Psoralen–UVA treatment for generalized prepubertal extragenital lichen sclerosus et atrophicus

Extragenital lichen sclerosus: a comprehensive review of clinical features and treatment

Lichen sclerosus (LS) is a chronic inflammatory skin disease commonly affecting the anogenital area with less frequent extragenital occurrence. Extragenital LS cutaneous manifestations vary and precipitating factors are not well described. Recent evidence for etiology and clinical associations of extragenital LS provide insight into disease recognition and pathogenesis. Novel diagnostic techniques as well as treatment standardization have the potential to improve management of this rare condition. This review details both past and new insights into the pathogenesis, clinical manifestations, and treatment options of extragenital LS.

Phototherapy for sclerosing skin conditions

Phototherapy is an effective treatment strategy for a variety of sclerosing skin conditions. There are a number of phototherapeutic modalities used for the treatment of sclerosing skin conditions, including ultraviolet (UV)A1, broadband UVA, psoralen plus UVA, and narrowband UVB phototherapy. As controlled trials with validated outcome measures are lacking for these therapies, existing evidence is largely level II for morphea and is even more minimal for scleroderma and other sclerosing disorders (scleroderma, lichen sclerosus, and chronic graft-versus-host disease, among others). Studies do suggest that phototherapy may be effective for many of these disorders, including those that have been unresponsive to other therapies. Phototherapy remains an attractive therapeutic option for patients due to its efficacy and favorable risk-versus-benefit profile. Phototherapy also offers a therapeutic alternative to systemic immunosuppressives for patients who cannot tolerate these medications.

Phototherapy of extragenital white spot disease

Objective. To study the effectiveness of UVA1therapy and PUVA therapy in patients with extragenital lichen sclerosus. Materials and methods. Effectiveness of the phototherapy methods was studied in 12 patients with extragenital lichen sclerosus (8 women, 4 men) aged from 19 to 61 years old with the disease history of 1-25 years. 6 patients received UVA1therapy while 3 patients received general PUVA therapy and 3 patients - local PUVA therapy. All the patients underwent phototherapy in the form of monotherapy. Results. After the treatment clinical improvement was observed in 6 patients from the UVA1 group (100%) and 4 patients from the PUVA group (66.7%), significant improvement of clinical picture and clinical remission were registered in 1 (16.7%) and 2 (33.3%) patients from the PUVA group, respectively. Phototherapy caused partial or full regress of main lichen sclerosus symptoms: sclerosis, induration, erythema, epidermal atrophy and skin hypopigmentation. The tolerability of treatment was satisfying, serious adverse effects were not reported. Conclusion. Conducted research indicates the effectiveness of UVA1therapy and PUVA therapy in patients with extragenital lichen sclerosus. Phototherapy may be a choice in the management of the disease.

Diagnosis and treatment of lichen sclerosus: an update

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

Significant improvement in extensive lichen sclerosus with tacrolimus ointment and PUVA

Lichen sclerosus is an uncommon, chronic inflammatory skin disorder of unknown origin. It is clinically characterized by sclerotic, whitish, atrophic-type lesions. The most frequent site of the lesions is generally the genital region, with about 15-20% having additional extragenital involvement. We present the case of a 62-year-old woman with a very extensive extragenital lichen sclerosus who showed great clinical and subjective improvement with 0.1% tacrolimus ointment and psoralen plus UVA (PUVA), without any topical or systemic adverse effects. Combined treatment of 0.1% tacrolimus ointment and PUVA may be a good option in extensive cases of lichen sclerosus or when other treatment options have failed, and has a good tolerability and safety profile.