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Li Z, Wang Y, Wang J, Li S, Xiao Z, Feng Y, Gu J, Li J, Peng X, Li C, Zeng K. Evaluation of the efficacy of 5-aminolevulinic acid photodynamic therapy for the treatment of vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2019; 29:101596. [PMID: 31704505 DOI: 10.1016/j.pdpdt.2019.101596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study aimed to evaluate the effects of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) on the improvement of symptoms and recurrence rate in patients with vulvar lichen sclerosus (VLS) and observe its side effects. METHODS The symptom scores before and after photodynamic therapy (PDT) in 13 enrolled patients with VLS were analyzed retrospectively. All patients were followed-up for at least 6 months to evaluate the recurrence rate after PDT. The patients were treated with PDT only during the study period. During the PDT treatment, a 20 % 5-aminolevulinic acid solution was applied to the lesions and marginal areas for 3 h, and the entire area was then irradiated with 635 nm red light of 80 J/cm2 at 80 mW/cm2 for 30 min. RESULTS In this study, the effective rate of PDT was 92.31 %. Lesions recurred in two patients at 6 months after PDT. Post-treatment, the total subjective, total objective, and the Dermatological Life Quality Index scores changed from 11.4, 4.3, and 13.4 at baseline to 4.9, 2, and 5.9, respectively. The difference was statistically significant (p <0.05). PDT was mildly toxic in most patients. CONCLUSIONS ALA-PDT is a safe and effective method for the treatment of VLS, and the therapeutic effects can be maintained for at least 3 months. The therapeutic effects may decrease during the 3-6-month period after PDT.
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Affiliation(s)
- Zhijia Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Yajie Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
| | - Jingying Wang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Songshan Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Zixuan Xiao
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Yingjun Feng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Jingjing Gu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
| | - Junpeng Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Xiaoming Peng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Changxing Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Kang Zeng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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102
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Paulis G, Berardesca E. Lichen sclerosus: the role of oxidative stress in the pathogenesis of the disease and its possible transformation into carcinoma. Res Rep Urol 2019; 11:223-232. [PMID: 31687365 PMCID: PMC6709801 DOI: 10.2147/rru.s205184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Lichen sclerosus (LS) is an autoimmune chronic inflammatory disease usually involving the anogenital skin of both sexes; more rarely LS exclusively involves extragenital areas. As a chronic inflammatory disease, in most cases, LS evolves and progresses causing scleroatrophy of the skin or scars which may cause stenosis in the affected areas. A few LS patients are at risk of developing squamous cell carcinoma in their lifetime, but appropriate long-term treatment diminishes the possibility of a malignant evolution. Oxidative stress (OS) has been proven to play a role not only in the pathogenesis of LS, but also in the development and progression of the disease. OS, by causing DNA damage and lipid peroxidation, contributes directly to the possible malignant transformation of LS. Moreover, the increase in oxidative DNA damage is associated with mutations in tumor suppressor genes. Considering the role that OS plays in LS, therapeutic use of antioxidants appears to be rational and possible, in association with other treatments. Antioxidants would counteract the oxidative DNA damage, which is the most important factor for the progression of LS and its malignant transformation.
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Affiliation(s)
- Gianni Paulis
- Andrology Center, Villa Benedetta Clinic, Rome, Italy.,Department of Uro-andrology, Castelfidardo Medical Team, Rome, Italy
| | - Enzo Berardesca
- Department of Clinical Dermatology, S. Gallicano Dermatological Institute, Rome, Italy
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103
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Basile S, Pinelli S, Bottone P, Artini PG, Plotti F, Panici PB. 'Primary gingival and later primary vulval carcinomas arising in lichen planus: report of a case and clinical suggestions for diagnosis of a neglected disease'. Gynecol Endocrinol 2019; 35:938-940. [PMID: 31131667 DOI: 10.1080/09513590.2019.1617265] [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] [Indexed: 10/26/2022] Open
Abstract
Lichen planus (LP) is a chronic immune-mediated dermatosis mainly affecting skin, oral, and genital mucosa. The heterogeneous clinical presentation, spectrum of symptoms depending on subtype and overlap with other vulval and cutaneous disorders can lead to challenging in diagnosis. We report an unusual case of vulval SCC arising within a patient with initial oral mucosal lichen planus who later developed lichen planus of the vulva. Discussion of this case is important as it typifies the difficulties in diagnosis of vulvo-vaginal disorders and potential complications. Evidence is available that lichen planus may be potentially precancerous condition and is associated with SCC development. This case may confirm an inherent oncologic potential of the disease. All efforts must be made by specialists involved in the management of this disease to obtain an early diagnosis, ensure proper treatment and adequate follow up. This highlights the need to perform vulval examination in patients with symptoms or with a history muco-cutaneous LP and if necessary consider referral to specialist center for biopsy and management.
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Affiliation(s)
- Stefano Basile
- Department of Obstetrics and Gynecology II, Pisa University Hospital , Pisa , Italy
| | - Sara Pinelli
- Department of Obstetrics and Gynecology II, Pisa University Hospital , Pisa , Italy
| | - Pietro Bottone
- Department of Obstetrics and Gynecology II, Pisa University Hospital , Pisa , Italy
| | - Paolo Giovanni Artini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa , Pisa , Italy
| | - Francesco Plotti
- Department of Gynecology, Campus Biomedico University of Rome , Rome , Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecologic-Obstetrical and Urologic Sciences, Sapienza University Hospital of Rome , Rome , Italy
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104
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Tran DA, Tan X, Macri CJ, Goldstein AT, Fu SW. Lichen Sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci 2019; 15:1429-1439. [PMID: 31337973 PMCID: PMC6643151 DOI: 10.7150/ijbs.34613] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022] Open
Abstract
Lichen sclerosus (LS) is an inflammatory dermatosis with a predilection for anogenital skin. Developing lesions lead to vulvar pain and sexual dysfunction, with a significant loss of structural anatomical architecture, sclerosis, and increased risk of malignancy. Onset may occur at any age in both sexes, but typically affects more females than males, presenting in a bimodal fashion among pre-pubertal children and middle-aged adults. A definitive cure remains elusive as the exact pathogenesis of LS remains unknown. A general review of LS, histologic challenges, along with amounting support for LS as an autoimmune disease with preference for a Th1 immune response against a genetic background is summarized. In addition to the classically referenced ECM1 (extracellular matrix protein 1), a following discussion of other immune and genetic targets more recently implicated as causative or accelerant agents of disease, particularly miR-155, downstream targets of ECM1, galectin-7, p53, and epigenetic modifications to CDKN2A, are addressed from the viewpoint of their involvement in three different, but interconnected aspects of LS pathology. Collectively, these emerging targets serve not only as inherently potential therapeutic targets for treatment, but may also provide further insight into this debilitating and cryptic disease.
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Affiliation(s)
- Davis A Tran
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Xiaohui Tan
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Charles J Macri
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrew T Goldstein
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC.,Center for Vulvovaginal Disorders, Washington, DC
| | - Sidney W Fu
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
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105
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Belzile E, Funaro D, Powell J. Localized vulvar bullous pemphigoid of childhood: A rare cause of persistent vulvar erosions in children. Pediatr Dermatol 2019; 36:349-351. [PMID: 30762244 DOI: 10.1111/pde.13771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Localized vulvar bullous pemphigoid of childhood is an excessively rare variant of bullous pemphigoid and affects almost exclusively young girls of 7-12 years of age. In contrast to adult-onset bullous pemphigoid, a prompt response to potent topical corticosteroids is observed in the majority of cases, with a favorable prognosis and rare relapses. We report the case of a 7-year-old girl who presented with this condition. Our case reinforces the recognition of this rare subtype of childhood bullous pemphigoid as a distinct entity and enlightens the importance of performing a cutaneous biopsy when clinically indicated.
