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Time series analysis of TP53 gene mutations in recurrent HPV-negative vulvar squamous cell carcinoma. Mod Pathol 2019; 32:415-422. [PMID: 30291345 DOI: 10.1038/s41379-018-0141-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/16/2023]
Abstract
The impact of TP53 gene mutations in recurrent HPV-negative vulvar squamous cell carcinomas is unclear. TP53 gene mutations were analyzed in archival tissues of 24 primary squamous cell carcinoma and local vulvar recurrences arising in chronic inflammatory dermatoses by analyzing the full coding sequence of the TP53 gene and correlated with disease-free survival. After resection of the primary squamous cell carcinoma with clear margins 19/24 patients had one and 5/24 had multiple recurrences. The first recurrence occurred after median of 46 months (range 12-180 months). In all, 17/24 (71%) primary squamous cell carcinomas had TP53 gene mutations and recurred after median disease-free intervals of 33 months (range 12-180). 14/17 (88%) recurrent squamous cell carcinomas carried again TP53 gene mutations, five with identical and nine with different, more complex TP53 gene mutations. 7/24 (29%) patients with a p53 wild-type primary SCC had the first recurrence after median 65 months (range 14-144) featuring p53 wild-type in 3/7 (43%) and TP53 gene mutations in 4/7 (57%) recurrent squamous cell carcinomas. Disease-free intervals of > 5 years (60-180 months) were observed in 10/24 patients total (42%; equally divided among p53 wild-type (5/7; 71%) and TP53 gene mutated (5/17; 29%) squamous cell carcinomas). In summary, squamous cell carcinomas recurred in the residual vulvar dermatosis independent of TP53 gene mutational status of the primary squamous cell carcinoma. The majority of TP53 gene mutated cancers recurred with different TP53 gene mutations, some of them more complex, and patients with p53 wild type developed TP53 gene mutations in the recurrent squamous cell carcinomas, possibly indicating increased genetic instability in longstanding chronic inflammatory dermatoses. A change of TP53 gene mutational status after > 5 years suggests de novo oncogenic events/carcinogenesis. Longer disease-free intervals in patients with p53 wild-type primary squamous cell carcinoma suggest that TP53 gene mutational status may serve as a prognostic marker for disease-free intervals.
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Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, Heller DS, Mangir N, Marchitelli C, Mourad S, Moyal-Barracco M, Peremateu S, Tailor V, Tarcan T, De EJB, Stockdale CK. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. Neurourol Urodyn 2019; 38:1009-1023. [PMID: 30742321 DOI: 10.1002/nau.23931] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. AIMS In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. MATERIALS & METHODS This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. RESULTS Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. DISCUSSION The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. CONCLUSION At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
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Affiliation(s)
- Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal.,Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | | | - Carol Emi Bretschneider
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Margot Damaser
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Oktay Demirkesen
- Faculty of Medicine, Department of Urology, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Debra S Heller
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Naside Mangir
- Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield, Sheffield, UK.,Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Claudia Marchitelli
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sherif Mourad
- Department of Urology, Massachusetts General Hospital-Harvard Medical School Boston, Boston, Massachusetts
| | | | - Sol Peremateu
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Visha Tailor
- Department of Urogynaecology, Imperial College Healthcare, London, UK
| | - Tufan Tarcan
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Elise J B De
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
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103
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Fact or Fiction? Adipose-Derived Stem Cells and Platelet-Rich Plasma for the Treatment of Vulvar Lichen Sclerosus. J Low Genit Tract Dis 2019; 23:65-70. [PMID: 30252710 DOI: 10.1097/lgt.0000000000000440] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the study was to summarize and review the evidence for the efficacy and safety of adipose-derived stem cells (ADSCs) and platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus (LS). MATERIALS AND METHODS PubMed/MEDLINE, Ovid, Web of Science, and clinicaltrials.gov were searched from inception up to May 7, 2018. RESULTS Seven observational studies were identified, with a total of 98 patients. Both ADSCs and PRP were reported to improve symptoms, quality of life measures, as well as clinical and histological signs of vulvar LS. There is a strong risk of biased estimates of treatment effect. CONCLUSIONS Current evidence is weak for ADSCs and/or PRP as treatment for vulvar LS. Further research is needed before recommending this therapy.
