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Richardson C, Kassels A, Elsensohn A, Akinshemoyin Vaughn OL, Kraus C. Use of systemic therapies for vulvar lichen sclerosus and vulvovaginal lichen planus: a survey study of dermatologists and gynecologists. Int J Womens Dermatol 2024; 10:e146. [PMID: 38638164 PMCID: PMC11025704 DOI: 10.1097/jw9.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
| | - Alexa Kassels
- School of Medicine, University of California, Irvine, California
| | - Ashley Elsensohn
- Departments of Dermatology and Pathology, Loma Linda University School of Medicine, Loma Linda, California
| | | | - Christina Kraus
- Department of Dermatology, University of California, Irvine, California
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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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Rivera S, Flood A, Dykstra C, Herbenick D, DeMaria AL. Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3965-3979. [PMID: 35900677 PMCID: PMC9332093 DOI: 10.1007/s10508-022-02353-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/30/2022] [Accepted: 05/08/2022] [Indexed: 05/10/2023]
Abstract
Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September-November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19-81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.
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Affiliation(s)
- Sydney Rivera
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, USA.
| | - Anna Flood
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Chandler Dykstra
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
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Kherlopian A, Fischer G. Identifying predictors of systemic immunosuppressive treatment of vulvovaginal lichen planus: A retrospective cohort study of 122 women. Australas J Dermatol 2022; 63:335-343. [PMID: 35500127 DOI: 10.1111/ajd.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Between 20% and 40% of women with vulvovaginal lichen planus (VLP) fail to respond to first-line ultra-potent topical corticosteroid treatment and require systemic immunosuppression to control disease. No data exist regarding risk factors for patients with severe VLP requiring systemic immunosuppression. We aimed to identify clinical features that predict women with VLP who are at risk of severe, recalcitrant disease requiring eventual escalation to systemic treatment. METHODS A chart review was performed on a cohort of 122 adult women with VLP followed prospectively for 15 years by the same clinician in a private dermatology practice in Australia between 1 January 2004 and 1 October 2021. Uni- and multivariable binary logistical regression analyses were performed to identify clinical features distinguishing women eventually requiring systemic treatment of VLP against those whose VLP was controlled with topical corticosteroids alone. RESULTS The mean age at diagnosis of VLP was 61 years, with 35 women (28.7%) requiring systemic treatment of VLP. A multivariable regression model utilising 'Age at Diagnosis' (adjusted OR = 0.97, 95% CI 0.94-0.99), 'Non-Caucasian Ethnicity' (adjusted OR = 10.3, 95% CI 2.27-73.9) and 'Vulvar Pruritus' (adjusted OR = 2.69, 95% CI 1.11-6.86) demonstrated moderate predictive capacity, with specificity and sensitivity for predicting whether a patient will require systemic treatment for VLP of 95.3% and 40.5%, respectively. CONCLUSIONS Our findings may indicate women with VLP who are younger, of non-Caucasian ethnicity, and presenting with vulval pruritus are the highest risk of severe disease requiring systemic immunosuppressive treatment and may benefit most from earlier initiation of systemic treatment.
