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Kolesnikova EV, Zharov AV, Todorov SS, Penzhoyan GA, Mingaleva NV. Morphological features of various variants of the course of scleroatrophic lichen of the vulva. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-17-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Relevance. Most of the scientific papers presented in the literature indicate morphological features of the stages of development of sclerotic lichen of the vulva, or in comparison with other vulvar skin lesions. At the same time, data on the features of morphological examination of vulvar biopsies, depending on the clinical variants of the course of sclerotic lichen of the vulva, is currently insufficient. The aim of the study - to determine the presence or absence of distinctive morphological features of the sclerotic lichen of the vulva, depending on the clinical variants of its course. Materials and Methods. The study included 292 patients with sclerotic lichen of the vulva (20-70 years old). Based on the scale of assessment of objective and subjective clinical signs of sclerotic lichen of the vulva developed by us, 3 clinical groups: 101 patients with an atrophic variant of the course, 154 with a sclerosing variant and 37 patients with a scleroatrophic variant of the course of sclerotic lichen of the vulva. In addition to clinical laboratory, instrumental and immunological studies, all patients underwent incisional biopsy of the vulva followed by morphological examination of biopsies. Results and Discussion. The features of the results of morphological examination of various clinical variants of the course of sclerotic lichen of the vulva are described and presented in the form of images. The characteristic morphological signs for each clinical group, as well as common signs characteristic of all variants of the course of this pathology, were revealed. Morphological examination of vulvar tissues is informative only to confirm the diagnosis of «Sclerotic lichen of the vulva», to determine the stage of the disease, as well as to exclude the malignant process, while for a clear differentiation of variants of the clinical course of sclerotic lichen of the vulva, conventional morphological examination is not enough, which requires further studies using immunohistochemical and molecular genetic methods. Conclusion. The revealed differences in morphological parameters of various variants of the course of sclerotic lichen of the vulva are insufficiently specific, which excludes the possibility of accurate morphological verification of the variants of the course of sclerotic lichen of the vulva and confirms the expediency of using clinical classification of variants of the course of sclerotic lichen of the vulva based on objective and subjective clinical signs.
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Hong E, Posligua A, Elwood H, Smidt AC. Excimer laser treatment for morphea-lichen sclerosus et atrophicus overlap in a pediatric patient. JAAD Case Rep 2022; 32:96-98. [PMID: 36698372 PMCID: PMC9867949 DOI: 10.1016/j.jdcr.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Emily Hong
- University of New Mexico, School of Medicine, Albuquerque, New Mexico
| | - Alba Posligua
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Hillary Elwood
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico,Pathology Associates of Albuquerque, Albuquerque, New Mexico,Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Aimee C. Smidt
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico,Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque New Mexico,Correspondence to: Aimee C. Smidt, MD, Chair, Professor of Dermatology and Pediatrics, Founding Director, Department of Dermatology, Vascular Anomalies Clinic, University of New Mexico School of Medicine, 1021 Medical Arts Ave NE, Albuquerque, NM 87102.
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Ozcan Y, Ozlu E, Karagun E, Uyar B, Gamsizkan M. Dermatopathological Correlation of Clinically Challenging Cutaneous Lesions: a Single Center Experience of 2184 Cases. Dermatol Pract Concept 2022; 12:e2022186. [PMID: 36534561 PMCID: PMC9682974 DOI: 10.5826/dpc.1204a186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Although a trained eye can easily identify typical skin lesions, histopathological examination and clinicopathological correlation are critical in challenging cases. OBJECTIVES The primary objective is to organize the final diagnoses reached following clinicopathological consensus in clinically challenging cutaneous lesions, identifying the most common diagnostic scenarios encountered by dermatopathologists and discussing their diverse differentials submitted by clinicians. The secondary objective is to investigate how the case profile and clinician decision-making processes evolved during the COVID-19 pandemic. METHODS Skin and mucosa samples collected by the dermatology department between 2016 and 2020 were classified based on pathology reports. For frequent diagnoses, preliminary diagnoses stated by clinicians on pathology requisition forms were reviewed. The years preceding and following the first nationally reported COVID-19 case were compared to investigate the pandemic's impact on the distribution of dermatology and dermatopathology cases. RESULTS One thousand nine hundred and eighty-nine reports were classified into 4 major categories: inflammatory (49.8%), neoplastic (30.1%), other diseases (7.1%), and non-diagnostic (12.8%). We further classified inflammatory diseases based on major tissue reaction patterns and neoplasms based on cell origin. We analyzed the leading diagnoses in each category, discussed their differential diagnoses, and provided clinicians with clues to reduce errors in practice. Following the pandemic, the overall number of pathology reports and patient admissions dropped dramatically, with significant changes in case profiles. CONCLUSIONS We presented and discussed the frequently encountered confounding cases to sketch the diagnostic landscape. In the authors' experience, clinicopathological correlation can increase the rate of reaching the diagnosis by up to 75.3%.