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Affiliation(s)
- Eugénie Belzile
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Deana Funaro
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Julie Powell
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
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106
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Acrochordon With Histological Features of Lichen Sclerosus. Am J Dermatopathol 2019; 41:e64-e65. [PMID: 30946102 DOI: 10.1097/dad.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that classically presents as sclerotic, atrophic plaques in the genital region. We present a case of acrochordon with histological features of LS, clinically mimicking intradermal nevus, in a 53-year-old man with no prior history of LS. Our case highlights an unusual morphologic variant of acrochordon and illustrates the role of chronic pressure and occlusion in the development of secondary features of LS.
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107
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Abstract
This article reviews the epidemiology, diagnosis, and management of vulvar preinvasive lesions, squamous cell carcinoma, and melanoma. There is an emphasis on sentinel lymph node dissection for early stage disease and advances in chemoradiation for late-stage disease. A brief review of vulvar Paget disease is also included.
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Affiliation(s)
- Daniel Weinberg
- Department of Obstetrics and Gynecology, University of New Mexico, MSC10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Ricardo A Gomez-Martinez
- Department of Obstetrics and Gynecology, University of New Mexico, MSC10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA
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108
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Childhood Phimosis Secondary to Lichen Sclerosus: Is There a Spatial Pattern of Histopathological Changes? Am J Dermatopathol 2019; 40:824-828. [PMID: 30124504 DOI: 10.1097/dad.0000000000001248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The accurate histopathological diagnosis of the phimotic prepuce is indispensable because early diagnosis, treatment, and close follow-up are crucial in genital dermatosis such as lichen sclerosus (LS). This study analyzes the histopathological spectrum of childhood phimosis with special emphasis on LS. We also highlight a peculiar pattern of histopathological evolution in LS, prepuce. MATERIAL AND METHODS The histopathology slides of all the pediatric preputial circumcision specimens performed for the indication of pathological phimosis (n = 43) during the study period (2012-2017) were analyzed. Eight histopathological features viz. hyperkeratosis, hypergranulosis, epidermal atrophy, acanthosis, dermoepidermal cleft, upper dermal edema and homogenization, mid dermal lymphocytic band, and interface dermatitis were studied in each case, separately in inner preputial surface, tip, and outer preputial surface. On the basis of evolution of the disease and histopathological features, the lesions of LS were classified into early, established, and advanced. RESULT LS was found in 32 cases, whereas 11 cases showed nonspecific inflammation and fibrosis. The upper dermal homogenization (n = 29), dermoepidermal cleft (n = 28), and mid dermal band (n = 27) were the commonest histopathological changes. The established and advanced changes were confined to the inner preputial surface (n = 31), and the outer preputial skin surface was unaffected in all the cases. A peculiar histopathological evolution pattern was seen with established or advanced lesions, early lesion, and normal histology on the inner preputial surface, mucocutaneous junction, and outer preputial skin, respectively. CONCLUSIONS LS is a common cause of childhood phimosis. It shows a peculiar histopathological evolution that mandates the thorough analysis of inner mucosal surface.
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109
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Ismail D, Owen CM. Paediatric vulval lichen sclerosus: a retrospective study. Clin Exp Dermatol 2019; 44:753-758. [PMID: 30623460 DOI: 10.1111/ced.13894] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory dermatosis with a predilection for the anogenital region, which mainly affects prepubertal girls and postmenopausal women. The cause is unknown, but a number of potential aetiological factors have been identified. AIM To examine a cohort of patients with prepubertal-onset vulval LS (VLS) and assess baseline characteristics, clinical presentation, potential precipitating and predisposing factors, and response to treatment. METHODS Data were collected from case notes on patients aged < 18 years diagnosed with prepubertal-onset VLS attending a specialist vulval dermatology service. Data included clinical presentation, comorbidities, family history, therapy and response to treatment. RESULTS In total, 26 paediatric patients were identified. The median age at onset of symptoms was 5 years (range 2-8.5 years). Many previously identified potential aetiological factors for the development of VLS were identified, including family history, trauma, autoimmune disease and hormonal factors. A significant proportion of patients had a history of urinary tract symptoms, including incontinence and urinary tract infection. Most patients responded well to a standard course of induction topical therapy followed by maintenance therapy, but some, including three patients with ongoing urinary incontinence and three postpubertal patients, continued to have active disease. CONCLUSION A detailed assessment is essential in patients with VLS so that potential predisposing factors and comorbidities can be identified and managed. Urinary incontinence may be implicated in the development of paediatric VLS and may prevent adequate disease control. Paediatric VLS can persist through puberty, thus long-term follow-up is advised.
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Affiliation(s)
- D Ismail
- Salford Royal Hospital NHS Foundation Trust, Manchester, UK
| | - C M Owen
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, Lancashire, UK
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110
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Borghi A, Virgili A, Corazza M. Dermoscopy of Inflammatory Genital Diseases: Practical Insights. Dermatol Clin 2019; 36:451-461. [PMID: 30201154 DOI: 10.1016/j.det.2018.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy.
| | - Annarosa Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
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Abstract
Vulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. Treatment of vulvar cancer depends primarily on histology and surgical staging. Treatment is predominantly surgical, particularly for squamous cell carcinoma, although concurrent chemoradiation is an effective alternative, particularly for advanced tumors. Management should be individualized, and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors.
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Affiliation(s)
- Linda J Rogers
- Division of Gynecological Oncology, Groote Schuur Hospital/University of Cape Town, Cape Town, South Africa.,South African Medical Research Council/University of Cape Town Gynaecological Cancer Research Centre (SA MRC/UCT GCRC), Cape Town, South Africa
| | - Mauricio A Cuello
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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112
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Przybylska R, Plagens-Rotman K, Jaracz K, Adamski Z, Czarnecka-Operacz M. Lichen sclerosus as a clinical problem. Postepy Dermatol Alergol 2018; 35:644-648. [PMID: 30618538 PMCID: PMC6320482 DOI: 10.5114/ada.2018.77618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Renata Przybylska
- Department of Neurological Nursing, Poznan University of Medial Sciences, Poznan, Poland
| | | | - Krystyna Jaracz
- Department of Neurological Nursing, Poznan University of Medial Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medial Sciences, Poznan, Poland
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113
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Robledo-Sierra J, Bäckman K, Öhman J, Jontell M. Oral lichen sclerosus: an overview and report of three cases. Int J Oral Maxillofac Surg 2018; 47:1550-1556. [DOI: 10.1016/j.ijom.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 01/15/2023]
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114
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Frost J, Ludeman L, Hillaby K, Gornall R, Lloyd G, Kendall C, Shore AC, Stone N. Raman spectroscopy and multivariate analysis for the non invasive diagnosis of clinically inconclusive vulval lichen sclerosus. Analyst 2018; 142:1200-1206. [PMID: 27827479 DOI: 10.1039/c6an02009g] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vulval lichen sclerosus (LS) is a common inflammatory condition associated with an increased risk of developing vulval carcinoma. Diagnosis is usually clinical although biopsy is necessary if the diagnosis is uncertain or if there is a failure to respond to adequate initial treatment. Raman spectroscopy has the potential to be applied in vivo for near real time objective non-invasive optical diagnosis, avoiding the need for invasive tissue biopsies. The aim of this study was to evaluate the diagnostic performance of Raman spectroscopy for differentiating LS from other vulval conditions in fresh vulval biopsies. Biopsies were analysed from 27 women with suspected LS in whom the attending gynaecologist could not establish the diagnosis on clinical presentation alone. Spectral variance was explored using principal component analysis and in conjunction with the histological diagnoses was used to develop and test a multivariate linear discriminant classification model. This model was validated with leave one sample out cross validation and the diagnostic performance of the technique assessed in comparison with the pathology gold standard. After cross validation the technique was able to correctly differentiate LS from other inflammatory vulval conditions with a sensitivity of 91% and specificity of 80%. This study demonstrates Raman spectroscopy has potential as a technique for in vivo non-invasive diagnosis of vulval skin conditions. Applied in the clinical setting this technique may reduce the need for invasive tissue biopsy. Further in vivo study is needed to assess the ability of Raman spectroscopy to diagnose other vulval conditions before clinical application.