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104
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Tziotzios C, Lee JYW, Brier T, Saito R, Hsu CK, Bhargava K, Stefanato CM, Fenton DA, McGrath JA. Lichen planus and lichenoid dermatoses: Clinical overview and molecular basis. J Am Acad Dermatol 2019; 79:789-804. [PMID: 30318136 DOI: 10.1016/j.jaad.2018.02.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Deriving from the Greek word λειχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders. The first article in this 2-part continuing medical education series provides a comprehensive overview of the clinical and pathologic characteristics of cutaneous lichenoid dermatoses and links these manifestations to recent advances in our understanding of the underlying pathobiology of such diseases.
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Affiliation(s)
- Christos Tziotzios
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom.
| | - John Y W Lee
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Timothy Brier
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Ryo Saito
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Chao-Kai Hsu
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Kapil Bhargava
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Catherine M Stefanato
- Department of Dermatopathology, St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom
| | - David A Fenton
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
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105
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Simpson RC, Cooper SM, Kirtschig G, Larsen S, Lawton S, McPhee M, Murphy R, Nunns D, Rees S, Tarpey M, Thomas KS. Future research priorities for lichen sclerosus - results of a James Lind Alliance Priority Setting Partnership. Br J Dermatol 2019; 180:1236-1237. [PMID: 30472735 PMCID: PMC6850137 DOI: 10.1111/bjd.17447] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R C Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - S M Cooper
- Department of Dermatology, Oxford University Hospitals, Oxford, U.K
| | | | | | - S Lawton
- Rotherham NHS Foundation Trust, Rotherham, U.K
| | - M McPhee
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - D Nunns
- Department of Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, U.K
| | - S Rees
- University of Warwick, Warwick, U.K
| | - M Tarpey
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
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Abstract
Objective The aim of the study was to assess for the presence of vulvar lichen planus (LP) in association with human papillomavirus (HPV)–independent squamous cell carcinoma (SCC). Materials and Methods We performed a clinicohistopathologic review of consecutive vulvectomies and wide local excisions for HPV-independent vulvar or vaginal SCC from 2007 to 2017. Data collected included site of SCC, adjacent precursor lesions and dermatoses, dermatologic treatment, and outcome. Results There were 43 cases of primary HPV-independent vulvar SCC treated by excision, but no vaginal cancers. Eighteen women (42%) had a preoperative diagnosis of lichen sclerosus (LS); none had a diagnosis of LP. Topical corticosteroids were prescribed in 19 (44%) of 43, with 4 women placed on maintenance therapy. Tumors arose from the labia minora, labia majora, and periclitoris, but not from vestibule or perianus. On histopathological review, LS was present in 41 (95%) of 43 specimens, 1 had a nonspecific lichenoid reaction, and 1 had lichen simplex; both of the latter had subsequent biopsies showing LS. Lichen planus was not seen in association with SCC. Differentiated vulvar intraepithelial neoplasia (dVIN) was present in 38 (88%) of 43 specimens, whereas 1 had acanthosis with altered differentiation and 4 (9%) had no precursor lesion. Differentiated vulvar intraepithelial neoplasia had standard, basaloid, and hypertrophic morphology, superficially resembling erosive LP in 9 (24%) of 38 and hypertrophic LP in 6 (16%) of 38. Conclusions Lichen planus was not seen in association with HPV-independent vulvar SCC, whereas LS was underrecognized and inadequately treated in this group. Pathologists should be aware that dVIN may superficially resemble erosive or hypertrophic LP.
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107
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Moinzadeh P, Kreuter A, Krieg T, Hunzelmann N. Morphea/lokalisierte Sklerodermie und extragenitaler Lichen sclerosus. Hautarzt 2018; 69:892-900. [DOI: 10.1007/s00105-018-4266-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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108
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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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109
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Grandi V, Sessa M, Pisano L, Rossi R, Galvan A, Gattai R, Mori M, Tiradritti L, Bacci S, Zuccati G, Cappugi P, Pimpinelli N. Photodynamic therapy with topical photosensitizers in mucosal and semimucosal areas: Review from a dermatologic perspective. Photodiagnosis Photodyn Ther 2018; 23:119-131. [PMID: 29669264 DOI: 10.1016/j.pdpdt.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
Photodynamic Therapy is a procedure based on the interaction between a Photosensitizer, a light source with a specific wavelength and oxygen. The aim of this review is to provide a brief and updated analysis of scientific reports on the use of PDT with topical PS in the management of oncological, infectious, and inflammatory disorders involving mucosal and semimucosal areas, with a specific focus on diseases of dermatologic interest.
