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Morrel B, Ten Kate-Booij MJ, van Dijk C, Bramer WM, Burger CW, Pasmans SGMA, van der Avoort IAM. Outcome Measures in Adult Vulvar Lichen Sclerosus: A Systematic Review. J Low Genit Tract Dis 2024; 28:282-294. [PMID: 38709568 DOI: 10.1097/lgt.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVES Core outcome domains (CODs) for treatment of adult vulvar lichen sclerosus (VLS) have recently been established through a Delphi study. A number of measuring tools are available for evaluating VLS. The aim of this study is to identify available standardized measurement tools for the major CODs for VLS that have recently been defined, namely, physical findings and quality of life (QoL) specific to VLS. MATERIALS AND METHODS A systematic search through September 8, 2023, for measuring tools applicable to VLS regarding physical findings and QoL including sexual function or sexual well-being and self-image was performed. RESULTS Thirty-five studies were included in the systematic review describing 26 tools covering the following 6 outcome domains: QoL-general health, QoL-lichen sclerosus specific, symptoms, clinical signs, emotional impact, and sexual functioning. CONCLUSIONS In current research, there is no uniformity in use of measurement tools for evaluating VLS. The established CODs to evaluate treatment of VLS are applicable for evaluating disease course as well. A comprehensive study to reach consensus regarding measurement of physical findings, QoL-lichen sclerosus specific, sexuality, and self-image taking the predetermined CODs and other factors such as age into account is needed.
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Affiliation(s)
| | - Marianne J Ten Kate-Booij
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Charlotte van Dijk
- Department of Dermatology, Sophia Children's Hospital-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Curt W Burger
- Research and Development Office (RDO), Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Sophia Children's Hospital-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
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Kirtschig G, Kinberger M, Kreuter A, Simpson R, Günthert A, van Hees C, Becker K, Ramakers MJ, Corazza M, Müller S, von Seitzberg S, Boffa MJ, Stein R, Barbagli G, Chi CC, Dauendorffer JN, Fischer B, Gaskins M, Hiltunen-Back E, Höfinger A, Köllmann NH, Kühn H, Larsen HK, Lazzeri M, Mendling W, Nikkels AF, Promm M, Rall KK, Regauer S, Sárdy M, Sepp N, Thune T, Tsiogka A, Vassileva S, Voswinkel L, Wölber L, Werner RN. EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus. J Eur Acad Dermatol Venereol 2024. [PMID: 38822598 DOI: 10.1111/jdv.20083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
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Affiliation(s)
- G Kirtschig
- Medbase Health Centre, Frauenfeld, Switzerland
| | - M Kinberger
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - R Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Günthert
- Gynäkologisches Tumorzentrum St. Anna, Lucerne, Switzerland
| | - C van Hees
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K Becker
- Office for Paediatric Surgery, Bonn, Germany
| | - M J Ramakers
- CenSeRe (Centre for Psychological, Relational, Sexual Health), Voorschoten, The Netherlands
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - S Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - R Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - C C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J N Dauendorffer
- Department of Dermatology, Centre for Genital and Sexually Transmitted Diseases, University Hospital Saint Louis, Paris, France
| | - B Fischer
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - M Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - E Hiltunen-Back
- Department of Dermatovenereology, Helsinki University Hospital, Helsinki, Finland
| | - A Höfinger
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - N H Köllmann
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - H Kühn
- The German Lichen Sclerosus Association, Hamburg, Germany
| | - H K Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Mendling
- German Center for Infections in Gynecology and Obstetrics, Helios University Hospital Wuppertal-University Witten/Herdecke, Wuppertal, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - M Promm
- Department of Paediatric Urology and Clinic St. Hedwig, University Medical Centre of Regensburg, Regensburg, Germany
| | - K K Rall
- Department of Women's Health, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - S Regauer
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - N Sepp
- Department of Dermatology and Venereology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - T Thune
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - A Tsiogka
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S Vassileva
- Department of Dermatology and Venereology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria
| | - L Voswinkel
- The German Lichen Sclerosus Association, Hamburg, Germany
| | - L Wölber
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf and Centre for Colposcopy and Vulvovaginal Disease Jersualem Hospital Hamburg, Hamburg, Germany
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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3
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Smith AB, Muhammad NI, Cigna ST, Krapf JM. A systematic review of sexual health consequences among women with lichen sclerosus. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Introduction
Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affecting the vulva. Studies have shown high rates of sexual dysfunction in patients with LS; however, the sexual effects of the condition are poorly acknowledged.
