pathogenesis of Vulvar Lichen Sclerosus. Front Genet 2022; 13:905450. [PMID: 35783265 PMCID: PMC9247155 DOI: 10.3389/fgene.2022.905450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis that affects female anogenital skin. Although VLS is considered a T cell-mediated autoimmune disease, the diagnosis criteria, molecular mechanism, and universally accepted therapies for this disease remain largely unresolved. To explore disease pathogenesis and potential biomarkers, we performed an RNA-Seq-based transcriptome analysis to profile the gene expression of VLS lesions. Differentially expressed gene (DEG) analysis revealed profound changes in expressions of coding genes, microRNAs, and long non-coding RNAs. Pathway and network analysis suggested that T cell activation-associated genes, including CD3G, CD3D, CD8B, LAT, LCK, ZAP70, CCR5, CXCR3, CXCL9, CXCL10, and CXCL11, were highly expressed in VLS, while NR4A family genes (NR4A1, NR4A2, NR4A3), whose coding products inhibit T cell activity, were significantly downregulated, suggesting heightened T cell response in VLS. Neutrophil chemoattractant genes CXCL1, CXCL2, CXCL3, CXCL8, and their cognate receptor CXCR2 were downregulated, suggesting dampened neutrophil activity. We also found the downregulation of genes involved in cell cycle progression, including cyclins (CCNB1, CCNB2, CCNL1, CCNE1, and CCNK) and centrosome factors (CENPA, CENPE, CENPF, and CENPN), while microRNA-203a and let-7, microRNAs known to inhibit cell growth, were found to be upregulated. These data collectively indicate that cell proliferation in VLS is compromised. In sum, these findings comprehensively deciphered key regulatory genes and networks in VLS, which could further our understanding of disease mechanisms and point toward therapeutic strategies.
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Affiliation(s)
- Lingyan Wang
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China
| | - Qingqing Lv
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, Beijing, China
| | - Jiayi Guo
- Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, Beijing, China
| | - Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Jianwei Wang, ; Jing Pan,
| | - Jing Pan
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Jianwei Wang, ; Jing Pan,
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38
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Kumar KS, Morrel B, van Hees CLM, van der Toorn F, van Dorp W, Mendels EJ. Comparison of lichen sclerosus in boys and girls: A systematic literature review of epidemiology, symptoms, genetic background, risk factors, treatment, and prognosis. Pediatr Dermatol 2022; 39:400-408. [PMID: 35229894 PMCID: PMC9545843 DOI: 10.1111/pde.14967] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies concerning pediatric lichen sclerosus are limited, and, to date, there have been no studies comparing the course of lichen sclerosus in boys and girls. We sought to examine all publications on boys and girls with lichen sclerosus and assess and compare epidemiology, symptoms and signs, genetic background, risk factors, treatment, and prognosis. METHODS A systematic search was performed in the Embase, Medline, Cochrane, and Web of Science databases. Inclusion criteria were information on children ages 0-18 years and a clinical or histologic diagnosis of lichen sclerosus. Literature from 1985 to 2021 was reviewed. RESULTS A total of 1780 articles were retrieved from the search, of which 90 articles were eligible for inclusion. Boys and girls present similarly on many aspects; nonetheless, treatment and follow-up are approached differently. CONCLUSIONS Though the clinical approach is often different, lichen sclerosus in boys and girls demonstrates many similarities. More research is needed, especially on follow-up, to gain a better understanding of the course of lichen sclerosus and establish an advanced management plan for children.
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Affiliation(s)
- Kajal S Kumar
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Beth Morrel
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Colette L M van Hees
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fred van der Toorn
- Department of Urology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wendy van Dorp
- Department of Obstetrics and Gynecology, IJsselland Hospital, Rotterdam, The Netherlands
| | - Elodie J Mendels
- Department of Dermatology, Center of Paediatric Dermatology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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van der Sluis N, Scheers EC, Krenning G, van der Lei B, Oonk MH, van Dongen JA. Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: A review on literature. Exp Dermatol 2022; 31:689-699. [PMID: 35276020 PMCID: PMC9314062 DOI: 10.1111/exd.14561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction; however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy-resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms-of-action of fat grafting to treat LS.