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Affiliation(s)
- Vieri Grandi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy.
| | - Maurizio Sessa
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Via L. De Crecchio 7, Naples, Italy
| | - Luigi Pisano
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Riccardo Rossi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Arturo Galvan
- Private Practice Dermatologist, C.M.R, Via S. Giovanni Bosco, 24, 36015, Schio, Italy
| | - Riccardo Gattai
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Largo Brambilla 3, 50141, Florence, Italy
| | - Moira Mori
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Luana Tiradritti
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Stefano Bacci
- Department of Clinical and Experimental Medicine, Research Unit of Histology and Embriology, University of Florence, 50141, Florence, Italy
| | - Giuliano Zuccati
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Pietro Cappugi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Nicola Pimpinelli
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
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110
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Marcos-Pinto A, Soares-de-Almeida L, Borges-Costa J. Nonvenereal Penile Dermatoses: A Retrospective Study. Indian Dermatol Online J 2018; 9:96-100. [PMID: 29644193 PMCID: PMC5885634 DOI: 10.4103/idoj.idoj_23_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis. Aims: To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period. Materials and Methods: A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses. Results: The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease. Conclusions: In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area.
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Affiliation(s)
- Ana Marcos-Pinto
- University Clinic of Dermatology, Hospital de Santa Maria, Lisbon, Portugal
| | - Luís Soares-de-Almeida
- University Clinic of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.,Institute of Molecular Medicine, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Borges-Costa
- University Clinic of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.,Institute of Molecular Medicine, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.,Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
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111
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Zhang J, Xue R, Lin E, Pan H, Chen Y. Linear orofacial lichen sclerosus. Indian J Dermatol Venereol Leprol 2018; 84:197-199. [PMID: 29405132 DOI: 10.4103/ijdvl.ijdvl_856_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jiao Zhang
- Department of Dermatological, Dermatology Hospital, Southern Medical University, Guangdong Povincial Dermatology Hospital, Guangzhou, China
| | - Ruzeng Xue
- Department of Dermatological, Dermatology Hospital, Southern Medical University, Guangdong Povincial Dermatology Hospital, Guangzhou, China
| | - Eryi Lin
- Department of Dermatological, Dermatology Hospital, Southern Medical University, Guangdong Povincial Dermatology Hospital, Guangzhou, China
| | - Huiqin Pan
- Department of Dermatological, Dermatology Hospital, Southern Medical University, Guangdong Povincial Dermatology Hospital, Guangzhou, China
| | - Yongfeng Chen
- Department of Dermatological, Dermatology Hospital, Southern Medical University, Guangdong Povincial Dermatology Hospital, Guangzhou, China
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112
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113
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Kirtschig G. Lichen Sclerosus-Presentation, Diagnosis and Management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:337-43. [PMID: 27232363 DOI: 10.3238/arztebl.2016.0337] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lichen sclerosus is a chronic inflammatory skin disease. It is thought to be underdiagnosed and undertreated. If it is not treated, lichen sclerosus is associated with a greater degree of scarring and an elevated risk of cancer in the genital area. METHODS This review is based on pertinent articles published up to October 2015 that were retrieved by a selective search in PubMed, Embase, and the Cochrane Library and on the European S3 guideline for lichen sclerosus. RESULTS Lichen sclerosus is mainly found in the anogenital area but can also be generalized. Extragenital involvement is reportedly present in 6% to 20% of patients. Neighboring mucous membranes, such as the vaginal or oral mucosa, are not typically affected. The disease is more common in women than in men, and occurs more often in adults than in children. About 10% of patients have other family members with the same condition. Anogenital lichen sclerosus often causes itching and pain. Functional impairment due to fissures and scars can arise over the course of the condition. The treatment of first choice is the local application of high-potency corticosteroids as early as possible (1/A). For boys and men in whom the condition does not remit after steroid treatment, circumcision is indicated (3/D). CONCLUSION Anogenital itching and clinical features such as erythema, white skin changes (such as hyperkeratosis and sclerosis), and fissures should arouse suspicion of lichen sclerosus. The diagnosis should be confirmed with a skin biopsy, and early, thorough treatment should be initiated. In this way, a mutilating disease course can be averted, and the risk of cancer can be lessened.