Objectives
We sought to identify sexual health consequences among women with vulvar LS through systematic review of available literature.
Methods
A systematic review of the literature was conducted to find reports on sexual health consequences among women with LS. PubMed, MEDLINE, and Scopus were queried. Included articles were observational studies evaluating women with LS and their sexual health and randomized controlled trials or comparative studies utilizing a validated sexual health measure before intervention among the same population. Articles must have been written in English and published from January 1991 to April 2022.
Results
The search produced 683 references, including 32 articles that met criteria for full-text review and 20 reported studies that met inclusion criteria. Two studies investigated the impact of LS on interpersonal relationships, 6 studies evaluated sexual symptoms, 16%-60% reported sexual dysfunction, and 22%-56.7% reported dyspareunia. Also described were decreased sexual frequency and satisfaction, negative impact on sexual relationships, and feelings of inadequacy. Eight publications evaluated the Female Sexual Function Index (FSFI); all described studies that demonstrated a central tendency less than 26.55. Four publications evaluated the Female Sexual Distress Scale (FSDS); all demonstrated average scores greater than 12. Two publications evaluated the Female Genital Self-Image Scale (FGSIS), both found decreased scores compared to controls. Four publications evaluated the Dermatology Life Quality Index (DLQI); impact on quality of life was small to very large, with sexual difficulties affecting most study patients. One publication evaluated the Vulvar Quality of Life Index (VQLI); sexuality was the second highest-scoring subgroup.
Conclusions
Sexual health consequences of LS include sexual pain, dysfunction, and distress; negative genital self-image; and negative impact on sexual relationships. Women with LS experience a negative impact on quality of life, particularly related to sexual functioning.
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Affiliation(s)
- Alyssa B Smith
- Department of Obstetrics and Gynecology,The George Washington University School of Medicine and Health Sciences , Washington. DC, United States
| | | | - Sarah T Cigna
- Department of Obstetrics and Gynecology,The George Washington University School of Medicine and Health Sciences , Washington. DC, United States
| | - Jill M Krapf
- Department of Obstetrics and Gynecology,The George Washington University School of Medicine and Health Sciences , Washington. DC, United States
- Center for Vulvovaginal Disorders , Washington, DC, United States
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Wu M, Kherlopian A, Wijaya M, Fischer G. Quality of life impact and treatment response in vulval disease: Comparison of 3 common conditions using the Vulval Quality of Life Index. Australas J Dermatol 2022; 63:e320-e328. [PMID: 35932464 PMCID: PMC9804714 DOI: 10.1111/ajd.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND/OBJECTIVES To compare the quality of life in patients with vulval lichen sclerosus (VLS), vulval lichen planus (VLP) and chronic vulvovaginal candidiasis (CVVC), as measured by the Vulval Quality of Life Index (VQLI). METHODS A retrospective, single-centre cohort study was conducted at a combined dermatology and gynaecology practice from March 2018 to November 2021. VQLI scores and patient data were systematically collected and recorded in an online patient database. Treatment regimens were individualised and titrated to clinical response. RESULTS Over 3 years, a total of 200 women were recruited: 59 with CVVC, 79 with VLP and 62 with VLS. The median duration of follow-up for all patients was 45.43 (16.25-80.89) weeks. At baseline, the median (interquartile range [IQR]) VQLI score was 24.00 (19.00-31.00), 21.00 (12.00-26.00) and 14.00 (7.00-26.00) for CVVC, VLP and VLS, respectively. At follow-up, the median (IQR) VQLI score for CVVC, VLP and VLS was 9.00 (3.00-15.00), 9.00 (3.00-16.00) and 5.00 (2.00-10.00), respectively. All three groups showed a significant improvement in VQLI score (p < 0.0001). At baseline, the highest scoring domains were 'Sexual Function' for CVVC and 'Future Health Concerns' for VLP and VLS. At follow-up, the highest scoring domains were 'Sexual Function' for CVVC and VLP, and 'Future Health Concerns' for VLS. CONCLUSIONS AND RELEVANCE Vulval disease has an immense impact on QOL, especially in patients with CVVC. The VQLI is useful to clinicians in identifying the unique impact of each vulval condition on a patient's QOL in order to provide better patient-focussed care.