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Affiliation(s)
- Nanouk van der Sluis
- Department of Plastic SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of Plastic‐, Reconstructive‐ and Hand SurgeryMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Esther C.A.H. Scheers
- Department of Obstetrics and GynecologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Guido Krenning
- Department of Pathology and Medical BiologyUniversity of Groningen and University Medical Center GroningenGroningenThe Netherlands
| | - Berend van der Lei
- Department of Plastic SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Maaike H.M. Oonk
- Department of Obstetrics and GynecologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Joris A. van Dongen
- Department of Plastic‐, Reconstructive‐ and Hand Surgery, Utrecht University Medical CenterUtrecht UniversityUtrechtThe Netherlands
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40
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Sakamoto H, Akimoto J, Tsutsumi M, ken KM, Ichimasu N, Kohno M. Radio-pathological characteristics of malignant transformation of an epidermoid cyst in the cerebellopontine angle: A case report. Surg Neurol Int 2022; 13:135. [PMID: 35509542 PMCID: PMC9062930 DOI: 10.25259/sni_1226_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intracranial epidermoid cysts are rare congenital neoplasms that are clinically indolent and histologically benign. They rarely show malignant transformation, and several such cases have been reported. Some radiological features that suggest malignant transformation have been reported. However, histopathological features that indicate a high risk of malignant transformation have not been reported to date. Case Description We report a 59-year-old woman with a benign epidermoid cyst in the cerebellopontine angle that showed malignant transformation after 6 years. Magnetic resonance imaging (MRI) at the time of initial onset displayed a high-intensity signal on diffusion-weighted imaging (DWI), no peritumoral edema, and no enhancement on contrast-enhanced T1-weighted imaging. On the other hand, MRI at the time of malignant transformation showed a low-intensity signal on DWI, peritumoral edema, and enhancement of the tumor capsule on contrast-enhanced T1-weighted imaging. Pathological findings at the time of the first surgery differed from normal benign epidermoid cysts, in that stratified squamous epithelial metaplasia was observed, and immunohistochemical (IHC) analysis showed positive p53 staining. In addition, IHC analysis at the time of malignant transformation demonstrated positive p16 staining. Conclusion In benign epidermoid cysts, it is considered to cause malignant transformation when squamous metaplasia or p53 mutation is observed. Therefore, strict follow-up is required while paying attention to the characteristic changes in MRI for early detection and timely treatment of malignant transformation.
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Affiliation(s)
| | | | | | | | | | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
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Fekete G, Schwarzkopf‑Kolb D, Brihan I, Boda D, Fekete L. Balanitis xerotica obliterans: An observational, descriptive and retrospective clinical study. Exp Ther Med 2022; 23:361. [DOI: 10.3892/etm.2022.11288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/15/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gyula Fekete
- Department of Dermatology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540142 Târgu Mureș, Romania
| | - Dominik Schwarzkopf‑Kolb
- Department of Dermatology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540142 Târgu Mureș, Romania
| | - Ilarie Brihan
- Department of Dermatology, Dermatology Clinic, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - László Fekete
- CMI DERMAMED Private Medical Office, 540530 Târgu Mureș, Romania
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42
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Manuelpillai N, Saunders H, Veysey E. Management of severe vulval lichen sclerosus with adalimumab. Australas J Dermatol 2022; 63:248-250. [PMID: 35262179 DOI: 10.1111/ajd.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Vulval Lichen Sclerosus (VLS) is a chronic inflammatory dermatosis that significantly impacts the quality of life. We report 2 cases of severe treatment-resistant VLS treated with subcutaneous adalimumab. One patient showed modest clinical improvement with no significant improvement in quality-of-life measures. The second patient showed a significant improvement in both clinical and quality-of-life measures. Both patients achieved optimal control with a maintenance dosing of 40 mg subcutaneously weekly. Adalimumab may be a treatment option for recalcitrant VLS; however, clinical trials are required to confirm efficacy for this indication.