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Affiliation(s)
- Yunus Ozcan
- Department of Dermatology, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Emin Ozlu
- Department of Dermatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Ebru Karagun
- Department of Dermatology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Belkiz Uyar
- Department of Dermatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Gamsizkan
- Department of Pathology, Faculty of Medicine, Duzce University, Duzce, Turkey
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Sink JR, Chiu YE. Pediatric morphea state-of-the-art literature review: Reframing morphea as a systemic disease. Pediatr Dermatol 2021; 38:1020-1031. [PMID: 34272748 DOI: 10.1111/pde.14688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric morphea is an inflammatory, fibrosing dermatologic disorder. Although morphea may be localized to the skin and subcutaneous tissues, differentiating it from systemic sclerosis, there is increasing evidence that morphea is a manifestation of a systemic inflammatory process, with the potential to involve many organ systems. Given the potential risk for irreversible sequelae, pediatric morphea should be treated early and aggressively. Long-term disease monitoring is essential.
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Affiliation(s)
- Jacquelyn R Sink
- Department of Dermatology, Northwestern Medicine Regional Medical Group, Winfield, IL, USA
| | - Yvonne E Chiu
- Departments of Dermatology (Section of Pediatric Dermatology) and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Friedland R, Ben-Amitai D, Didkovsky E, Feinmesser M, Zvulunov A. Vascular lesions in genital lichen sclerosus in pediatric patients. Pediatr Dermatol 2020; 37:849-852. [PMID: 32638397 DOI: 10.1111/pde.14277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Lichen sclerosus is a rare, pruritic, mucocutaneous disease affecting mostly the anogenital area. Reports have occasionally associated lichen sclerosus with overlapping vascular lesions. This study explores this association in children. METHODS A retrospective study was conducted in the dermatology unit of a pediatric tertiary care medical center. Electronic medical records were searched for patients diagnosed with lichen sclerosus from 2006 to 2019. Review of the cases was performed to identify overlapping vascular lesions and review the clinical course of overlap cases. RESULTS Of 74 children diagnosed with lichen sclerosus during the study period, five (6.75%) had overlapping vascular lesions and genital lichen sclerosus. Four patients presented with reticular telangiectatic macules and patches (n = 4, 5.4%) that appeared at or shortly after disease onset; resolution occurred a few months after treatment initiation. The fifth patient presented with telangiectases that appeared more than 2 years after the onset of the first symptoms of lichen sclerosus (n = 1, 1.3%). CONCLUSION Vascular lesions in children with genital lichen sclerosus are common and have variable clinical manifestations. Early appearance of reticular macules, patches, and papules is a variant of the disease and is followed by prompt resolution of these lesions. Pathogenesis is attributed to structural changes and repositioning of the papillary vascular plexus. These changes may be alarming to parents and therefore must be recognized by physicians to prevent unnecessary concern and investigations.
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Affiliation(s)
- Rivka Friedland
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Ben-Amitai
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Didkovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Meora Feinmesser
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Alex Zvulunov
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Faculty of Health Sciences, BenGurion University of the Negev, Beer Sheva, Israel
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Superficial Morphea: Clinicopathological Characteristics and a Novel Therapeutic Outcome to Excimer Light Therapy. Dermatol Res Pract 2019; 2019:1967674. [PMID: 31641348 PMCID: PMC6770326 DOI: 10.1155/2019/1967674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/24/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Superficial morphea (SM) is an uncommon entity that was described in the literature without definitive correlation to localized scleroderma (LS) or other atrophoderma diseases. Aim To demonstrate the clinicopathological features of SM and evaluate the efficacy of different therapeutic modalities in its management. Patients and methods A total of 28 patients with SM were studied during the period from 2010 to 2015. Clinicopathological features and therapeutic outcomes were recorded and analyzed. Results Clinically, SM was predominant in females (71.4%) with an average onset at 33 years of age and an average duration of 15 months. It was commonly presented as asymptomatic, darkly pigmented, and multiple and slightly indurated patches. The lesions were mostly ill-defined, large-sized, and located more on the trunk. Histologically, thickening of collagen fibers was observed either localized to the papillary dermis only (38.9%) or extended into the upper reticular dermis (61.1%). Elastic fibers were generally diminished in the upper reticular dermis while the number of fibroblasts and basal melanin pigmentation were increased in the majority of cases (92.9% and 96.4%, respectively). The most commonly associated diseases were diabetes mellitus (50%) and hepatitis C virus (HCV) infection (42.8%), and their incidence was significantly higher than that in patients with LS. Excimer light showed promising effective results in the treatment of most cases (78.9%) while the response to other modalities such as topical corticosteroid alone or in combination with tacrolimus or treatment with UVA1 alone was less effective (7.1%, 23.1%, and 5%, respectively). Conclusion Our results proposed that SM is a distinctive clinicopathological variant and not a stage in the spectrum of LS. The novel response of SM to excimer light and not for UVA1 therapy also suggests the different therapeutic outcome of SM from LS. Although SM has a significant association with DM and HCV infection, they seem not to affect the course of the disease.