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Affiliation(s)
- Gudula Kirtschig
- Department of General Medicine and Interprofessional Care, University Hospital Tübingen
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114
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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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115
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Abstract
Lichen sclerosus is a chronic, inflammatory dermatosis that usually affects the anogenital area. Early diagnosis and subsequent long-term anti-inflammatory treatment may reduce symptoms and signs and the risk of a mutilating course and the development of carcinomas.
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Affiliation(s)
- G Kirtschig
- Hautklinik, Universitätsklinikum Marburg & Gießen, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
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116
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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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117
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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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118
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Ljubojević Hadžavdić S, Krtanjek J, Đurinec P, Žele-Starčević L, Skerlev M, Bartenjev I. Coexistence of genital lichen sclerosus and genital warts. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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119
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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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120
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Nerantzoulis I, Grigoriadis T, Michala L. Genital lichen sclerosus in childhood and adolescence-a retrospective case series of 15 patients: early diagnosis is crucial to avoid long-term sequelae. Eur J Pediatr 2017; 176:1429-1432. [PMID: 28856426 DOI: 10.1007/s00431-017-3004-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/02/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Lichen sclerosus is a chronic skin disease, mainly localised at the introitus and perineum. When the condition remains untreated, gradual atrophy of skin structures leads to permanent scarring, making early diagnosis and treatment crucial. We reviewed all patients diagnosed with lichen sclerosus presenting to a tertiary referral centre for paediatric and adolescent gynaecology between January 2011 and December 2015 to assess disease presentation and response to treatment. We identified 15 cases, with a mean age at diagnosis of 8.8 years. Their main presenting symptoms were vulvar pruritus and vulvar soreness. Seven girls had already atrophic changes, and in four girls, this amounted to clitoral phimosis, labial resorption or labial adhesion formation. The median delay in diagnosis was 7 months. Thirteen patients received local treatment with potent corticosteroids, responding well to treatment. However, 4 girls relapsed within 2 to 36 months. Two adolescents required surgical treatment, one because of urinary retention and the second because of dyspareunia caused by clitoral entrapment. CONCLUSIONS There was a delay in diagnosis in most patients and this resulted in irreversible genital skin changes, which would have been preventable, had treatment been instituted promptly. The response to treatment with local corticosteroids was usually effective, leading to both symptom alleviation and prevention of disease progression. Atrophic changes and skin complications however were not reversed. What is Known: • Lichen sclerosus affects women of all ages, including girls, particularly prior to adolescence. • Lichen sclerosus responds well to local corticosteroid treatment. What is New: • In the majority of patients with lichen sclerosus there was a long delay between onset of symptoms and diagnosis. • Nearly half of the children diagnosed with lichen sclerosus had irreversible atrophic genital skin changes at the time of first presentation. These changes may have been prevented by a timely diagnosis and intervention.
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Affiliation(s)
- Ioannis Nerantzoulis
- First Department of Obstetrics and Gynaecology, University of Athens, 80 Vas Sofias Avenue, Athens, Greece
| | - Themistoklis Grigoriadis
- First Department of Obstetrics and Gynaecology, University of Athens, 80 Vas Sofias Avenue, Athens, Greece
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, University of Athens, 80 Vas Sofias Avenue, Athens, Greece.