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Affiliation(s)
| | - Helen Saunders
- Department of Dermatology, St Vincent's Hospital, Melbourne, Australia.,Vulvar Clinic, The Royal Women's Hospital, Melbourne, Australia
| | - Emma Veysey
- Department of Dermatology, St Vincent's Hospital, Melbourne, Australia.,Vulvar Clinic, The Royal Women's Hospital, Melbourne, Australia
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43
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Angotti R, Fusi G, Coradello E, Miracco C, Ferrara F, Sica M, Taddei A, Vasta G, Messina M, Molinaro F. Lichen sclerosus in pediatric age: A new disease or unknown pathology? Experience of single centre and state of art in literature. LA PEDIATRIA MEDICA E CHIRURGICA 2022; 44. [PMID: 35230046 DOI: 10.4081/pmc.2022.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Lichen Sclerosus (LS) is a chronic inflammatory skin disease with unknown etiology. In pediatric age the main disease "lichenlinked" is the phimosis in male. This is a retrospective study that reports the experience of our clinic and review of the literature. We included all patients affected by pathological phimosis, treated by circumcision between January 2015 and May 2020, older than 6 years old and with an histopathological diagnosis of lichen sclerosus. The aim was to identify prognostic factors based on histological report to plan the clinical management of patients. Statistical analysis was done. We included 207 patients. The mean age of children was 9,78 years (5-18 years, DS±3.29). Based on the histological features we divided patients in 2 groups: early lesions (70/207, 34%) and advanced (137/207, 66%). In term of complications lichen linked we considered meatal stenosis that needed of urethral dilatations. We included 7 patients (7/207, 3,4%). We report P value Statistical Significance in many aspects. An early diagnosis of LS and surgical treatment of foreskin are essential to prevent early and late complications in children. The size of sample is a limit of the study but results encourage our management.
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Affiliation(s)
- Rossella Angotti
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Giulia Fusi
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Elena Coradello
- Department of Medical, Surgical and Neurological Sciences, University of Siena.
| | - Clelia Miracco
- Pathological Anatomy Unit, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Francesco Ferrara
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Marina Sica
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Alessandra Taddei
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Gabriele Vasta
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Mario Messina
- Pediatric Surgery, Department of Women and Children; Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Francesco Molinaro
- Pediatric Surgery, Department of Women and Children; Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
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44
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The Immunogenetics of Morphea and Lichen Sclerosus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:155-172. [DOI: 10.1007/978-3-030-92616-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Filippini M, Sozzi J, Farinelli M, Verdelli A. Effects of Fractional CO 2 Laser Treatment on Patients Affected by Vulvar Lichen Sclerosus: A Prospective Study. Photobiomodul Photomed Laser Surg 2021; 39:782-788. [PMID: 34878932 DOI: 10.1089/photob.2021.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Fractional carbon dioxide (CO2) lasers are today considered the most effective and efficient treatment for many vulvovaginal disorders, providing mini-invasive procedures without side effects. Previous studies demonstrated the efficacy of fractional CO2 lasers in vulvar lichen sclerosus (VLS), a chronic skin disorder characterized by itching and painful lesions. Complications include pain, sexual and/or urinary dysfunction, with a negative quality of life, and an increased risk of squamous cell carcinoma. A definitive VLS treatment is still lacking. Objectives: This is a prospective, single-center study aimed at evaluating the effect of fractional microablative CO2 laser treatment on women affected by VLS. Materials and methods: Patients with histologically confirmed