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Affiliation(s)
- Ashod Kherlopian
- Department of Dermatology, Dermatology Research Office, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Leis M, Singh A, Li C, Ahluwalia R, Fleming P, Lynde CW. Risk of Vulvar Squamous Cell Carcinoma in Lichen Sclerosus and Lichen Planus: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:182-192. [PMID: 34678521 DOI: 10.1016/j.jogc.2021.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study were to determine: 1) the prevalence of lichen sclerosus (LS) and lichen planus (LP) present in association with vulvar squamous cell carcinoma (VSCC), and 2) the incidence and absolute risk of developing VSCC in LS and LP. METHODS A search was performed of MEDLINE, EMBASE and CINAHL databases. Three independent reviewers screened articles published before September 1, 2020, first on title/abstract and then on the full text. Women with a history of VSCC, human papillomavirus, smoking, or autoimmune disease were excluded. Newcastle-Ottawa observational study scales were used to assess the risk of bias and methodological quality of the included studies. Of the 3132 studies assessed, 31 were selected for analysis. Due to study heterogeneity, a qualitative synthesis was conducted. RESULTS The prevalence of LS and LP in association with VSCC ranged from 0% (95% CI 0-5) to 83% (95% CI 36-100) and 1% (95% CI 0-7) to 33% (95% CI 4-78), respectively. The incidence of VSCC ranged from 1.16 (95% CI 0.03-6.44) to 13.67 (95% CI 5.50-28.17) per 1000 person-years for LS. The absolute risk of developing VSCC in patients ranged from 0.0% (95% CI 0.0-5.52) to 21.88% (95% CI 9.28-39.97) with LS and was 1.16% (95% CI 0.1-4.1) with LP. Incidence was not calculable for LP owing to study characteristics. CONCLUSIONS This review provides evidence that there is an increased risk of developing VSCC in women with LS, while associations with LP are less clear. Early identification, treatment, and long-term follow-up are essential to prevent potential malignant progression of these vulvar dermatoses.
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Affiliation(s)
- Maria Leis
- Faculty of Medicine, University of Toronto, ON.
| | | | - Calandra Li
- Faculty of Medicine, University of Toronto, ON
| | - Renita Ahluwalia
- Women's College Hospital, Toronto, ON; Division of Dermatology, University of Toronto, ON
| | - Patrick Fleming
- Division of Dermatology, University of Toronto, ON; Lynde Institute of Dermatology, Markham, ON
| | - Charles W Lynde
- Division of Dermatology, University of Toronto, ON; Lynde Institute of Dermatology, Markham, ON
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6
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Diagnosis and Management of Vulvovaginal Lichen Planus. Obstet Gynecol Surv 2021; 75:624-635. [PMID: 33111963 DOI: 10.1097/ogx.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Genital lichen planus is a debilitating disorder that lacks definitive recommendations regarding diagnosis and treatment. Objective The aim of this study was to present best practices from available evidence for the diagnosis and treatment of genital lichen planus. Evidence Acquisition We conducted a narrative review of the literature on genital lichen planus by searching PubMed using the following search terms: "vulvar lichen planus" OR (vulvar diseases[mesh] OR vulva[mesh]) AND lichen planus[mesh] OR vulvar[ti] AND "lichen planus"[ti]. We included all languages and years in the search. Results The search resulted in 273 citations that we reviewed for relevancy and selected 60 as the foundation for this review that focuses on genital sites. Diagnosis can be made without biopsy, and when a biopsy is taken, the pathologic findings may be nonspecific. Topical ultrapotent corticosteroids are most commonly used as first-line treatment of genital lichen planus. Conclusions and Relevance When patients present with genital lichen planus, a complete review of systems and a thorough physical examination should be performed because of the prevalence of extragenital sites. Treatment of genital disease should start with a topical, ultrapotent steroid, and follow-up visits should occur to ensure improvement and to monitor for adverse drug reactions and malignancy.
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Kherlopian A, Fischer G. Disease remission of refractory vulvovaginal and gingival lichen planus with tildrakizumab. Australas J Dermatol 2021; 62:246-247. [PMID: 33742446 DOI: 10.1111/ajd.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Ashod Kherlopian
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Unwarranted hysterectomy in a case of oro-vaginal-vulvar lichen planus in a young woman: a case report. J Med Case Rep 2021; 15:97. [PMID: 33632292 PMCID: PMC7908714 DOI: 10.1186/s13256-021-02720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Lichen planus is a rare autoimmune disease primarily affecting the skin and mucous membranes of the oral mucosa, vulva, and vagina. Diagnosis is difficult and often delayed as the clinicians do not associate the oral symptoms with the genital symptoms. This has a negative impact on the out-of-pocket expenditure and quality of life of the patients. We report this case, as only anecdotal cases have been reported so far from a developing country such as India. We highlight the unindicated hysterectomy that the patient had undergone because of lack of awareness regarding this condition. Our case report also highlights the importance of the multidisciplinary team approach to optimize outcomes and avoid unnecessary morbidity to such patients. Case presentation We report a North-Indian patient with oro-vaginal-vulvar lichen planus who presented to us with complaints of recurrent vulvovaginal symptoms for the last 5 years. She had been previously treated with multiple courses of antibiotics, antifungals, and topical steroids over the course of 3 years and finally offered laparoscopic-assisted vaginal hysterectomy (LAVH) by a private practitioner but got no relief. She also had complained of oral symptoms in the form of a burning sensation after eating spicy food, but did not seek any treatment for this. After multidisciplinary team discussion, a final diagnosis of oro-vaginal-vulvar lichen planus was made at our institute based on the clinical and histopathological findings. The patient was immediately started on oral prednisolone to which she responded with improvement in her symptoms. Conclusion Lichen planus is a chronic painful condition with significant impact on the quality of life. Women often suffer for several years before an accurate diagnosis is made. Treatment is challenging and needs to be individualized with a multidisciplinary approach to prevent progressive anatomical distortion and associated morbidity.