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121
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Gocev G, Nikolovska S, Dohcheva-Karajovanov I. A Pediatric Case of Disseminated Lichen Sclerosus – a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2017. [DOI: 10.1515/sjdv-2017-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Lichen sclerosus (LS) is an uncommon chronic inflammatory skin disorder with a predilection for the anogenital area, characterized by porcelain white papules, plaques and atrophic patches. We report a prepubertal, 12-year-old girl who presented with chronic, disseminated pearly, flat-topped papules, plaques and atrophic patches located on the trunk, limbs and in the anogenital area, consistent with LS based on clinical and histologic findings. Potent and ultrapotent topical corticosteroids should be considered as first-line treatment. The ultraviolet A1 (UVA1) and calcipotriol for extragenital lesions, as well as calcineurin inhibitors for anogenital lesions, are other treatment options for pediatric LS.
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Affiliation(s)
- Gjorgji Gocev
- University Clinic of Dermatology , Medical Faculty , Skopje , Macedonia (the former Yugoslav Republic of)
| | - Suzana Nikolovska
- University Clinic of Dermatology , Medical Faculty , Skopje , Macedonia (the former Yugoslav Republic of)
| | - Ivana Dohcheva-Karajovanov
- University Clinic of Dermatology , Medical Faculty , Skopje , Macedonia (the former Yugoslav Republic of)
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122
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Borghi A, Virgili A, Minghetti S, Toni G, Corazza M. Clearance in vulvar lichen sclerosus: a realistic treatment endpoint or a chimera? J Eur Acad Dermatol Venereol 2017; 32:96-101. [DOI: 10.1111/jdv.14516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
Affiliation(s)
- A. Borghi
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - A. Virgili
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - S. Minghetti
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - G. Toni
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - M. Corazza
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
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123
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Lewin MR, Hick RW, Selim MA. Lichenoid Dermatitis of the Vulva: Diagnosis and Differential Diagnosis for the Gynecologic Pathologist. Adv Anat Pathol 2017; 24:278-293. [PMID: 28654444 DOI: 10.1097/pap.0000000000000160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inflammatory processes affecting the vulva may present a unique challenge due to location specific changes. Different factors are behind the intricacy in the presentation of vulvar dermatoses. First, the vulva is lined by different epithelia (hair-bearing keratinized epithelium, modified mucosa, and mucosa). Furthermore, among other factors, this organ is exposed to friction, occlusion, and trauma. Lastly, as there is a tendency to look for health care advice at an advanced stage of the disease, the lesion may be modified by secondary changes due to self-treatment. This article describes the clinical presentation and pathologic features of vulvar dermatoses with a lichenoid pattern and highlights practical points for their diagnoses.
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124
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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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125
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Affiliation(s)
- F. R. Pérez-López
- Department of Obstetrics and Gynaecology, Hospital Universitario Lozano-Blesa, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - P. Vieira-Baptista
- Lower Genital Tract Disease Unit, Centro Hospitalar de São João, Porto, Portugal
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126
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Abstract
During complete inspection of skin a variety of penile skin alterations may be found. Not all dermatological findings have clinical relevance. Pearly papules and heterotopic sebaceous glands are physiological variations. Most penile melanotic macules, angiokeratoma, fibroma and angioma have not to be treated. However, other more severe diseases such as malignant skin lesions (erythroplasia of Queyrat), infectious disease (human papillomavirus-induced penile warts) or systemic skin diseases (psoriasis) may be detected. Since patients are alarmed by genital skin lesions and their sexuality may be affected, the initiation of adequate therapy is an important task for urologists and dermatologists.
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127
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Köhn FM, Schultheiss D, Krämer-Schultheiss K. [Dermatological diseases of the external male genitalia : Part 1]. Urologe A 2017; 55:829-42. [PMID: 27250104 DOI: 10.1007/s00120-016-0136-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The urological examination of male patients includes an inspection of the external genitalia whereby a variety of dermatological alterations can be found. Not all dermatological findings are of clinical relevance. Pearly penile papules and heterotopic sebaceous glands are examples of normal physiological variations. Most penile melanotic macules, angiokeratomas, fibromas and angiomas do not have to be treated; however, penile skin lesions may also be symptoms of other diseases, such as circinate balanitis in Reiter's syndrome and multiple angiokeratomas in Fabry's disease. A typical manifestation of reactions to various drugs is the fixed drug eruption of penile skin. The differential diagnosis of various forms of balanoposthitis may be difficult and requires histological investigations (e.g. plasma cell balanitis or Zoon's disease). In contrast, the clinical manifestation of lichen sclerosus et atrophicus is easy to recognize. The clinical relevance of this disease is due to phimosis and problems during sexual intercourse.