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Affiliation(s)
- Michelle Wu
- Northern Clinical SchoolUniversity of SydneyCamperdownNew South WalesAustralia
| | - Ashod Kherlopian
- Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Marlene Wijaya
- Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Gayle Fischer
- Northern Clinical SchoolUniversity of SydneyCamperdownNew South WalesAustralia,Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
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5
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The Quality and Quantity of Lower Genital Tract Research Across Multiple Journals. J Low Genit Tract Dis 2022; 27:83-86. [PMID: 36074162 DOI: 10.1097/lgt.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study aimed to determine the quantity and quality of lower genital tract disease (LGTD) research by topic published across a variety of gynecology and dermatology journals. METHODS Authors accessed all articles that were rejected (1,111, 59.5%) and accepted (755, 40.5%) by the Journal of Lower Genital Tract Disease (JLGTD) from 2008 to 2020. Studies were categorized by key topic: Cervix, Human Papillomavirus, Vulva, Vagina, Anal, and Other. Studies were further subcategorized based on methodology. These data were compared with all LGTD publications from 2018 to 2020 in 4 other widely recognized journals (Obstetrics and Gynecology, The British Journal of Obstetrics and Gynaecology, JAMA Dermatology, and the British Journal of Dermatology). RESULTS Most JLGTD-accepted submissions were related to the cervix (298/755, 39.5%) and vulva (189/755, 25.0%). Rates of acceptance were similar across all key topic areas. Only 3.2% of publications in the other 4 journals (92/2,932) were related to LGTD topics. Across all 5 journals, vulva studies were most commonly case reports/case series (82/218, 37.6%), with a low prevalence of systematic reviews/meta-analyses (4/218 1.8%). In comparison, cervix studies had the highest number of systematic reviews/meta-analyses (14/317, 4.4%) and the lowest number of case reports (14/317, 4.4%). CONCLUSIONS Vulvar research is of lower quality compared with cervix research published across 5 journals. Comparing accepted versus rejected articles in JLGTD, there is no publication bias against vulva topics noted; rather, the overall research quality in vulva is lower than that of cervical disease. This is a call to action for higher quality vulvar research.
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Ashraf I, Veitch D, Wernham A. Dermatological surgery wound outcomes: assessing the evidence. Clin Exp Dermatol 2021; 46:1592-1593. [PMID: 34101240 DOI: 10.1111/ced.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- I Ashraf
- Department of Dermatology, Solihull Hospital, Solihull, UK
| | - D Veitch
- Department of Dermatology, Leicester Royal Infirmary, Leicester, UK
| | - A Wernham
- Department of Dermatology, Leicester Royal Infirmary, Leicester, UK.,Department of Dermatology, Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
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Almadori A, Zenner N, Boyle D, Swale V, Reid W, Maclean A, Butler PEM. Development and Validation of a Clinical Grading Scale to Assess the Vulvar Region: The Vulvar Architecture Severity Scale. Aesthet Surg J 2020; 40:1319-1326. [PMID: 32382752 DOI: 10.1093/asj/sjz342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The vulva is composed of aesthetic units that can be affected differently by vulvar conditions. A reliable, comprehensive, and quick-to-use clinical scoring system is required to assess the disease extent in the vulvar area. OBJECTIVES The aim of this study was to develop and validate a grading scale based on the aesthetic unit principle to evaluate the extent of vulvar lichen sclerosus (VLS). METHODS After reviewing photographs of 100 patients affected by VLS, the authors targeted the aesthetic units most frequently affected. The disease signs were recorded and graded in 4 levels of severity (none, mild, moderate, severe) taking into account the vulvar architecture and skin involvement. To validate the scale, 14 observers were asked to apply it to photographs of 25 VLS patients on 2 different occasions. Intra- and inter-observer reliabilities were