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Affiliation(s)
- Jonathan Frost
- Biomedical Physics, School of Physics and Astronomy, University of Exeter, Exeter, EX4 4QL, UK.
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115
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Li J, Deng C, Peng Q. Underestimation of genital lichen sclerosus incidence in boys with phimosis: results from a systematic review. Pediatr Surg Int 2018; 34:1245-1250. [PMID: 30264374 DOI: 10.1007/s00383-018-4357-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Previous histological studies have shown a variable incidence of genital lichen sclerosus (LS). However, the results of these studies were inconsistent. To overcome the limitation of individual studies, we performed this systematic review to explore the true incidence of LS. METHODS A comprehensive search of Pubmed, Embase, Web of Science and Cochrane Library was performed including cross-referencing independently by two assessors. RESULTS A total of 22 articles published from 1980 to 2017 were included in our study. The proportion of LS in those with phimosis had been described in many literature studies, ranging from 2 to 95%. The actual incidence of LS is thought to be clinically underestimated by as much as 50%. CONCLUSIONS The true incidence of LS in boys is more common than previously realized. LS may be observed in foreskin with or without phimosis. The presence of acquired phimosis may be an aggravating factor in the incidence of LS. The diagnosis LS must be based on biopsy for acquired phimosis because clinical findings underestimated the incidence of LS.
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Affiliation(s)
- Jinfeng Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue avenue, Qinyang District, Chengdu, China
| | - Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue avenue, Qinyang District, Chengdu, China.
| | - Qiang Peng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue avenue, Qinyang District, Chengdu, China
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116
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Yang M, Wen W, Chang J. Vulvar lichen sclerosus: A single-center retrospective study in China. J Dermatol 2018; 45:1101-1104. [PMID: 29984529 DOI: 10.1111/1346-8138.14533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Min Yang
- Department of Dermatology; Beijing Hospital; National Center of Gerontology; Beijing China
| | - Wei Wen
- Department of Dermatology; Beijing Hospital; National Center of Gerontology; Beijing China
| | - Jianmin Chang
- Department of Dermatology; Beijing Hospital; National Center of Gerontology; Beijing China
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117
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Matela AM, Hagström J, Ruokonen H. Lichen sclerosus of the oral mucosa: clinical and histopathological findings. Review of the literature and a case report. Acta Odontol Scand 2018; 76:364-373. [PMID: 29658796 DOI: 10.1080/00016357.2018.1463452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Lichen sclerosus (LS) is a rare, chronic mucocutaneous disease that most frequently affects the female genital area. Oral manifestations are seldom detected; only 36 well-documented and histopathologically verified oral LS cases have been published. MATERIALS AND METHODS Here we describe one patient affected by oral (LS) and review of the literature 1957-2017. RESULTS Findings in our review suggest a female to male ratio of 1.64:1. It is most commonly diagnosed at the age of 10-29 years (46%). Oral LS can appear as symptomless, irregular-shaped, porcelain-white and flat lesions situated asymmetrically. Lesion is commonly sole, well-demarcated area and its size varies from 2 mm (small macula) to 7 cm (large plaque). The most common sites in the oral cavity include the labial mucosa, lips and gingiva. The histopathological criteria include atrophy and sometimes hyperkeratosis of the epithelium, hydropic degeneration of basal cells, hyalinization of the lamina propria, lymphocyte infiltration beneath the zone of hyalinization and scantiness of elastin. Surgical excision is an effective treatment for small lesions; intralesional triamcinolone or corticosteroid injections are used for larger lesions. CONCLUSIONS Oral LS may be under-recognized due to its asymptomatic nature and rarity.
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Affiliation(s)
- Anna-Maija Matela
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, Oral and Maxillofacial Diseases, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Hellevi Ruokonen
- Head and Neck Center, Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
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118
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Goussot R, Francès C, Cury K, Bessis D, Martin T, Chatelus E, Mahé A, Messer L, Séverac F, Meyer N, Lipsker D. Prospective evaluation of the frequency of genital lichen sclerosus in 79 patients with systemic sclerosis. Br J Dermatol 2018; 179:999-1000. [PMID: 29928761 DOI: 10.1111/bjd.16898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Goussot
- Clinique Dermatologique des Hôpitaux Universitaires, 1 Place de l'Hôpital, 67091, Strasbourg CEDEX, France
| | - C Francès
- Service de Dermatologie-Allergologie, Université Paris 6, AP-HP, Hôpital Tenon, Paris, France.,EMSED (Etude des Maladies Systémiques en Dermatologie/Study Group of Systemic Diseases in Dermatology), 61 rue Charles Laffitte, 92200, Neuilly-sur-Seine, France
| | - K Cury
- Service de Dermatologie-Allergologie, Université Paris 6, AP-HP, Hôpital Tenon, Paris, France.,EMSED (Etude des Maladies Systémiques en Dermatologie/Study Group of Systemic Diseases in Dermatology), 61 rue Charles Laffitte, 92200, Neuilly-sur-Seine, France
| | - D Bessis
- EMSED (Etude des Maladies Systémiques en Dermatologie/Study Group of Systemic Diseases in Dermatology), 61 rue Charles Laffitte, 92200, Neuilly-sur-Seine, France.,Service de Dermatologie, Hôpital Public Saint-Eloi et CHRU de Montpellier, Montpellier, France
| | - T Martin
- Service d'Immunologie Clinique et de Médecine Interne, Centre de Référence des Maladies Autoimmunes Systémiques Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Chatelus
- Service de Rhumatologie, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - A Mahé
- Service de Dermatologie, Hôpital Louis Pasteur, Hôpitaux Civils de Colmar, Colmar, France
| | - L Messer
- Service de Rhumatologie, Hôpital Louis Pasteur, Hôpitaux Civils de Colmar, Colmar, France
| | - F Séverac
- GMRC, Service de Santé Publique, CHU de Strasbourg, iCUBE, UMR 7357, Université de Strasbourg, 67091, Strasbourg, France
| | - N Meyer
- GMRC, Service de Santé Publique, CHU de Strasbourg, iCUBE, UMR 7357, Université de Strasbourg, 67091, Strasbourg, France
| | - D Lipsker
- EMSED (Etude des Maladies Systémiques en Dermatologie/Study Group of Systemic Diseases in Dermatology), 61 rue Charles Laffitte, 92200, Neuilly-sur-Seine, France.,Clinique Dermatologique des Hôpitaux Universitaires et Faculté de Médecine, Université de Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg CEDEX, France
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119
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Guo H, Peng X, Jin C, Wang L, Chen F, Sa Y. Lichen Sclerosus Accompanied by Urethral Squamous Cell Carcinoma: A Retrospective Study From a Urethral Referral Center. Am J Mens Health 2018; 12:1692-1699. [PMID: 29926751 PMCID: PMC6142166 DOI: 10.1177/1557988318782095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To evaluate the characteristics of lichen sclerosus (LS) accompanied by urethral squamous cell carcinoma (USCC) and to raise urologists' awareness about the early management of LS, a retrospective analysis was performed on the clinical features, diagnosis, treatment, and prognosis of 18 male genital LS accompanied by USCC patients who were referred to Shanghai Sixth People's Hospital between June 2000 and August 2014. All of the patients had a long-term history of LS, urethral strictures, and urethral dilatation. Seven patients are with distal (glanular or penile) USCC, 10 patients with proximal USCC, and one with entire USCC. The most common presentation, except for LS and urethral strictures, was periurethral abscess, followed by extraurethral mass, pelvic pain, urethrocutaneous fistula, hematuria, and bloody urethral discharge. All had primary surgical excision that was adapted to tumor location and extension. All of the USCC were positive for P53 and Ki-67. P16 was positive in four cases of human papillomavirus (HPV)-associated USCC and negative in 14 cases of HPV-independent USCC. Patients with distal USCC had a significant longer survival time than proximal USCC ( p < .05). LS should be treated early to prevent the disease progression. LS probably has some associations with USCC. Distal USCC has a relatively better prognosis than proximal USCC.