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Affiliation(s)
- F M Köhn
- Andrologicum München, Burgstr. 7, 80331, München, Deutschland.
| | - D Schultheiss
- Gemeinschaftspraxis für Dermatologie und Urologie, Gießen, Deutschland
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128
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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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129
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Barbagli G, Fossati N, Larcher A, Montorsi F, Sansalone S, Butnaru D, Lazzeri M. Correlation Between Primary Hypospadias Repair and Subsequent Urethral Strictures in a Series of 408 Adult Patients. Eur Urol Focus 2017; 3:287-292. [DOI: 10.1016/j.euf.2017.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/07/2017] [Indexed: 12/20/2022]
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130
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Chi CC, Kirtschig G, Aberer W, Gabbud JP, Lipozenčić J, Kárpáti S, Haustein UF, Wojnarowska F, Zuberbier T. Updated evidence-based (S2e) European Dermatology Forum guideline on topical corticosteroids in pregnancy. J Eur Acad Dermatol Venereol 2017; 31:761-773. [DOI: 10.1111/jdv.14101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- C.-C. Chi
- Department of Dermatology; Chang Gung Memorial Hospital; Linkou and College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - G. Kirtschig
- Department of Dermatology; University of Marburg; Marburg Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - J.-P. Gabbud
- Dermatologist, retired from private practice; Bern Switzerland
| | - J. Lipozenčić
- Department of Dermatology and Venereology; Zagreb University Hospital Center and School of Medicine; Zagreb Croatia
| | - S. Kárpáti
- Department of Dermatology, Venereology and Dermato-oncology; Semmelweis University; Budapest Hungary
| | - U.-F. Haustein
- Department of Dermatology, Venerology and Allergology; University of Leipzig; Leipzig Germany
| | - F. Wojnarowska
- Nuffield Department of Clinical Medicine; University of Oxford; Oxford UK
| | - T. Zuberbier
- Allergy-Centre-Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Berlin Germany
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131
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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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132
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Kirtschig G. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:24. [PMID: 28447932 PMCID: PMC5400005 DOI: 10.3238/arztebl.2017.024b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Gudula Kirtschig
- *Institute for General Medicine and Interprofessional Care Faculty of Medicine, University of Tübingen,
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133
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Borghi A, Minghetti S, Toni G, Virgili A, Corazza M. Combined therapy in vulvar lichen sclerosus: does topical tretinoin improve the efficacy of mometasone furoate? J DERMATOL TREAT 2017; 28:559-563. [DOI: 10.1080/09546634.2016.1277178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alessandro Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Sara Minghetti
- 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
| | - Annarosa Virgili
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Monica Corazza
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
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134
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Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis characterized by ivory-white plaques or patches with glistening surface commonly affecting the vulva and anus. Common symptoms are irritation, soreness, dyspareunia, dysuria, and urinary or fecal incontinence. Anogenital lichen sclerosus (LS) is characterized by porcelain-white atrophic plaques, which may become confluent extending around the vulval and perianal skin in a figure of eight configuration. Thinning and shrinkage of the genital area make coitus, urination, and defecation painful. LS is not uncommon in India and present as an itchy vulvar dermatosis which a gynecologist may mistake for candidal vulvovaginitis. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. There is no curative treatment for LS. Various medications available only relieve the symptoms. Chronic nature of the disease affects the quality of life. Proper and regular follow-up is required as there are chances of the development of squamous cell carcinoma.
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Affiliation(s)
- Pragya Ashok Nair
- Department of Dermatology and Venereology, Pramukshwami Medical College, Karamsad, Gujarat, India
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135
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Abstract
Proctology is a medical subspecialty that encompasses diseases of the perianal region, anal canal, and rectum. Dermatologists play a pivotal role in this realm, as inflammatory perianal disorders, infectious and sexually transmitted diseases, as well as perianal tumors and their precursor lesions fall within the core competency of dermatology. In a concise manner, the present article highlights all relevant disease groups in the field of proctology. With a particular focus on aspects pertinent to dermatologists, this includes inflammatory disorders, "classic" proctologic diseases, sexually transmitted diseases, malignancies of the anal region, as well as pathogen-induced diseases. Despite the wide variety of disorders, there are only five key symptoms prompting patients to consult a proctologist, including anal pruritus and burning, discharge, bleeding, pain, and foreign body sensation. A simple algorithm, which incorporates these symptoms as well as key clinical features, may assist in quickly establishing the correct diagnosis in everyday clinical practice.