determined employing Pearson's and intraclass correlation coefficients. RESULTS A 6-region, 4-point grading system was designed and identified as the Vulvar Architecture Severity Scale (VASS). In all 6 areas, the Pearson's r was greater than 0.9 (mean, 0.994; 95% confidence interval [CI] = 0.992), indicating that the intra-observer reliability of the VASS was consistent over time (P < 0.001). Intraclass correlation at time 1 was 0.928 (95% CI = 0.910, 0.943) and at time 2 was 0.944 (95% CI = 0.931, 0.996), indicating a high reliability level among different observers. CONCLUSIONS The VASS is a reliable scale to assess the severity of VLS, and it might be considered as an outcome measure in future VLS trials. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Aurora Almadori
- Centre for Nanotechnology and Regenerative Surgery, University College of London
- Department of Plastic Surgery, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Nicole Zenner
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Deborah Boyle
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Victoria Swale
- Department of Dermatology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Wendy Reid
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Allan Maclean
- Department of Obstetrics and Gynaecology, NHS Foundation Trust Royal Free Hospital, London, UK
| | - Peter E M Butler
- Department of Plastic Surgery, NHS Foundation Trust Royal Free Hospital, London, UK
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Sadownik LA, Koert E, Maher C, Smith KB. A Qualitative Exploration of Women's Experiences of Living With Chronic Vulvar Dermatoses. J Sex Med 2020; 17:1740-1750. [PMID: 32741746 DOI: 10.1016/j.jsxm.2020.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many vulvar dermatoses (VDs) are chronic and cannot be "cured," thus affected women must learn to live with the impact of the disease, and its treatment, on their quality of life. AIM To qualitatively investigate the impact of VDs on women's quality of life through firsthand accounts. METHODS 12 women, 7 with lichen sclerosus and 5 with erosive vulvovaginal lichen planus recruited from a vulvar disease clinic participated in in-depth, exploratory interviews. Scripts were analyzed by applying a thematic network. The following steps were used: (1) coding the text, (2) development of descriptive themes, and (3) generation of thematic networks. OUTCOMES The main outcome explored was the narrative experiences of women living with VDs. RESULTS A global theme of suffering emerged. Themes associated with this suffering were organized under the themes of isolation, interference, and grieving. Women felt isolated because they felt unable to talk about their suffering; experienced a lack of external validation and support; and felt different as individuals, women, and sexual beings. Most women expressed negative views of their genitalia. Women spoke of the VDs, and its management, as interfering with thoughts, activities, and sex life. Symptoms were described as all-encompassing. Women spoke about limiting and/or avoiding daily activities and, in particular, sexual activities. Women described diminished sexual pleasure and experienced loss in their intimate relationships. Women described an ongoing grieving process; anger and sadness over the loss of their former healthy self; the burden of ongoing treatment; and attempts to cope and accept their current condition. CLINICAL IMPLICATIONS The findings suggest that assessment of women with VDs should include a detailed history of the impact of the VDs on women's psychological and sexual health. STRENGTHS AND LIMITATIONS A strength of this study is that we openly explored the lived experiences of women who had been clinically diagnosed with vulvar lichen sclerosus and erosive vulvovaginal lichen planus. A limitation is that the findings may not represent the experience of women living with VDs who do not wish to discuss their VDs or who are undiagnosed, untreated, and/or treated by other health-care providers. CONCLUSIONS Women described profound impact of VDs on psychological and sexual health. Sadownik LA, Koert E, Maher C, et al. A Qualitative Exploration of Women's Experiences of Living With Chronic Vulvar Dermatoses. J Sex Med 2020;17:1740-1750.