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Affiliation(s)
- Hailin Guo
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.,3 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xufeng Peng
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Chongrui Jin
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Lin Wang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.,3 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.,3 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinglong Sa
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
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120
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Lewis F, Tatnall F, Velangi S, Bunker C, Kumar A, Brackenbury F, Mohd Mustapa M, Exton L, McHenry P, Leslie T, Wakelin S, Hunasehally R, Cork M, Johnston G, Chiang N, Worsnop F, Buckley D, Petrof G, Salin A, Callachand N, Saunders C, Salad A. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol 2018; 178:839-853. [DOI: 10.1111/bjd.16241] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/18/2022]
Affiliation(s)
- F.M. Lewis
- Frimley Health NHS Foundation Trust Slough SL2 4HL U.K
- St John's Institute of Dermatology Guy's & St Thomas’ NHS Foundation Trust London SE1 9RT U.K
| | - F.M. Tatnall
- West Hertfordshire NHS Trust Watford WD18 0HB U.K
| | - S.S. Velangi
- University Hospitals Birmingham NHS Foundation Trust Birmingham B15 2TH U.K
| | - C.B. Bunker
- University College London Hospitals NHS Foundation Trust University College Hospital London NW1 2BU U.K
- Chelsea & Westminster NHS Foundation Trust London SW10 9NH U.K
| | - A. Kumar
- King's College London London SE1 3ER U.K
| | - F. Brackenbury
- Association for Lichen Sclerosus and Vulval Health Brighton U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
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121
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Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: A case report. Case Rep Womens Health 2018; 18:e00062. [PMID: 29785390 PMCID: PMC5960026 DOI: 10.1016/j.crwh.2018.e00062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 11/22/2022] Open
Abstract
The use of platelet-rich plasma (PRP) for the treatment of lichen sclerosus (LS) in a 38-year-old premenopausal woman is reported. The diagnosis was confirmed histologically and the symptoms documented using the ICIQ Vaginal Symptoms Questionnaire (ICIQ-VS) and the Female Sexual Function Index (FSFI) questionnaire. PRP was prepared from autologous blood using the Regen Cellular Matrix Kit. PRP was administered twice over two months. Histology at follow-up one month after the second administration showed the epidermis was nearly normal and upper dermal cellularity had been restored. The patient was symptom-free and both her ICIQ-VS and her FSFI scores had improved significantly. PRP is a potential new treatment option for LS which needs further assessment in randomized controlled trials. Lichen sclerosus is an auto-immune inflammatory skin disease. The therapy of choice is clobetasol 0.05% ointment, so far PRP is a regeneration treatment option for LS. Histopathology after PRP proved normal epidermis with returned upper dermal cellularity. After PRP treatment, the ICIQ-VS score and FSFI full scale score range improved significantly.
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122
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Abstract
Vulval lichen planus–lichen sclerosus overlap is an emerging observation. Few clinical reports exist with no reviews of literature. We present a focused update of this phenomenon and discuss a clinical case. We report a 63-year-old woman with a 20-year history of ulcerative vulvo-vaginitis, initially diagnosed as benign mucous membrane (cicatricial) pemphigoid. This led to prolonged treatment with oral corticosteroids with minimal improvement in symptoms. Subsequent complications of long-term use of systemic corticosteroid ensued. A clinico-pathological diagnosis of severe erosive lichen planus was made on clinical findings and on non-specific biopsy changes of ulceration and inflammation. Treatment with topical clobetasol propionate 0.05% ointment twice daily led to dramatic improvement of ulceration, easing of discomfort and marked improvement in quality of life. Clinical examination revealed Wickham’s striae on the labia majora supporting the diagnosis. Six years after commencement of topical clobetasol, white plaques were noticed on the labia majora, perineum and peri-anal region consistent with lichen sclerosus, confirmed by repeat vulval skin biopsy and on vulvectomy. This case highlights the challenge of diagnosis of extensive vulvo-vaginal ulceration and the necessity to re-examine a previous diagnosis if there is poor response to treatment.
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Affiliation(s)
- Matthew Howard
- Department of Medicine, St Vincent’s Hospital, Melbourne, Australia
| | - Anthony Hall
- School of Medicine, Deakin University, Geelong, Australia
- Skin and Cancer Foundation (Inc), Carlton, Australia
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123
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124
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Virgili A, Borghi A, Cazzaniga S, Di Landro A, Naldi L, Minghetti S, Fierro MT, Verrone A, Caproni M, Micali G, Gaspari V, Papini M, Di Lernia V, Germi L, Girolomoni G, Belloni Fortina A, Cannavò SP, Bilenchi R, Corazza M. Gender differences in genital lichen sclerosus: data from a multicenter Italian study on 729 consecutive cases. GIORN ITAL DERMAT V 2018; 155:155-160. [PMID: 29368855 DOI: 10.23736/s0392-0488.17.05819-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies specifically conducted to assess gender differences in genital lichen sclerosus (GLS) are not available. This multicenter study aimed to identify possible gender-related differences on GLS clinical features, history and course, through collecting data from a large mixed-sex sample of patients. METHODS This was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was specifically collected: clinical features and severity of symptoms related to GLS, extragenital involvement, previous therapies, diagnostic suspicion at referral, type of referring physicians, development of genital squamous-cell carcinoma (SCC). RESULTS Females complained of symptoms more frequent and severe than men; pallor and scarring-sclerosis-atrophy were the most frequent features without gender differences; itching-related signs were more frequent in females than in males as well as extragenital involvement; prior to receiving a definitive diagnosis, females received treatment more frequently than males; 40% of patients were referred with a misdiagnosis; the highest rate of correct suspected diagnosis at referral came from dermatologists than from other physicians; duration of the disease was found to predispose to SCC development. CONCLUSIONS Our findings highlighted several gender differences on clinical presentation and symptom profile of GLS. In spite of some characteristic features, misdiagnosis at referrals was frequent.