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Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital, Oberhausen, Germany
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136
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Virgili A, Borghi A, Cazzaniga S, Di Landro A, Naldi L, Minghetti S, Verrone A, Stroppiana E, Caproni M, Nasca MR, D'Antuono A, Papini M, Di Lernia V, Corazza M. New insights into potential risk factors and associations in genital lichen sclerosus: Data from a multicentre Italian study on 729 consecutive cases. J Eur Acad Dermatol Venereol 2016; 31:699-704. [PMID: 27515901 DOI: 10.1111/jdv.13867] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited data are available on risk factors associated with lichen sclerosus and no data are available on gender differences in genital lichen sclerosus (GLS). OBJECTIVE This multicentre study aimed at identifying potential risk factors for GLS, through data collection from a large, mixed-sex sample of patients comparing gender-related differences in relation to data from the general population. 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 collected: demographic data, anthropometric measures, comorbidities, family history of LS, clinical features and symptoms related to GLS. RESULTS Overweight and obesity, blood hypertension, hypothyroidism and an educational attainment equal or above upper secondary school level were more frequent among the study patients than among the general Italian population. Moreover, a family history of GLS was reported more frequently than expected among GLS patients. These factors were similar in males and females. The disease tended to occur later in females than in males. CONCLUSIONS Our findings suggest that metabolic factors, and possibly a sedentary lifestyle, may play a role in GLS pathogenesis in genetically predisposed patients, and that risk profile is similar in males and females despite some difference in the onset of symptoms.
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Affiliation(s)
- A Virgili
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - A Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | | | | | - L Naldi
- Centro Studi GISED - FROM, Bergamo, Italy.,UO di Dermatologia, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | - S Minghetti
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - A Verrone
- Dermosifilopatia 2, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - E Stroppiana
- Dermosifilopatia 2, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Caproni
- Malattie Rare Dermatologiche e Immunopatologia Cutanea, U.O. Dermatologia I ASF-Università di Firenze, Firenze, Italy
| | - M R Nasca
- UOC Dermatologia, P. O. G. Rodolico Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Catania, Italy
| | - A D'Antuono
- Dermatologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - M Papini
- Clinica Dermatologica di Terni, Dipartimento di Specialità Chirurgiche e Biomediche, Università degli Studi di Perugia, Perugia, Italy
| | - V Di Lernia
- Struttura Semplice di Dermatologia Immunologica e Pediatrica, Arcispedale Santa Maria Nuova - IRCCS Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - M Corazza
- 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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Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper SM, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury FA, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Response to Letter by Prof. C.B.B. Bunker. J Eur Acad Dermatol Venereol 2016; 31:e104-e105. [PMID: 27401731 DOI: 10.1111/jdv.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.,Institute of General Medicine and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - K Becker
- Office for Paediatric surgery, Bonn, Germany
| | - A Günthert
- Deptartment of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - D Jasaitiene
- Department of Skin and Venereal Diseases, Republican Hospital of Panevezys, Panevezys, Lithuania
| | - S M Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - K K Rall
- Department of Gynaecology, Universitäts-Frauenklinik, Tübingen, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S Riechardt
- Departments of Urology and paediatric Urology, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - F Casabona
- S. C. Chirurgia Plastica, Chirurgia Plastica Rigenerativa, Ospedale Andrea Gallino, Genova-Pontedecimo, Italy
| | - J Powell
- Department of Dermatology, Hampshire Hospitals foundation Trust, Basingstoke, UK
| | | | - R Erdmann
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS Clinical and Research Hospital, Rozzano Milano, Italy
| | - G Barbagli
- Centre for Reconstructive Urethral Surgery, Arezzo, Italy
| | - F Wojnarowska
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