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Affiliation(s)
- Leslie A Sadownik
- BC Centre for Vulvar Health, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
| | - Emily Koert
- University of British Columbia, Vancouver, British Columbia, Canada; Department of Educational and Counselling Psychology and Special Education, Vancouver, British Columbia, Canada
| | - Ciana Maher
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Kelly B Smith
- BC Centre for Vulvar Health, Vancouver, British Columbia, Canada
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9
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Goodrum C, Leighton P, Simpson R. Outcome domains in lichen sclerosus. Br J Dermatol 2020; 183:966-968. [DOI: 10.1111/bjd.19253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C.A. Goodrum
- Centre of Evidence Based Dermatology University of Nottingham UK
| | - P.A. Leighton
- Centre of Evidence Based Dermatology University of Nottingham UK
| | - R.C. Simpson
- Centre of Evidence Based Dermatology University of Nottingham UK
- Department of Dermatology Nottingham University Hospitals NHS Trust Queen’s Medical Centre Derby Road Nottingham NG7 2UH UK
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10
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Felmingham C, Chan L, Doyle LW, Veysey E. The Vulval Disease Quality of Life Index in women with vulval lichen sclerosus correlates with clinician and symptom scores. Australas J Dermatol 2019; 61:110-118. [DOI: 10.1111/ajd.13197] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | - Lydia Chan
- The Royal Women’s Hospital Parkville Victoria Australia
| | - Lex W Doyle
- The Royal Women’s Hospital Parkville Victoria Australia
| | - Emma Veysey
- The Royal Women’s Hospital Parkville Victoria Australia
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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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12
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13
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Core Outcome Sets for Clinical Trials and Observational Studies in Vulvovaginal Disease. J Low Genit Tract Dis 2018. [PMID: 28644190 DOI: 10.1097/lgt.0000000000000320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fahy CM, Torgerson RR, Davis MD. Lichen planus affecting the female genitalia: A retrospective review of patients at Mayo Clinic. J Am Acad Dermatol 2017; 77:1053-1059. [DOI: 10.1016/j.jaad.2017.07.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 12/29/2022]
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Kelekçi KH, Özyurt S, Özkan B, Karaca Ş, Karakuzu A, Bilgin İ. The Impact of Inflammatory and Infectious Diseases of Vulvar on Quality of Life. J Menopausal Med 2016; 22:131-138. [PMID: 28119892 PMCID: PMC5256362 DOI: 10.6118/jmm.2016.22.3.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/12/2016] [Accepted: 08/26/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives This study aimed to evaluate the effects of vulvar dermatoses (VD) and vulvar infections (VE) on anxiety, depression scores, general, and dermatological quality of life (QOL) of women. Methods We conducted a cross-sectional survey on patients diagnosed with VD and VE. All patients were assessed using a sociodemographic form, Skindex-29 scale, World Health Organization QOL (WHOQOL) BREF scale, Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D). Results HAM-A score was significantly higher in the VD group than in the control group. Based on age groups, all subscales of Skindex-29 were found to be higher in women > 50 years. For women with severe pruritus, the symptom subscale was higher in patients with skin involvement and the function and emotion subscales were higher in patients with and emotion subscales were higher in patients with mucosal involvement. Conclusions We found that VD was particularly significantly associated with decreased QOL.
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Affiliation(s)
- Kıymet Handan Kelekçi
- Department of Dermatology, İzmir Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
| | - Selçuk Özyurt
- Department of Dermatology, İzmir Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
| | - Bülent Özkan
- Department of Dermatology, İzmir Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
| | - Şemsettin Karaca
- Department of Dermatology, İzmir Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
| | - Ali Karakuzu
- Department of Dermatology, İzmir Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
| | - İlgül Bilgin
- Department of Dermatology, İzmir Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
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16
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Hirsch M, Duffy JM, Kusznir JO, Davis CJ, Plana MN, Khan KS, Duffy JM, Farquhar C, Hirsch M, Johnson N, Khan K. Variation in outcome reporting in endometriosis trials: a systematic review. Am J Obstet Gynecol 2016; 214:452-464. [PMID: 26778385 DOI: 10.1016/j.ajog.2015.12.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We reviewed the outcomes and outcome measures reported in randomized controlled trials and their relationship with methodological quality, year of publication, commercial funding, and journal impact factor. DATA SOURCES We searched the following sources: (1) Cochrane Central Register of Controlled Trials, (2) Embase, and (3) MEDLINE from inception to November 2014. STUDY ELIGIBILITY We included all randomized controlled trials evaluating a surgical intervention with or without a medical adjuvant therapy for the treatment of endometriosis symptoms. STUDY DESIGN Two authors independently selected trials, assessed methodological quality (Jadad score; range, 1-5), outcome reporting quality (Management of Otitis Media with Effusion in Cleft Palate criteria; range, 1-6), year of publication, impact factor in the year of publication, and commercial funding (yes or no). Univariate and bivariate analyses were performed using Spearman Rh and Mann-Whitney U tests. We used a multivariate linear regression model to assess relationship associations between outcome reporting quality and other variables. RESULTS There were 54 randomized controlled trials (5427 participants), which reported 164 outcomes and 113 outcome measures. The 3 most commonly reported primary outcomes were dysmenorrhea (10 outcome measures; 23 trials), dyspareunia (11 outcome measures; 21 trials), and pregnancy (3 outcome measures; 26 trials). The median quality of outcome reporting was 3 (interquartile range 4-2) and methodological quality 3 (interquartile range 5-2). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.325; P = .038) and year of publication (β = 0.067; P = .040). No relationship was demonstrated between outcome reporting quality with journal impact factor (Rho = 0.190; P = .212) or commercial funding (P = .370). CONCLUSION Variation in outcome reporting within published endometriosis trials prohibits comparison, combination, and synthesis of data. This limits the usefulness of research to inform clinical practice, enhance patient care, and improve patient outcomes. In the absence of a core outcome set for endometriosis we recommend the use of the 3 most common pain (dysmenorrhea, dyspareunia, and pelvic pain) and subfertility (pregnancy, miscarriage, and live birth) outcomes. International consensus among stakeholders is needed to establish a core outcome set for endometriosis trials.