VLS underwent three fractional microablative CO2 laser treatments, 4 weeks apart, on the genital affected areas. Clinical and VLS-related symptoms, side effects, and patient satisfaction index were assessed and recorded for all the patients using the visual analog scale (VAS). Results: Data from a total of 70 patients were included, paired at different time points and analyzed. VLS-related symptoms and other relevant parameters (pH, vaginal introitus discomfort, dyspareunia, vaginal dryness, itching, and burning) showed a statistically significant improvement (p < 0.001) after the first laser treatment and kept improving after second and third sessions. According to VAS, the two most common symptoms, vaginal introitus discomfort and dyspareunia, went from (mean ± standard deviation) 8.2 ± 2.3 and 8.3 ± 2.2, respectively, at baseline, to 3.6 ± 2.6 and 3.8 ± 2.6, respectively, 1 month after the last treatment. Vaginal dryness, itching, and burning were significantly improved as well. Most patients declared to be very satisfied with the results of the treatment. A total of 62.8% of the women expressed a satisfaction score ≥8 on a scale from 0 to 10. Conclusions: Fractional microablative CO2 laser treatment seems to be safe and effective to treat VLS and improve VLS-related symptoms.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Jessica Sozzi
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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46
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Gerkowicz A, Szczepanik-Kułak P, Krasowska D. Photodynamic Therapy in the Treatment of Vulvar Lichen Sclerosus: A Systematic Review of the Literature. J Clin Med 2021; 10:5491. [PMID: 34884193 PMCID: PMC8658411 DOI: 10.3390/jcm10235491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease involving the genital skin and mucous membrane. Patients exhibit focal atrophy and destructive scarring, with an increased risk of malignant transformation. Due to objective symptoms as well as subjective complaints, patients with VLS experience emotional distress, lowered mood, and sexual dysfunction, which is reflected in impaired health-related quality of life. Thus, the necessity of implementing appropriate therapy at the earliest possible stage of the disease in order to avoid serious complications is highlighted. We presented the systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, and Web of Science databases. We identified a total of twenty relevant studies which indicate that photodynamic therapy (PDT) is a valuable therapeutic modality in the treatment of VLS.
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Affiliation(s)
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (A.G.); (D.K.)
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Conteduca V, Medri M, Mazzoni L, De Giorgi U, Stanganelli I. Anogenital lichen sclerosus et atrophicus lesions in a case series of cancer patients on immunotherapy. Cancer Immunol Immunother 2021; 71:1545-1548. [PMID: 34705086 DOI: 10.1007/s00262-021-03094-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
Lichenoid reactions are one of the most frequently observed toxicities with anticancer agents and, recently, a rapid emergence of immunotherapies in oncology has hastened the need to better characterize their unique toxicity profiles, particularly for less common skin toxicities, including anogenital lichen sclerosus et atrophicus (LSA). This case series describes four patients with advanced cancer (one melanoma, two lung cancers, and one kidney tumor) developing LSA lesions while receiving an immunotherapy. Medical records from 2017 to 2020 were retrospectively reviewed. Two patients received pembrolizumab, anti-programmed cell death-1 (PD-1), one nivolumab, anti-programmed cell death-1 (PD-1), and one ipilimumab, an immune checkpoint inhibitor. LSA emerged after a median of 3 months (range, 2-4 months) from starting immunotherapy. All LSA cases were grade 2. Three cases occurred on the penis and one case on the anus. All patients improved after a specific treatment for LSA, and no LSA-related antineoplastic treatment interruption/life-threatening condition were reported. To date, this is the first case series of LSA lesions associated with immunotherapy. Early LSA recognition and management is helpful in cancer patients on immunotherapy allowing a long survival and treatment response.