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Affiliation(s)
- Annarosa Virgili
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Simone Cazzaniga
- GISED Research Center, FROM Foundation, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital, Bern, Switzerland
| | | | - Luigi Naldi
- GISED Research Center, FROM Foundation, Bergamo, Italy.,Unit of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sara Minghetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria T Fierro
- Department of Dermosyphilopathy #2, Città della Salute e della Scienza, Turin, Italy
| | - Anna Verrone
- Department of Dermosyphilopathy #2, Città della Salute e della Scienza, Turin, Italy
| | - Marzia Caproni
- Division of Rare Skin Diseases and Immunopathology, Unit of Dermatology I, University of Florence, Florence, Italy
| | - Giuseppe Micali
- Unit of Dermatology, G. Rodolico University Hospital, Vittorio Emanuele Polyclinic Hospital, Catania, Italy
| | - Valeria Gaspari
- Unit of Dermatology, Department of Specialty, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Manuela Papini
- Division of Clinical Dermatology in Terni, Department of Surgery and Biomedicine, University of Perugia, Perugia, Italy
| | - Vito Di Lernia
- Unit of Immunodermatology and Pediatric Dermatology, Arcispedale Santa Maria Nuova, Reggio Emilia Hospital and IRCCS, Reggio Emilia, Italy
| | - Lerica Germi
- Unit of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Giampiero Girolomoni
- Unit of Dermatology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Anna Belloni Fortina
- Unit of Clinical Dermatology, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Serafinella P Cannavò
- Unit of Dermatology, Department of Specialty Medicine, Gaetano Martino Polyclinic Hospital, Messina, Italy
| | - Roberta Bilenchi
- Unit of Dermatology, Department of Clinical Medicine and Applied Immunology, Siena University Hospital, Siena, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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125
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Kakko T, Salo T, Siponen MK. Oral lichen sclerosus: a systematic review of reported cases and two new cases. Int J Dermatol 2018; 57:521-528. [DOI: 10.1111/ijd.13870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/11/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Tuomas Kakko
- Institute of Dentistry; Faculty of Medicine; University of Oulu; Oulu Finland
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit; Faculty of Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
- Department of Oral and Maxillofacial Diseases; University of Helsinki; Oulu Finland
- Medical Research Center; Oulu University Hospital; Oulu Finland
| | - Maria K. Siponen
- Cancer and Translational Medicine Research Unit; Faculty of Medicine; University of Oulu and Oulu University Hospital; Oulu Finland
- Department of Oral and Maxillofacial Diseases; Kuopio University Hospital; Kuopio Finland
- Institute of Dentistry; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
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126
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Mercuri SR, Brianti P, Foti A, Bartolucci M, Dattola A, Nisticò SP. Penile Lichen Sclerosus Treated with 1927 nm Thulium Fiber Laser and Photodynamic Therapy: A New Possible Therapeutic Approach. Photomed Laser Surg 2018; 36:333-336. [PMID: 29298401 DOI: 10.1089/pho.2017.4386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We treated two patients with recalcitrant lichen sclerosus (LS) of the penis with a combination of 1927 nm thulium fiber laser and methyl-aminolevulinate (MAL) photodynamic therapy (PDT). BACKGROUND DATA Therapy of LS is based on topical potent steroids, emollients, and topical calcineurin inhibitors. Circumcision is effective, but not always accepted. PDT represents a valid therapeutic option in refractory cases, but there are no reports about the association with 1927 nm thulium laser in the treatment of this pathology. MATERIALS AND METHODS We used to treat the affected areas with a combination of 1927 nm thulium fiber laser and MAL PDT in the same section. The same protocol was repeated after 1 month. RESULTS An improvement of lesions after the first treatment and complete cleaning after 3 months of therapy were noted. Results were maintained in the follow-up after 2 years. CONCLUSIONS Association with 1927 nm thulium laser was able to amplify the effectiveness of PDT and to promote tissue remodeling. Despite the positive response to our case, clinical studies are lacking and further analysis could be performed on a wider population to better define correct dosage and safety profile. Further, it is necessary to compare this procedure with other treatments to establish the real effectiveness.
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Affiliation(s)
| | - Pina Brianti
- 1 Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital , Milan, Italy
| | - Antonio Foti
- 1 Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital , Milan, Italy
| | - Marco Bartolucci
- 1 Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital , Milan, Italy
| | - Annunziata Dattola
- 2 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
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127
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Vujić N, Viduljević M, Bižić M. Frequency of balanitis xerotica obliterans among boys with phimosis. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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128
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129
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Corazza M, Virgili A, Minghetti S, Borghi A. Dyspareunia in vulvar lichen sclerosus: an overview of a distressing symptom. GIORN ITAL DERMAT V 2017; 155:299-305. [PMID: 29249126 DOI: 10.23736/s0392-0488.17.05849-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dyspareunia is a symptom of vulvar lichen sclerosus (VLS). This study specifically addressed prevalence and severity of dyspareunia in patients affected with VLS as well as the factors that can influence its occurrence. Changes in the severity of dyspareunia with treatment were also explored. METHODS In this retrospective, cohort study we included VLS patients who had undergone any topical treatment for 12 weeks, between January 2011 and March 2016, at our Vulva Unit; demographics, history and clinical features recorded at baseline and at treatment completion were elaborated. RESULTS The study included 177 patients; among the 90 patients who reported having sexual activity 56.7% complained of dyspareunia; the frequency and severity of dyspareunia was higher among the patients who had not previously been treated with topical corticosteroids than among those who had undergone previous treatments; the patients complaining of dyspareunia reported significantly higher scores for itching and burning compared with those who did not have painful intercourses; after the treatment, 52.5%, 78.4% and 64.3% of the patients reported an improvement ≥75% compared with baseline in dyspareunia, itching and burning scores, respectively. CONCLUSIONS Dyspareunia occurred in more than half VLS patients. The patients who complained of dyspareunia had a more severe overall symptom profile than those who did not report having painful intercourses. The objective severity of VLS did not seem to significantly affect dyspareunia occurrence and severity. Dyspareunia was found to be the symptom most resistant to treatment, however early treatment can be expected to reduce its occurrence and severity.
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Affiliation(s)
- Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Annarosa Virgili
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Sara Minghetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
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130
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Peng X, Guo H, Jin C, Wang L, Sa Y. Squamous Cell Carcinoma of the Bulbar Urethra Accompanied by Lichen Sclerosus: A Case Report. Am J Mens Health 2017; 12:493-497. [PMID: 29182032 PMCID: PMC5818129 DOI: 10.1177/1557988317743386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the bulbar urethra accompanied by lichen sclerosus (LS) is rarely reported. This study reports the case of a 56-year-old man with urethral squamous cell carcinoma (USCC) accompanied by a long history of genital LS. The man presented with a painful perineal mass and had a long-term history of urethral strictures and urethral dilatation. The patient developed a periurethral abscess that expanded to the perineum and formed an urethrocutaneousperineal fistula. An organ-sparing perineal resection and fistulectomy was performed according to the patient's wishes. During the operation, residue-like pus mixed with necrotic tissues drained out. A section of the prepuce and the necrotic tissues were sent for histological analysis. Hematoxylin and eosin (HE) staining of the excised prepuce revealed classical LS. HE and immunohistochemical (IHC) staining of the necrotic tissues showed well-differentiated USCC. IHC staining showed the USCC to be positive for P53 and Ki-67 and negative for P16, suggesting the USCC was probably associated with LS. The patient received high-dose chemotherapy and radiation therapy and died 10 months after surgery.
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Affiliation(s)
- Xufeng Peng
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Hailin Guo
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Chongrui Jin
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Lin Wang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Yinglong Sa
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
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131
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Mashayekhi S, Flohr C, Lewis FM. The treatment of vulval lichen sclerosus in prepubertal girls: a critically appraised topic. Br J Dermatol 2017; 176:307-316. [PMID: 28244087 DOI: 10.1111/bjd.15202] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/29/2022]
Abstract
Lichen sclerosus is one of the dermatoses that specifically affects the anogenital skin. It has peaks of incidence in prepubertal girls and postmenopausal women. The objective of this critical appraisal was to review systematically the evidence for efficacy and safety of different treatments. There are no randomized controlled studies of treatment in prepubertal girls and most studies are small case series or case reports. There is little focus on quality of life.