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Vermeer HAB, Rashid H, Esajas MD, Oldhoff JM, Horváth B. The use of hydroxychloroquine as a systemic treatment in erosive lichen planus of the vulva and vagina. Br J Dermatol 2021; 185:201-203. [PMID: 33548058 PMCID: PMC8360049 DOI: 10.1111/bjd.19870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- H A B Vermeer
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - H Rashid
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M D Esajas
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J M Oldhoff
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B Horváth
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Lyra J, Melo C, Figueiredo R, Polonia-Valente R, Falcão V, Beires J, Vieira-Baptista P. Erosive Vulvar Lichen Planus and Risk of Vulvar Neoplasia. J Low Genit Tract Dis 2021; 25:71-75. [PMID: 33214502 DOI: 10.1097/lgt.0000000000000581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients. MATERIALS AND METHODS A retrospective cohort study, including all the women with the diagnosis of vulvar LP, followed in one institution during a period of 11 years, was performed. Demographic and clinical data, as well as treatment, follow-up, and histology results, were evaluated. RESULTS A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.9 ± 0.5 years (range = 1-11 years). Ultrapotent topical corticosteroids were first-line treatment in 91.8% (n = 112), with 32 cases (25.2%) needing an alternative treatment. Overall, 30 biopsies were performed in 19 women (15%). Vulvar high-grade squamous intraepithelial lesion was diagnosed in 3 women (2.4%), 2 (1.6%) of whom were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed. CONCLUSIONS Premalignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up seems to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion seems during follow-up.
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Affiliation(s)
- Joana Lyra
- Serviço de Ginecologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Catarina Melo
- Serviço de Ginecologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rita Figueiredo
- Serviço de Ginecologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rita Polonia-Valente
- Serviço de Ginecologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Vera Falcão
- Serviço de Ginecologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Jorge Beires
- Serviço de Ginecologia, Centro Hospitalar Universitário São João, Porto, Portugal
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Shalin SC, Racher LM, Campbell KK. Lichenoid dermatoses involving the vulva: A clinical-pathologic correlation ✰. Semin Diagn Pathol 2020; 38:3-18. [PMID: 32951943 DOI: 10.1053/j.semdp.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
The lichenoid tissue reaction pattern generally signifies cytotoxic damage to the epithelium. When such reaction pattern occurs on vulvar skin or mucosa, the effects can result in considerable morbidity. None of the entities discussed in this review are entirely unique to the vulva, however, some entities may classically occur at this site, while others tend to be widespread diseases that may incidentally affect vulvar skin and mucosa. Given the complex anatomy of the vulva and the bridging of a site showing both keratinizing squamous epithelium and non-keratinizing squamous mucosa, histopathologic features may display variation in presentation. Although identification of a "lichenoid reaction pattern" alone may provide insight into the disease process, understanding of clinical presentation and specific sites of involvement, along with recognition of the nuanced features of the disease entities can help establish a specific diagnosis. Accurate histopathologic diagnoses by pathologists can improve the ability for treating clinicians to implement timely and effective treatment.