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17
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Schmitt J, Deckert S, Alam M, Apfelbacher C, Barbaric J, Bauer A, Chalmers J, Chosidow O, Delamere F, Doney E, Eleftheriadou V, Grainge M, Johannsen L, Kottner J, Le Cleach L, Mayer A, Pinart M, Prescott L, Prinsen CAC, Ratib S, Schlager JG, Sharma M, Thomas KS, Weberschock T, Weller K, Werner RN, Wild T, Wilkes SR, Williams HC. Report from the kick-off meeting of the Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN). Br J Dermatol 2016; 174:287-95. [PMID: 26779929 DOI: 10.1111/bjd.14337] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
A major obstacle of evidence-based clinical decision making is the use of nonstandardized, partly untested outcome measurement instruments. Core Outcome Sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcomes and outcome measurement instruments in clinical trials, in order to pool results of trials or to allow indirect comparison between interventions. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. The international, multidisciplinary Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN) aims to develop and implement COSs in dermatology, thus making trial evidence comparable and, herewith, more useful for clinical decision making. The inaugural meeting of CSG-COUSIN was held on 17-18 March 2015 in Dresden, Germany, as the exclusive theme of the Annual Cochrane Skin Group Meeting. In total, 29 individuals representing a broad mix of different stakeholder groups, professions, skills and perspectives attended. This report provides a description of existing COS initiatives in dermatology, highlights current methodological challenges in COS development, and presents the concept, aims and structure of CSG-COUSIN.
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Affiliation(s)
- J Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.,Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - S Deckert
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - M Alam
- Department of Dermatology, Northwestern University, Chicago, IL, U.S.A
| | - C Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - J Barbaric
- Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| | - A Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - J Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - O Chosidow
- Department of Dermatology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Université Paris-Est Créteil, Créteil, France.,Satellite Français du Cochrane Skin Group, France.,EA EpiDermE, INSERM Créteil, Créteil, France
| | - F Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - E Doney
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - V Eleftheriadou
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - M Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, U.K
| | - L Johannsen
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - J Kottner
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Le Cleach
- Department of Dermatology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Université Paris-Est Créteil, Créteil, France.,Satellite Français du Cochrane Skin Group, France.,EA EpiDermE, INSERM Créteil, Créteil, France
| | - A Mayer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Pinart
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Prescott
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C A C Prinsen
- VU University Medical Center, Department of Epidemiology and Biostatistics, the EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
| | - S Ratib
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - J G Schlager
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Sharma
- Derby Teaching Hospitals NHS Foundation Trust, Derby, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - T Weberschock
- Department of Dermatology, Venereology, and Allergology, J.W. Goethe-University, Hospital, Frankfurt, Germany.,Evidence-Based Medicine Frankfurt, Institute for General Practice, Goethe-University, Frankfurt, Germany
| | - K Weller
- Department of Dermatology, Venerology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R N Werner
- Department of Dermatology, Venerology and Allergy, Division of Evidence Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Wild
- Centre of Wound Healing, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - S R Wilkes
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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18
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Page MJ, McKenzie JE, Green SE, Beaton DE, Jain NB, Lenza M, Verhagen AP, Surace S, Deitch J, Buchbinder R. Core domain and outcome measurement sets for shoulder pain trials are needed: systematic review of physical therapy trials. J Clin Epidemiol 2015; 68:1270-81. [PMID: 26092288 PMCID: PMC4711903 DOI: 10.1016/j.jclinepi.2015.06.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To explore the outcome domains and measurement instruments reported in published randomized controlled trials of physical therapy interventions for shoulder pain (rotator cuff disease, adhesive capsulitis, or nonspecific shoulder pain). STUDY DESIGN AND SETTING We included trials comparing physical therapy to any other intervention for shoulder pain, indexed up to March 2015 in CENTRAL, MEDLINE, EMBASE, or CINAHL Plus. Two authors independently selected trials for inclusion and extracted information on the domains and measurement instruments reported. RESULTS We included 171 trials. Most trials measured pain (87%), function (72%), and range of movement (67%), whereas adverse events, global assessment of treatment success, strength, and health-related quality of life were measured in 18-27% of trials, and work disability and referral for surgery were measured in less than 5% of trials. Thirty-five different measurement instruments for pain and 29 for function were noted. Measurement of function increased markedly from 1973 to 2014. In rotator cuff disease trials, there was a more frequent measurement of pain and strength and a less frequent measurement of range of movement compared with adhesive capsulitis trials. CONCLUSIONS There was wide diversity in the domains and measurement instruments reported. Our results provide the foundation for the development of a core domain and outcome measurement set for use in future shoulder pain trials.