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Affiliation(s)
- S Mashayekhi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, U.K
| | - C Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, U.K
| | - F M Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, U.K
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132
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Abstract
Vulvovaginal conditions are common in mature women. This reflects age-related changes in immunity and skin barrier function of vulvovaginal tissues. Vaginal atrophy is commonly complicated by dryness and inflammation, which makes postmenopausal atrophic vaginitis a virtually ubiquitous condition. The differential of vaginitis includes inflammatory, infectious, and malignant diseases, plus drug hypersensitivity. Atrophic vaginitis is treated with estrogen replacement therapy. Vulvovaginal malignant melanoma occurs predominantly in postmenopausal women and carries a poor prognosis. Similarly, the incidence of vulvovaginal malignancies, such as squamous cell carcinoma and extramammary Paget disease, rises exponentially after 65 years of age. Early diagnosis of these malignancies is of utmost importance. Lichen sclerosus et atrophicus and vulvovaginal candidosis are among the most common postmenopausal vulvovaginal conditions. Lichen sclerosus et atrophicus is associated with significant morbidity, and its management can be challenging. The incidence of vulvovaginal candidosis increases in patients on estrogen replacement therapy.
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Affiliation(s)
- Natalie Matthews
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | - Vivian Wong
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
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133
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Bevans SL, Keeley JM, Sami N. Oral lichen sclerosus—a review of clinical presentation, treatment, and clinical outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e243-e248. [DOI: 10.1016/j.oooo.2017.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
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134
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Uzuncakmak TK, Akdeniz N, Suslu H, Zemheri E, Karadag AS. Folliculocentric hyperkeratotic lichen sclerosus in a 7-year-old child successfully treated with narrowband ultraviolet B phototherapy. Clin Exp Dermatol 2017; 43:91-93. [DOI: 10.1111/ced.13216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- T. K. Uzuncakmak
- Department of Dermatology; Istanbul Medeniyet University Medical Faculty; Goztepe Research and Training Hospital; Istanbul Turkey
| | - N. Akdeniz
- Department of Dermatology; Istanbul Medeniyet University Medical Faculty; Goztepe Research and Training Hospital; Istanbul Turkey
| | - H. Suslu
- Department of Dermatology; Istanbul Medeniyet University Medical Faculty; Goztepe Research and Training Hospital; Istanbul Turkey
| | - E. Zemheri
- Department of Pathology; Istanbul Medeniyet University Medical Faculty; Goztepe Research and Training Hospital; Istanbul Turkey
| | - A. S. Karadag
- Department of Dermatology; Istanbul Medeniyet University Medical Faculty; Goztepe Research and Training Hospital; Istanbul Turkey
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135
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136
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Maździarz A, Osuch B, Kowalska M, Nalewczyńska A, Śpiewankiewicz B. Photodynamic therapy in the treatment of vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2017; 19:135-139. [PMID: 28526592 DOI: 10.1016/j.pdpdt.2017.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/29/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vulvar lichen sclerosus is a chronic and incurable disease that causes various unpleasant symptoms and serious consequences. OBJECTIVE The purpose of the study was to assess the effectiveness of photodynamic therapy in the treatment of vulvar lichen sclerosus. METHODS Participants in the study included 102 female patients aged 19-85 suffer from vulvar lichen sclerosus. The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form. The affected areas were irradiated with a halogenic lamp PhotoDyn 501 (590-760nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks. RESULT PDT has brought about a good therapeutic effect (complete or partial clinical remission), with 87.25% improvement rate in patients suffering from lichen sclerosus. The greatest vulvoscopic response was observed in the reduction of subepithelial ecchymoses and teleangiectasia (78.95%), and the reduction of erosions and fissures (70.97%). A partial remission of lichenification with hyperkeratosis was observed in 51.61% of cases. The least response was observed in the atrophic lesions reduction (improvement in 37.36% of cases). CONCLUSION Our patients suffering from vulvar lichen sclerosus demonstrated positive responses to photodynamic therapy and the treatment was well tolerated. Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.
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Affiliation(s)
- Agnieszka Maździarz
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Roentgena Street 5, 02-781 Warsaw, Poland.
| | - Beata Osuch
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Roentgena Street 5, 02-781 Warsaw, Poland
| | - Magdalena Kowalska
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Roentgena Street 5, 02-781 Warsaw, Poland
| | - Agnieszka Nalewczyńska
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Roentgena Street 5, 02-781 Warsaw, Poland
| | - Beata Śpiewankiewicz
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Roentgena Street 5, 02-781 Warsaw, Poland.
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137
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Corazza M, Virgili A, Toni G, Borghi A. Mometasone furoate in the treatment of vulvar lichen sclerosus: could its formulation influence efficacy, tolerability and adherence to treatment? J DERMATOL TREAT 2017; 29:305-309. [DOI: 10.1080/09546634.2017.1360990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Monica Corazza
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Annarosa Virgili
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Giulia Toni
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
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138
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Sand FL, Thomsen SF. Skin diseases of the vulva: inflammatory, erosive-ulcerating and apocrine gland diseases, zinc and vitamin deficiency, vulvodynia and vestibulodynia. J OBSTET GYNAECOL 2017; 38:149-160. [DOI: 10.1080/01443615.2017.1328590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Freja Lærke Sand
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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139
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Tomo S, Santos IS, de Queiroz SA, Bernabé DG, Simonato LE, Miyahara GI. Uncommon oral manifestation of lichen sclerosus: critical analysis of cases reported from 1957 to 2016. Med Oral Patol Oral Cir Bucal 2017; 22:e410-e416. [PMID: 28578370 PMCID: PMC5549513 DOI: 10.4317/medoral.21606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 04/22/2017] [Indexed: 12/24/2022] Open
Abstract
Background Lichen sclerosus is a mucocutaneous autoimmune disease which might be initiated by infectious pathogens as Borrelia Bugrdorferi and HPV. This disease shows destructive potential and is rarely diagnosed in oral mucosa. The purpose of this paper is to evaluate the characteristics of cases described in literature from 1957 to 2016, looking to provide valuable evidence about clinicopathologic features of this disease. Material and Methods A MedLine search was performed aiming to find oral lichen sclerosus cases in literature and discuss its demographical and pathological characteristics as well as treatment methods performed for these cases. Results 34 oral lichen sclerosus cases with histological confirmation and one clinicopathologic study linked with this disease were found in literature. Oral lichen sclerosus affected most commonly female patients, were asymptomatic and not associated to skin or genital lesions. Furthermore, affected patients in a range of 7 – 70-years old (Average age = 31.81). Conclusions Oral lichen sclerosus is a rare pathologic process with slight predilection for prepubertal girls, for which topical corticosterois have demonstrated satisfactory therapeutic value. Key words:Lichen sclerosus et atrophicous, skin diseases, mouth disease, autoimmune diseases, mouth.