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Affiliation(s)
- Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Luann M Racher
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Katelynn K Campbell
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
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12
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Wu M, Lee G, Fischer G. Forming diagnostic criteria for vulvar lichen planus. Australas J Dermatol 2020; 61:324-329. [PMID: 32671833 DOI: 10.1111/ajd.13350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Vulvar lichen planus is a debilitating skin condition usually complicated by delayed diagnosis due to its highly variable clinical appearance and inconsistent histopathological characteristics. This study aims to devise a clinical diagnostic tool for the disease and to correlate this with histopathology findings. METHODS The retrospective single-centre chart review was conducted for patients presenting between January 2010 and December 2019. Clinical features were compared between 243 women with clinically suspected vulvar lichen planus with available histopathology, 50 patients with biopsy-proven vulvar lichen sclerosus and 50 patients with culture-proven chronic vulvovaginal candidiasis. Features which significantly differentiated between conditions were further studied using multivariate nonlinear regression analyses to formulate a score-based diagnostic criteria. Criteria was then applied to the remaining patients with inconclusive biopsies (classified as 'normal', 'non-specific' or 'suggestive or lichenoid') to determine sensitivity and specificity. RESULTS The clinical features that significantly differentiated the conditions were the presence of erosions (P < 0.001), glazed erythema (P < 0.001), oral involvement (P < 0.001), pain/burning sensation (P < 0.001) and hyperkeratotic border (P < 0.001). A score ≥2 correlated with a histopathological diagnosis of vulvar lichen planus with a sensitivity of 100%. The specificity was 92% and 88% when compared against vulvar lichen sclerosus and chronic vulvovaginal candidiasis, respectively. Sensitivity was 97%, 97% and 93% in suggestive, nonspecific and normal histopathological subgroups, respectively. CONCLUSIONS AND RELEVANCE The proposed criteria may aid clinicians in diagnosing patients if histopathology is inconclusive. Nonspecific and suggestive findings on biopsy for patients with ≥2 features on diagnostic criteria are comparable to a conclusive biopsy.
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Affiliation(s)
- Michelle Wu
- Northern Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Geoffrey Lee
- Northern Clinical School, University of Sydney, Camperdown, NSW, Australia.,Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Gayle Fischer
- Northern Clinical School, University of Sydney, Camperdown, NSW, Australia.,Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
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13
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Corazza M, Virgili A, Toni G, Valpiani G, Morotti C, Borghi A. Pictorial Representation of Illness and Self-Measure to assess the perceived burden in patients with chronic inflammatory vulvar diseases: an observational study. J Eur Acad Dermatol Venereol 2020; 34:2645-2651. [PMID: 32597539 DOI: 10.1111/jdv.16637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronic inflammatory vulvar diseases can have a huge detrimental impact on patient welfare. A few studies have addressed this issue so far, mainly measuring patients' quality of life or sexual dysfunction. OBJECTIVE To assess the burden of suffering in patients with chronic inflammatory vulvar diseases using the Pictorial Representation of Illness and Self-Measure (PRISM), a visual, non-verbal instrument. We also assessed (i) the concordance between PRISM and the Dermatology Life Quality Index (DLQI), (ii) whether some variables, both patient-related and disease-related, affect the patient's suffering and quality-of-life impairment. METHODS We evaluated for inclusion in this cross-sectional study all patients who attended our Vulva Unit over a 9-month period with histologically proven lichen sclerosus (LS), lichen planus (LP), lichen simplex chronicus (LSC), eczema, plasma cell vulvitis and psoriasis (at least five for each disease). Demographics and disease-related subjective and objective scores were recorded. The PRISM and DLQI were administered. RESULTS We included 87 patients affected with LS, 13 with LSC and seven with LP. Median PRISM values (0-273 mm) ranged from 95 to 120 mm, depending on the disease, and median DLQI scores (0-30) were five for all three groups. Neither PRISM nor DLQI scores differed significantly among the three groups. Moderate coherence was found between PRISM and DLQI (ρ = 0.5455, P < 0.001). Global subjective score was the only variable significantly associated with the degree of suffering and quality-of-life impairment. CONCLUSIONS Pictorial Representation of Illness and Self-Measure proved to be a valuable, highly reliable tool for measuring the perceived burden in these patients. In spite of a moderate correlation, PRISM resulted more sensitive in capturing patient distress than DLQI.