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Affiliation(s)
- V Conteduca
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", via Piero Maroncelli 40, 47014, Meldola, Italy. .,Department of Medical and Surgical Sciences, Unit of Medical Oncology and Biomolecular Therapy, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy.
| | - M Medri
- Skin Cancer Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - L Mazzoni
- Skin Cancer Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", via Piero Maroncelli 40, 47014, Meldola, Italy
| | - I Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy.,Department of Dermatology, University of Parma, Parma, Italy
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48
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Tan X, Ren S, Yang C, Ren S, Fu MZ, Goldstein AR, Li X, Mitchell L, Krapf JM, Macri CJ, Goldstein AT, Fu SW. Differentially Regulated miRNAs and Their Related Molecular Pathways in Lichen Sclerosus. Cells 2021; 10:cells10092291. [PMID: 34571940 PMCID: PMC8465596 DOI: 10.3390/cells10092291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
Lichen sclerosus (LS) is a chronic inflammatory skin disorder with unknown pathogenesis. The aberrant expression of microRNAs (miRNAs) is considered to exert a crucial role in LS. We used the next-generation sequencing technology (RNASeq) for miRNA profiling and Ingenuity Pathway Analysis (IPA) for molecular network analysis. We performed qRT-PCR, miRNA transfection and Matrigel assays for functional studies. We identified a total of 170 differentially expressed miRNAs between female LS and matched adjacent normal tissue using RNASeq, with 119 upregulated and 51 downregulated. Bioinformatics analysis revealed molecular networks that may shed light on the pathogenesis of LS. We verified the expression of a set of miRNAs that are related to autoimmunity, such as upregulated miR-326, miR-142-5p, miR-155 and downregulated miR-664a-3p and miR-181a-3p in LS tissue compared to the matched adjacent normal tissue. The differentially expressed miRNAs were also verified in blood samples from LS patients compared to healthy female volunteers. Functional studies demonstrated that a forced expression of miR-142-5p in human dermal fibroblast PCS-201-010 cells resulted in decreased cell proliferation and migration. These findings suggest that differentially expressed miRNAs may play an important role in LS pathogenesis; therefore, they could serve as biomarkers for LS management.
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Affiliation(s)
- Xiaohui Tan
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Shuyang Ren
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Canyuan Yang
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Shuchang Ren
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Melinda Z. Fu
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | | | - Xuelan Li
- Department of OB/GYN, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Leia Mitchell
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
| | - Jill M. Krapf
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
- Department of OB/GYN, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Charles J. Macri
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
| | - Andrew T. Goldstein
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
- Department of OB/GYN, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Correspondence: (A.T.G.); (S.W.F.); Tel.: +1-410-279-0209 (A.T.G.); +1-202-994-4767 (S.W.F.)
| | - Sidney W. Fu
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
- Correspondence: (A.T.G.); (S.W.F.); Tel.: +1-410-279-0209 (A.T.G.); +1-202-994-4767 (S.W.F.)
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Veronesi G, Virdi A, Leuzzi M, Gurioli C, Chessa MA, Guglielmo A, Neri I. Vulvar vitiligo and lichen sclerosus in children: A clinical challenge. Pediatr Dermatol 2021; 38:1012-1019. [PMID: 34561885 DOI: 10.1111/pde.14771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS), both feature skin and mucosal hypo-/depigmentation. The aim of this study was to describe the clinical and dermoscopic features of VV and VLS in the pediatric population, providing diagnostic clues, and to define their association. We performed a systematic literature review of the clinical and dermoscopic features of pediatric VV and VLS. An observational study was conducted on children affected by VLS associated with VV, referred to the Dermatology Unit of the Sant'Orsola Polyclinic in Bologna, Italy. Medical history, age at diagnosis, ethnicity, clinical and dermoscopic features, and symptoms were recorded for all patients. 124 cases of VLS and 10 cases of VV were reviewed. Clinical manifestations included hypo-/depigmented patches in both conditions, while ecchymosis/purpura and fissures/erosion were observed in VLS. Symptoms including pruritus, pain, or burning were reported only by VLS patients. In our study five patients with VLS associated with VV were retrieved. Clinical features included well-demarcated depigmented patches in VV and translucent areas, erythema, ecchymoses/purpura, and labial fusion in VLS. Dermoscopy showed white structureless areas with a whipped cream-like appearance, linear or dotted vessels, white chrysalis-like structures, erosion and red-purpuric blotches in VLS and reduced pigment network or pigment absence, intralesional spots of residual pigmentation and telangiectasias in VV. Symptoms were present in all patients. Both VV and VLS show hypo-/depigmented patches. In the presence of associated symptoms, possible VLS should be investigated with clinical and dermoscopic examination to achieve a prompt diagnosis.