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Affiliation(s)
- S Tomo
- Oral Oncology Center and Department of Pathology and Clinical Propedeutics, Araçatuba Dental School, São Paulo State University - UNESP 1193 José Bonifácio St. Araçatuba, São Paulo, Brazil, 16015-050,
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140
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Pappova T, Pec J, Kozarova A, Adamicova K. Cutaneous Paraneoplastic Manifestation (Morphea, Lichen Sclerosus) – Two Case Reports. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Internal malignancy may be presented in the form of paraneoplastic syndromes, which may indicate either formation or recurrence of a previously treated malignancy. Furthermore cutaneous paraneoplastic disorders often precede a diagnosis of cancer. We present 2 unique case reports with cutaneous paraneoplastic manifestations. The first one describes a patient with sudden progression of long-term stabilized morphea in connection with newly diagnosed hepatocellular carcinoma (HCC). The second one describes female patient with breast cancer preceded by the development of extragenital lichen sclerosus (LS) with typical sclerotic lesions and hemorrhagic bullae.
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Affiliation(s)
- T. Pappova
- Comenius University Jessenius Faculty of Medicine and University Hospital, Department of Dermatovenerology, Martin, Kollarova Str. N.2, 03601, Martin , Slovak Republic
| | - J. Pec
- Comenius University Jessenius Faculty of Medicine and University Hospital, Department of Dermatovenerology, Martin , Slovak Republic
| | - A. Kozarova
- Comenius University Jessenius Faculty of Medicine and University Hospital, Department of Dermatovenerology, Martin , Slovak Republic
| | - K. Adamicova
- Comenius University, Jessenius Faculty of Medicine and University Hospital, Department of Pathology, Martin , Slovak Republic
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141
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Lomax AJ, McGuire HM, McNeil C, Choi CJ, Hersey P, Karikios D, Shannon K, van Hal S, Carr U, Crotty A, Gupta SK, Hollingsworth J, Kim H, Fazekas de St Groth B, McGill N. Immunotherapy-induced sarcoidosis in patients with melanoma treated with PD-1 checkpoint inhibitors: Case series and immunophenotypic analysis. Int J Rheum Dis 2017; 20:1277-1285. [PMID: 28480561 DOI: 10.1111/1756-185x.13076] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM Sarcoidosis is a multisystem granulomatous disease. This condition has a documented association with the diagnosis of melanoma and can be induced in melanoma patients receiving anti-neoplastic therapy. We evaluated a case series of melanoma patients who developed immunotherapy-induced sarcoidosis. METHODS Three patients with melanoma (n = 1 resected Stage III, n = 2 metastatic) treated with anti-programmed cell death (PD)-1 antibody therapy at two institutions developed biopsy-proven sarcoidosis. We used mass cytometry to determine expression of the relevant chemokine receptors (CR) by peripheral blood mononuclear cells for two of the three patients who developed sarcoidosis and 13 melanoma patients who did not. Blood samples were collected before receiving PD-1 checkpoint inhibitor therapy. RESULTS Immunophenotypic analysis demonstrated abnormally high numbers of circulating Th17.1 (CCR6+ CCR4- CXCR3+ CCR10- ) cells prior to commencing PD-1 checkpoint inhibitor therapy in five of 15 melanoma patients, including both the patients who developed sarcoidosis during the course of therapy. CONCLUSION Our findings support prior literature implicating Th17.1 cells in the pathogenesis of sarcoidosis. However, we demonstrate these findings in patients with melanoma prior to administration of checkpoint therapy and before the onset of clinically symptomatic sarcoidosis. The identification of elevated Th17.1 cells in melanoma patients who have not developed sarcoidosis may reflect the established association between melanoma and sarcoidosis. With some patients receiving these agents over a prolonged period, the clinical course of immunotherapy-induced sarcoidosis is uncertain.
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Affiliation(s)
- Anna J Lomax
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Helen M McGuire
- University of Sydney, Sydney, New South Wales, Australia.,Centenary Institute, Sydney, New South Wales, Australia
| | - Catriona McNeil
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Clara J Choi
- University of Sydney, Sydney, New South Wales, Australia.,Centenary Institute, Sydney, New South Wales, Australia
| | - Peter Hersey
- Centenary Institute, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Deme Karikios
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Nepean Hospital, Sydney, New South Wales, Australia
| | - Kerwin Shannon
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Sebastian van Hal
- University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Urszula Carr
- Kossard Dermatopathologists, Sydney, New South Wales, Australia
| | - Anne Crotty
- Pathology North - Hunter, Newcastle, New South Wales, Australia
| | - Sandeep K Gupta
- John Hunter and Calvary Mater Hospitals, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Jane Hollingsworth
- University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Haewon Kim
- University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Barbara Fazekas de St Groth
- University of Sydney, Sydney, New South Wales, Australia.,Centenary Institute, Sydney, New South Wales, Australia
| | - Neil McGill
- University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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142
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Morris BJ, Krieger JN. Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision. Int J Prev Med 2017; 8:32. [PMID: 28567234 PMCID: PMC5439293 DOI: 10.4103/ijpvm.ijpvm_377_16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/07/2017] [Indexed: 01/12/2023] Open
Abstract
Penile inflammatory skin conditions such as balanitis and posthitis are common, especially in uncircumcised males, and feature prominently in medical consultations. We conducted a systematic review of the medical literature on PubMed, EMBASE, and Cohrane databases using keywords "balanitis," "posthitis," "balanoposthitis," "lichen sclerosus," "penile inflammation," and "inflammation penis," along with "circumcision," "circumcised," and "uncircumcised." Balanitis is the most common inflammatory disease of the penis. The accumulation of yeasts and other microorganisms under the foreskin contributes to inflammation of the surrounding penile tissue. The clinical presentation of inflammatory penile conditions includes itching, tenderness, and pain. Penile inflammation is responsible for significant morbidity, including acquired phimosis, balanoposthitis, and lichen sclerosus. Medical treatment can be challenging and a cost burden to the health system. Reducing prevalence is therefore important. While topical antifungal creams can be used, usually accompanied by advice on hygiene, the definitive treatment is circumcision. Data from meta-analyses showed that circumcised males have a 68% lower prevalence of balanitis than uncircumcised males and that balanitis is accompanied by a 3.8-fold increase in risk of penile cancer. Because of the high prevalence and morbidity of penile inflammation, especially in immunocompromised and diabetic patients, circumcision should be more widely adopted globally and is best performed early in infancy.
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Affiliation(s)
- Brian J. Morris
- Department of Physiology, School of Medical Sciences and Bosch Institute, University of Sydney, New South Wales 2006, Australia
| | - John N. Krieger
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Section of Urology, Seattle, Washington 98108, USA
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143
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Toxic shock syndrome due to community-acquired methicillin-resistant Staphylococcus aureus infection: Two case reports and a literature review in Japan. IDCases 2017; 8:77-80. [PMID: 28491813 PMCID: PMC5423323 DOI: 10.1016/j.idcr.2017.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022] Open
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus has been spreading worldwide, including in Japan. However, few cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus have been reported in Japan. We report 2 cases, in middle-aged women, of toxic shock syndrome due to Community-acquired methicillin-resistant Staphylococcus aureus via a vaginal portal of entry. The first patient had used a tampon and the second patient had vaginitis due to a cleft narrowing associated with vulvar lichen sclerosus. Both patients were admitted to our hospital with septic shock and severe acute kidney injury and subsequently recovered with appropriate antibiotic treatment. In our review of the literature, 8 cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus were reported in Japan. In these 8 cases, the main portals of entry were the skin and respiratory tract; however, the portal of entry of Community-acquired methicillin-resistant Staphylococcus aureus from a vaginal lesion has not been reported in Japan previously.