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Van der Cruyssen F, Meeus J, Schoenaers J, Politis C. Parry Romberg syndrome: A long-term retrospective cohort study of 10 patients. ORAL AND MAXILLOFACIAL SURGERY CASES 2018. [DOI: 10.1016/j.omsc.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Khamaganova I. Progressive Hemifacial Atrophy and Linear Scleroderma En Coup de Sabre: A Spectrum of the Same Disease? Front Med (Lausanne) 2018; 4:258. [PMID: 29445726 PMCID: PMC5798413 DOI: 10.3389/fmed.2017.00258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/26/2017] [Indexed: 11/25/2022] Open
Abstract
Similar clinical and histhopathological features in progressive hemifacial atrophy and linear scleroderma en coup de sabre are well known. Trauma may predispose to the development of both diseases. The lack of association with anti-Borrelia antibodies was shown in both cases as well. The otolaryngological and endocrine disorders may be associated findings in both diseases. However, there are certain differences in neurological and ophthalmological changes in the diseases.
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Affiliation(s)
- Irina Khamaganova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Ruiz-Villaverde R, Sánchez-Cano D, Salvador-Rodriguez L, Cuenca-Barrales C. Atrophoderma of Pasini and Pierini. Sultan Qaboos Univ Med J 2017; 17:e373-e374. [PMID: 29062569 DOI: 10.18295/squmj.2017.17.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/21/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022] Open
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Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. Best Pract Res Clin Obstet Gynaecol 2017; 48:14-27. [PMID: 28927766 DOI: 10.1016/j.bpobgyn.2017.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
Vulvovaginitis is one of the most common gynecological complaints presenting in the pediatric and adolescent female. The common causes of vulvovaginitis in the pediatric patient differ than that considered in adolescent females. When a child present with vulvar itching, burning and irritation the most common etiology is non-specific and hygiene measures are recommended. However these symptoms can mimic more serious etiologies including infection, labial adhesion, lichen sclerosis, pinworms and foreign body must be considered. Yeast infection is rare in the pediatric population but common in the adolescent. In the adolescent patient infections are more common. Yeast and bacterial vaginosis are commonly seen but due to the higher rate of sexual activity in this population sexually transmitted infections must also be considered.
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Affiliation(s)
- Meredith Loveless
- Norton Children's Hospital, University of Louisville, Dutchman Lane Plaza 2 Suite 303, Louisville, KY, United States.
| | - Ohmar Myint
- University of California Los Angeles, Department of Obstetrics and Gynecology, United States
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Abstract
Lupus erythematosus panniculitis, also known as lupus profundus, is a variant in the clinicopathological spectrum of lupus erythematosus (LE) affecting about 2%-3% of LE patients. A linear configuration of LE panniculitis has been reported rarely with rare reports describing the coexistence of different forms of cutaneous LE and localized morphea. In this study, the authors present a 9-year-old girl with linear arrangement of subcutaneous nodules on her left forearm. Microscopic findings from 2 biopsies included lymphocytes at the dermoepidermal junction with mild interface dermatitis, a dense lymphocytic infiltrate that was concentrated around adnexae and subcutaneous fat in concert with thickened collagen bundles and mild widening of fibrous septae surrounding fat lobules. Although the clinical differential diagnosis included panniculitis or a sporotrichoid infection, 1 biopsy showed a dense lymphocytic infiltrate histologically bordered on that of cutaneous lymphoid hyperplasia or a late stage of Lyme disease, and a second also demonstrated more prominent sclerodermoid collagen bundles rendering the diagnosis of linear sclerodermoid LE profundus.
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Tong LX, Sun GS, Teng JMC. Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options. Pediatr Dermatol 2015; 32:593-9. [PMID: 25940739 DOI: 10.1111/pde.12615] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lichen sclerosus (LS) is a rare, chronic, inflammatory disease of the skin that primarily affects postmenopausal women but may occur in men and children as well. Approximately 7% to 15% of cases are believed to occur in children. The epidemiologic data for LS have been limited and treatment options are not well studied, particularly in children. We reviewed new developments available in the current literature on the epidemiology and management of LS for children.
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Affiliation(s)
- Lana X Tong
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Grace S Sun
- Department of Dermatology, Stanford University, Palo Alto, California
| | - Joyce M C Teng
- Department of Dermatology, Stanford University, Palo Alto, California
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