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Affiliation(s)
- Giulia Veronesi
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalucia Virdi
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Miriam Leuzzi
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Gurioli
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Adriano Chessa
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alba Guglielmo
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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50
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Rossi A, Tadiotto Cicogna G, Caro G, Fortuna MC, Magri F, Grassi S. Frontal Fibrosing Alopecia: A New Association with Lichen Sclerosus in Men. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:54-58. [PMID: 34980973 PMCID: PMC8675336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a scarring alopecia that has been reported mostly in postmenopausal women and is characterized by frontotemporal hairline. Currently, there are only a few reports about FFA in male patients. OBJECTIVE This study sought to analyze clinical and trichoscopic features of FFA in a case series of men and to describe the main features of FFA in male patients through a review of the literature. METHODS Male patients with clinical and trichoscopical signs of FFA, histologically confirmed, who attended to our clinic from 2014 to 2019 were included in our study. From each patient, clinical and trichoscopic data were collected. RESULTS Eight men with an average age of 59 years were recruited. In five patients, serrated hairline recession (i.e., a "zig-zag" pattern) was present, while three presented with linear hairline recession. Also, the eyebrows (n=3 patients), sideburns (n=2 patients), and beard (n=2 patients) were involved. Surprisingly, in two patients, an association with lichen sclerosus (LS) was present. CONCLUSION To the best of our knowledge, this is the first report of a serrated hairline recession pattern in male patients with FFA. A new association between FFA and LS in men was also found. Further studies need to establish the extent of this association and facilitate a better comprehension of the pathophysiologic mechanisms underlying these two diseases.
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Affiliation(s)
- Alfredo Rossi
- Drs. Rossi, Fortuna, Caro, Magri, and Grassi are with the Department of Internal Medicine and Medical Specialties, Dermatology at the Sapienza University of Rome in Rome, Italy
- Dr. Tadiotto Cicogna is with the Unit of Dermatology at the University of Padua in Padua, Italy
| | - Giulia Tadiotto Cicogna
- Drs. Rossi, Fortuna, Caro, Magri, and Grassi are with the Department of Internal Medicine and Medical Specialties, Dermatology at the Sapienza University of Rome in Rome, Italy
- Dr. Tadiotto Cicogna is with the Unit of Dermatology at the University of Padua in Padua, Italy
| | - Gemma Caro
- Drs. Rossi, Fortuna, Caro, Magri, and Grassi are with the Department of Internal Medicine and Medical Specialties, Dermatology at the Sapienza University of Rome in Rome, Italy
- Dr. Tadiotto Cicogna is with the Unit of Dermatology at the University of Padua in Padua, Italy
| | - Maria Caterina Fortuna
- Drs. Rossi, Fortuna, Caro, Magri, and Grassi are with the Department of Internal Medicine and Medical Specialties, Dermatology at the Sapienza University of Rome in Rome, Italy
- Dr. Tadiotto Cicogna is with the Unit of Dermatology at the University of Padua in Padua, Italy
| | - Francesca Magri
- Drs. Rossi, Fortuna, Caro, Magri, and Grassi are with the Department of Internal Medicine and Medical Specialties, Dermatology at the Sapienza University of Rome in Rome, Italy
- Dr. Tadiotto Cicogna is with the Unit of Dermatology at the University of Padua in Padua, Italy
| | - Sara Grassi
- Drs. Rossi, Fortuna, Caro, Magri, and Grassi are with the Department of Internal Medicine and Medical Specialties, Dermatology at the Sapienza University of Rome in Rome, Italy
- Dr. Tadiotto Cicogna is with the Unit of Dermatology at the University of Padua in Padua, Italy
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