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144
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Women With Primary Sjögren Syndrome and With Non-Sjögren Sicca Syndrome Show Similar Vulvar Histopathologic and Immunohistochemical Changes. Int J Gynecol Pathol 2017; 35:585-592. [PMID: 27532148 DOI: 10.1097/pgp.0000000000000295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this study was to evaluate the characteristics and the prevalence of histopathologic and immunohistochemical changes in vulvar biopsies, in women with Primary Sjögren Syndrome (pSS) and non-Sjögren Sicca Syndrome (nS-SS). Twenty-one women with pSS and 11 with nS-SS (investigated by xerophtalmia and xerostomia tests, biopsy of minor salivary glands, gynecological history, and gynecologic symptoms score) underwent vulvar biopsies, evaluated for histopathologic and immunohistochemicalchanges, and compared with those obtained from 26 patients with lichen sclerosus. An inflammatory infiltrate was present in 31/32 biopsies (96.9%); biopsies from pSS patients showed a mild infiltrate in 10 cases and a moderate infiltrate in 11 cases; and patients with nS-SS had a mild infiltrate in 8 biopsies and moderate infiltrate in the other 2 biopsies. By immunohistochemistry, the infiltrate was composed predominantly of T lymphocytes (CD3), CD20 B cells were sparse and mean CD4:CD8 T-cell ratio was 1.5. No differences were observed between the grading of the inflammatory infiltrate in nS-SS and pSS; no correlation was shown between vulvar inflammatory infiltrate score (mild or moderate) and salivary glands inflammatory score. No differences were found in gynecologic symptoms, as well as in clinical and demographical characteristics between patients with mild and those with moderate vulvar inflammatory score. A higher prevalence of moderate inflammatory infiltrate was observed in biopsies from women with lichen sclerosus than in pSS and nS-SS patients (61.5% vs. 27.5%, P=0.02). Women with pSS and nS-SS show a high and similar prevalence of vulvar inflammatory infiltrate. A gynecologic evaluation is needed both in pSS and nS-SS to assess genital involvement and, eventually, to address a therapy targeted to genital symptoms.
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145
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Rangatchew F, Knudsen J, Thomsen MV, Drzewiecki KT. Surgical treatment of disabling conditions caused by anogenital lichen sclerosus in women: An account of surgical procedures and results, including patient satisfaction, benefits, and improvements in health-related quality of life. J Plast Reconstr Aesthet Surg 2017; 70:501-508. [DOI: 10.1016/j.bjps.2016.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/13/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
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146
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Fruchter R, Melnick L, Pomeranz MK. Lichenoid vulvar disease: A review. Int J Womens Dermatol 2017; 3:58-64. [PMID: 28492056 PMCID: PMC5419035 DOI: 10.1016/j.ijwd.2017.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/05/2017] [Accepted: 02/05/2017] [Indexed: 12/18/2022] Open
Abstract
Vulvar dermatoses are common, potentially debilitating conditions that can be seen by a variety of medical specialists. Lichenoid vulvar diseases, namely lichen sclerosus (LS), lichen planus (LP), and lichen simplex chronicus (LSC), can all negatively impact patients' quality of life and LS and LP also have an association with squamous cell carcinoma. It is essential that dermatologists are familiar with the unique features of each of these conditions to ensure the appropriate management and follow up. Herein, we provide an update on the epidemiology, clinical presentation, histopathology, and treatment of patients with vulvar LS, LP, and LSC.
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Affiliation(s)
- R Fruchter
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY
| | - L Melnick
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY
| | - M K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY.,Department of Dermatology, NYC Health and Hospital/Bellevue, New York, NY
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147
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van Cranenburgh O, Nijland S, Lindeboom R, de Korte J, de Rie M, ter Stege J, Prinsen C. Patients with lichen sclerosus experience moderate satisfaction with treatment and impairment of quality of life: results of a cross-sectional study. Br J Dermatol 2017; 176:1508-1515. [DOI: 10.1111/bjd.15125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 01/03/2023]
Affiliation(s)
- O.D. van Cranenburgh
- Dutch Skin Foundation; Utrecht the Netherlands
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | | | - R. Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - J. de Korte
- Dutch Skin Foundation; Utrecht the Netherlands
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - M.A. de Rie
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- VU University Medical Center; Department of Dermatology; Amsterdam the Netherlands
| | | | - C.A.C. Prinsen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- VU University Medical Center; Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; Amsterdam the Netherlands
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148
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Filippini M, Del Duca E, Negosanti F, Bonciani D, Negosanti L, Sannino M, Cannarozzo G, Nisticò SP. Fractional CO2 Laser: From Skin Rejuvenation to Vulvo-Vaginal Reshaping. Photomed Laser Surg 2017; 35:171-175. [DOI: 10.1089/pho.2016.4173] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maurizio Filippini
- Department of Obstetric and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino
| | - Ester Del Duca
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Negosanti
- Dermatology Center srl, Bologna, Italy
- “Laser in Dermatology,” University of Rome Tor Vergata, Rome, Italy
| | - Diletta Bonciani
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Ospedale “Piero Palagi,” Florence, Italy
| | - Luca Negosanti
- Division of Plastic Surgery, S.Orsola-Malpighi University Hospital Bologna, Bologna, Italy
| | - Mario Sannino
- “Laser in Dermatology,” University of Rome Tor Vergata, Rome, Italy
| | | | - Steven Paul Nisticò
- “Laser in Dermatology,” University of Rome Tor Vergata, Rome, Italy
- Dermatology Department of Health Sciences, “Magna Grecia” University of Catanzaro, Catanzaro, Italy
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149
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Olejek A, Gabriel I, Bilska-Janosik A, Kozak-Darmas I, Kawczyk-Krupka A. ALA-Photodynamic treatment in Lichen sclerosus-clinical and immunological outcome focusing on the assesment of antinuclear antibodies. Photodiagnosis Photodyn Ther 2017; 18:128-132. [PMID: 28219801 DOI: 10.1016/j.pdpdt.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/22/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a difficult to treat, often relapsing disease with unknown background. Autoimmune diseases also coexist with LS. Over recent years photodynamic therapy (PDT) has been shown to be a noninvasive and successful therapeutic approach for the effective treatment of many conditions. However, the change of immune status of the patients based on ANA antibodies has not been yet reported. Our aim was to observe the clinical response followed by possible changes in autoimmune antibodies levels before and after PDT for LS. MATERIAL AND METHODS We enrolled 100 women with Lichen sclerosus with or without a concomitant autoimmune disease. All patients received 10 cycles of PDT (65 treated with DIOMED Light, 35 with PhotoDYN Light). We assessed autoimmune antibodies before and after PDT in addition to the clinical response evaluation.Two-year prospective controlled before-and-after study. RESULTS Following PDT, patients showed a significant attenuation in symptoms' intensity (itching, pruritus, vulvar discomfort). After therapy 41% of patients had partial response, 51% of patients had no symptoms and 8% had persistent or worsened symptoms. The most frequent autoimmune disease were thyroid disorders, followed by vitiligo and arthritis. 57% patients with an additional autoimmune disease before PDT had ANA antibodies. The mean level of ANA in this group diminished significantly after PDT treatment (261.74 IU/ml before vs. 123.20 IU/ml after treatment). CONCLUSION Based on our results, we assume that PDT may influence the immune status of patients with Lichen sclerosus.
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Affiliation(s)
- Anita Olejek
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Iwona Gabriel
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland; Division of Urogynecology, Brigham and Women's Hospital, Boston, USA
| | - Anna Bilska-Janosik
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Iwona Kozak-Darmas
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Batorego 15, 41-902, Bytom, Poland.
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150
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Casabona F, Gambelli I, Casabona F, Santi P, Santori G, Baldelli I. Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus: the impact on tissue repair and patient quality of life. Int Urol Nephrol 2017; 49:573-580. [DOI: 10.1007/s11255-017-1523-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
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