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Affiliation(s)
- Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Level 1, 549 St Kilda Road, Melbourne, Victoria, 3004, Australia; School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Level 1, 549 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Level 1, 549 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Dorcas E Beaton
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA; Department of Orthopaedics, Vanderbilt University School of Medicine, 215 Light Hall, Nashville, TN, 37232, USA
| | - Mario Lenza
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, 05652-900, Brazil
| | - Arianne P Verhagen
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Stephen Surace
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, 183 Wattletree Road, Malvern, Victoria, 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Jessica Deitch
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, 183 Wattletree Road, Malvern, Victoria, 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, 183 Wattletree Road, Malvern, Victoria, 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.
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19
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Helgesen ALO, Warloe T, Pripp AH, Kirschner R, Peng Q, Tanbo T, Gjersvik P. Vulvovaginal photodynamic therapy vs. topical corticosteroids in genital erosive lichen planus: a randomized controlled trial. Br J Dermatol 2015; 173:1156-62. [PMID: 26189484 DOI: 10.1111/bjd.14033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Genital erosive lichen planus (GELP) in women is a chronic inflammatory disease characterized by painful vulval and vaginal erosions. Topical photodynamic therapy (PDT) is increasingly used in premalignant and malignant diseases and may have an effect in inflammatory diseases. OBJECTIVES To assess the feasibility, efficacy and safety of hexyl 5-aminolevulinate-hydrocloride (HAL)-PDT in GELP. METHODS Forty women, diagnosed with GELP at a specialized vulva clinic, were randomized to one session HAL-PDT in vulva and/or vagina (n = 20) or daily applications of clobetasol propionate 0·05% ointment in vulva and optional hydrocortisone acetate 1·0% foam in vagina for 6 weeks (n = 20). After 6 weeks, all patients were allowed to use topical corticosteroids as needed. Clinical examinations were performed at weeks 0, 6 and 24, using a clinical score developed for the study. All patients wrote a weekly log on pain, topical corticosteroid use and adverse events. RESULTS Three patients, all in the corticosteroid group, withdrew from the study after 1-3 weeks. The mean reduction in clinical scores was similar in the PDT group and the corticosteroid group; 25% vs. 22% after 6 weeks (P = 0·787) and 35% vs. 38% after 24 weeks (P = 0·801). The mean reduction in pain visual analogue scale scores was 38% vs. 55% after 6 weeks (P = 0·286) and 39% vs. 12% after 24 weeks (P = 0·452). Patients in the PDT group reported significantly less topical corticosteroid use during weeks 7-24 than those in the corticosteroid group. No major adverse events were reported. CONCLUSIONS Vulvovaginal HAL-PDT seems to be an effective and safe treatment for GELP.