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139
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Kirtschig G, Cooper S, Aberer W, Günthert A, Becker K, Jasaitiene D, Chi CC, Kreuter A, Rall K, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2016; 31:e81-e83. [DOI: 10.1111/jdv.13740] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - S. Cooper
- Department of Dermatology; Oxford University Hospitals NHS Trust and University of Oxford; Oxford UK
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - A. Günthert
- Department of Obstetrics and Gynecology; Cantonal Hospital of Lucerne; Lucerne Switzerland
| | - K. Becker
- Office for Paediatric surgery; Bonn Germany
| | - D. Jasaitiene
- Department of Skin and Venereal Diseases of Republican Hospital of Panevezys; Panevezys Lithuania
| | - C.-C. Chi
- Dermatology Department; Chang Gung Memorial Hospital; Chiayi, and College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - A. Kreuter
- Department of Dermatology, Venereology, and Allergology; HELIOS St. Elisabeth Hospital Oberhausen; Oberhausen Germany
| | - K. Rall
- Katharina Department of Gynaecology; Universitäts-Frauenklinik; Tübingen Germany
| | - S. Riechardt
- Department of Urology and paediatric Urology; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - F. Casabona
- Dirigente Medico; S. C. Chirurgia Plastica; Chirurgia Plastica Rigenerativa; Ospedale Andrea Gallino; Via Andrea Gallino; Genova-Pontedecimo Italy
| | - J. Powell
- Department of Dermatology; Hampshire Hospitals foundation Trust; Basingstoke UK
| | | | - R. Erdmann
- Klinik für Dermatologie; Venereologie und Allergologie; Campus Charité Mitte; Division of Evidence Based Medicine; Berlin Germany
| | - M. Lazzeri
- Center for Reconstructive Urethral Surgery; Via dei Lecci, 22, 52100 Arezzo Italy
| | - G. Barbagli
- Center for Reconstructive Urethral Surgery; Via dei Lecci, 22, 52100 Arezzo Italy
| | - F. Wojnarowska
- Nuffield Department of Clinical Medicine; John Radcliffe Hospital; University of Oxford; Oxford UK
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140
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Borghi A, Corazza M, Minghetti S, Toni G, Virgili A. Clinical and dermoscopic changes of vulvar lichen sclerosus after topical corticosteroid treatment. J Dermatol 2016; 43:1078-82. [PMID: 27075682 DOI: 10.1111/1346-8138.13374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/21/2016] [Indexed: 12/31/2022]
Abstract
With the aim to assess changes in both clinical and dermoscopic features of vulvar lichen sclerosus (VLS) after a treatment with topical corticosteroid, 29 VLS patients treated with mometasone furoate 0.1% ointment for 12 weeks were evaluated for symptoms, objective signs and dermoscopic variables at baseline and treatment completion. Numeric scores were assigned to each parameter. Mean itching and burning values had decreased significantly at the 12-week control visit compared with baseline, as well as values referring to pallor, hyperkeratosis and purpuric lesions. Among the dermoscopic variables, the vessel score increased while the scores of patchy, structureless, whitish areas, whitish background, purpuric globules and scales decreased significantly after treatment. Scores referring to gray-blue dots, comedo-like openings and structures like ice slivers did not change significantly throughout the treatment. Based on these findings, dermoscopic features may change, even significantly, with topical corticosteroids and may be useful for monitoring the response to treatment.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - Sara Minghetti
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - Giulia Toni
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - Annarosa Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
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141
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Kreuter A. Proktologie - Erkrankungen der Analregion. J Dtsch Dermatol Ges 2016. [DOI: 10.1111/ddg.12986_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie; HELIOS St. Elisabeth Klinik; Oberhausen
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143
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Barbagli G, Lazzeri M. Reply to Nadir I. Osman, Christopher R. Chapple, Sheila MacNeil's Letter to the Editor re: Guido Barbagli, Massimo Lazzeri. Clinical Experience with Urethral Reconstruction Using Tissue-engineered Oral Mucosa: A Quiet Revolution. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2015.05.043. Eur Urol 2015; 68:e101-2. [PMID: 26260002 DOI: 10.1016/j.eururo.2015.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Centre, Humanitas University, Rozzano (Milan), Italy.
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