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Jiang Q, Chen H, Chen K, Xia P, Chen J, Su F, Huang M, Xia Y, Hu F, Chen L. Reflectance confocal microscopy for non-invasive diagnosis of childhood-onset vulvar lichen sclerosus: A retrospective study. J Eur Acad Dermatol Venereol 2023; 37:e303-e305. [PMID: 36433788 DOI: 10.1111/jdv.18786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Qian Jiang
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Hongying Chen
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Kai Chen
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Ping Xia
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Jinbo Chen
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Fei Su
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Meng Huang
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Yun Xia
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Feng Hu
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, China
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De Luca DA, Papara C, Vorobyev A, Staiger H, Bieber K, Thaçi D, Ludwig RJ. Lichen sclerosus: The 2023 update. Front Med (Lausanne) 2023; 10:1106318. [PMID: 36873861 PMCID: PMC9978401 DOI: 10.3389/fmed.2023.1106318] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.
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Affiliation(s)
- David A De Luca
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Cristian Papara
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Hernán Staiger
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Angotti R, Fusi G, Coradello E, Miracco C, Ferrara F, Sica M, Taddei A, Vasta G, Messina M, Molinaro F. Lichen sclerosus in pediatric age: A new disease or unknown pathology? Experience of single centre and state of art in literature. LA PEDIATRIA MEDICA E CHIRURGICA 2022; 44. [PMID: 35230046 DOI: 10.4081/pmc.2022.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Lichen Sclerosus (LS) is a chronic inflammatory skin disease with unknown etiology. In pediatric age the main disease "lichenlinked" is the phimosis in male. This is a retrospective study that reports the experience of our clinic and review of the literature. We included all patients affected by pathological phimosis, treated by circumcision between January 2015 and May 2020, older than 6 years old and with an histopathological diagnosis of lichen sclerosus. The aim was to identify prognostic factors based on histological report to plan the clinical management of patients. Statistical analysis was done. We included 207 patients. The mean age of children was 9,78 years (5-18 years, DS±3.29). Based on the histological features we divided patients in 2 groups: early lesions (70/207, 34%) and advanced (137/207, 66%). In term of complications lichen linked we considered meatal stenosis that needed of urethral dilatations. We included 7 patients (7/207, 3,4%). We report P value Statistical Significance in many aspects. An early diagnosis of LS and surgical treatment of foreskin are essential to prevent early and late complications in children. The size of sample is a limit of the study but results encourage our management.
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Affiliation(s)
- Rossella Angotti
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Giulia Fusi
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Elena Coradello
- Department of Medical, Surgical and Neurological Sciences, University of Siena.
| | - Clelia Miracco
- Pathological Anatomy Unit, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Francesco Ferrara
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Marina Sica
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Alessandra Taddei
- Pediatric Surgery, Department of Women and Children, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Gabriele Vasta
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Mario Messina
- Pediatric Surgery, Department of Women and Children; Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
| | - Francesco Molinaro
- Pediatric Surgery, Department of Women and Children; Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria alle Scotte Hospital, University of Siena, Siena.
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