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Affiliation(s)
- A L O Helgesen
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, N-0424, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Oslo University Hospital, N-0424, Oslo, Norway
| | - T Warloe
- Department of Internal Medicine, Oslo University Hospital, N-0424, Oslo, Norway
| | - A H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, N-0424, Oslo, Norway
| | - R Kirschner
- Department of Gynaecology, Oslo University Hospital, N-0424, Oslo, Norway
| | - Q Peng
- Department of Pathology, Oslo University Hospital, N-0424, Oslo, Norway
| | - T Tanbo
- Institute of Clinical Medicine, Oslo University Hospital, N-0424, Oslo, Norway.,Department of Gynaecology, Oslo University Hospital, N-0424, Oslo, Norway
| | - P Gjersvik
- Department of Dermatology, Oslo University Hospital, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Oslo University Hospital, N-0424, Oslo, Norway
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20
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Enamandram M, Rathmell JP, Kimball AB. Chronic pain management in dermatology. J Am Acad Dermatol 2015; 73:563-73; quiz 573-4. [DOI: 10.1016/j.jaad.2014.11.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023]
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21
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Comino R, Coronado PJ, Cararach M, Nieto A, Martinez-Escoriza JC, Salamanca A, Torres-Garcia LM, Vidart JA, Mendoza N, Torne A, Sánchez-Borrego R. Spanish consensus on vulvar disorders in postmenopausal women. Maturitas 2014; 80:226-33. [PMID: 25529938 DOI: 10.1016/j.maturitas.2014.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The consequences of vulvar disorders in terms of health, sexuality, and quality of life are usually undervalued, with disparities in the conceptual, diagnosis and treatment criteria. AIM The objective of this guide will be to analyse the factors associated with the diagnosis and treatment of vulvar disorders and to provide recommendations for the most appropriate diagnostic and therapeutic measures. METHODOLOGY A panel of experts from various Spanish scientific societies related to sexual health (Spanish Menopause Society [SMS] and the Asociación Española de Patología Cervical y Colposcopia [AEPCC]) met to reach a consensus on these issues and to decide the optimal timing and methods based on the best evidence available. RESULTS We recommend a biopsy of all vulvar lesions with an uncertain diagnosis, especially with asymmetry, irregular borders, variegated and irregular colour and diameter >6mm. For vulvodynia, we recommend the use of lubricants or topical treatments with lidocaine or bupivacaine, amitriptyline, baclofen or triamcinolone. For vulvar epithelial disorders, we recommend beginning with topical corticosteroids of moderate to high potency. For sexual dysfunction, a multidisciplinary approach is the best management strategy in these patients.
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Tirlapur SA, Ni Riordain R, Khan KS. Variations in the reporting of outcomes used in systematic reviews of treatment effectiveness research in bladder pain syndrome. Eur J Obstet Gynecol Reprod Biol 2014; 180:61-7. [PMID: 25020277 DOI: 10.1016/j.ejogrb.2014.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/06/2014] [Accepted: 06/04/2014] [Indexed: 01/08/2023]
Abstract
This paper investigates the quality of outcomes reported in systematic reviews and randomised controlled trials (RCTs) of bladder pain syndrome and its relationship with study quality and journal impact factor. We searched until August 2013 the Cochrane Library, EMBASE, Medline, CINAHL, LILACS and SIGLE, without language restrictions. Quality of outcome reporting in systematic reviews and constituent RCTs was assessed using a 6-point scale. Overall study quality was assessed using the AMSTAR and Jadad scoring systems, and impact factor in the year of publication was noted. Spearman's rank correlation was calculated. There were 8 systematic reviews, with a total of 28 RCTs (1732 patients), reporting 5 outcomes using 19 different measurement scales. The outcomes reported in individual RCTs were urinary symptoms (100%), pain (64%), quality of life (39%), general wellbeing (36%) and bladder capacity (36%). The mean quality of outcomes reported was 1.63 (95% CI 0.29-2.96) for systematic reviews and 3.25 (95% CI 2.80-3.70) for RCTs. The quality of outcomes reported showed correlation with overall study quality (0.90, 95% CI 0.79-0.95, p<0.0001) but not with journal impact factor (0.07, 95% CI -0.31-0.43, p=0.35). Multivariable linear regression showed a relationship between quality of outcome reporting and study quality (β=0.05, p<0.0001), adjusting for effects of study type, impact factor and journal type. There is a need to generate consensus over a set of core outcomes in bladder pain syndrome using standardised reporting tools and to disseminate these through good publication practice.
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Affiliation(s)
- Seema A Tirlapur
- Women's Health Research Unit, Barts and The London School of Medicine, Queen Mary, University of London, Turner Street, London E1 2AB, United Kingdom.
| | - Richeal Ni Riordain
- Barts and The London School of Medicine and Dentistry, London E1 2AB, United Kingdom
| | - Khalid S Khan
- Women's Health Research Unit, Barts and The London School of Medicine, Queen Mary, University of London, Turner Street, London E1 2AB, United Kingdom; Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom
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