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Affiliation(s)
- M Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - A Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - G Toni
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - G Valpiani
- Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - C Morotti
- Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - A Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
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Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases. J Am Acad Dermatol 2020; 82:1287-1298. [DOI: 10.1016/j.jaad.2019.10.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
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15
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Dunaway S, Tyler K, Kaffenberger J. Update on treatments for erosive vulvovaginal lichen planus. Int J Dermatol 2020; 59:297-302. [PMID: 31631346 DOI: 10.1111/ijd.14692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/02/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course of the disease and its resistance to treatment. While topical steroids have been accepted as the first-line treatment, they fail to achieve symptomatic control in approximately 40% of patients. Second-line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. This review provides an overview of the current treatments and explores the level of evidence supporting each of them.
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Affiliation(s)
- Spencer Dunaway
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelly Tyler
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Khurana A, Tandon S, Marfatia YS, Madnani N. Genital lichen planus: An underrecognized entity. Indian J Sex Transm Dis AIDS 2020; 40:105-112. [PMID: 31922099 PMCID: PMC6896385 DOI: 10.4103/ijstd.ijstd_45_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Genital lichen planus (LP) is an underrecogonized dermatosis. The appearance is often unlike classical LP elsewhere, and hence, the condition goes undiagnosed in many. Vulvo-vaginal LP in particular, can be a distressing condition often leading to scarring and a poor quality of life. Treatment for most of the genital LP variants is similar to managing LP elsewhere; however, the erosive variant requires special attention as treatment outcomes are often disappointing and the disease runs a protracted course. Potential for development of malignancy also exists, as in oral LP, and hence close follow up is essential.
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Affiliation(s)
- Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sidharth Tandon
- Department of Dermatology, Santosh Medical College, Gaziabad, Uttar Pradesh, India
| | - Yogesh S Marfatia
- Department of Dermatology, Government Medical College, Vadodara, Gujarat, India
| | - Nina Madnani
- Department of Dermatology, P. D. Hinduja National Hospital and Sir H. N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
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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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Mi L, Zhang H, Zhang D, Zhang M. Lichen planus with multiple system involvement including the mouth, vagina, urethra, and scalp: a case report. ACTA ACUST UNITED AC 2019; 52:e8823. [PMID: 31618369 PMCID: PMC6787949 DOI: 10.1590/1414-431x20198823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/02/2019] [Indexed: 01/03/2023]
Abstract
This is a case report of lichen planus (LP) with multiple system involvement. A 35-year-old female patient was admitted in November 2014 with a 5-year history of painful/difficult sexual intercourse and loss of oral mucosa, and an 8-year history of focal hair loss. Earlier, the patient had been unable to adhere to corticosteroid therapy because of severe adverse side effects. In September 2014, labia minora mucosa defects and stricture of the urethral orifice (with dysuria), vaginal orifice, and vagina were identified. Biopsy was performed and a diagnosis of erosive LP was made. The patient was treated with an oral immunosuppressant (cyclosporine A) and urethral/vaginal dilatation. Urine flow rate and sex life were improved after 6 months and she discontinued medication. Four years later, the patient reported a good overall treatment efficacy. LP can involve multiple systems and should be considered in patients with dyspareunia. Immunosuppressive agents can achieve a satisfactory effect in patients with contraindication to corticosteroid.
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Affiliation(s)
- Lan Mi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Dai Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Miao Zhang
- Department of Obstetrics and Gynecology, Beijing Aiyuhua Hospital for Women and Children, Beijing, China
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Dubey R, Fischer G. Vulvo-vaginal lichen planus: A focussed review for the clinician. Australas J Dermatol 2018; 60:7-11. [PMID: 29961956 DOI: 10.1111/ajd.12875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/22/2018] [Indexed: 01/04/2023]
Abstract
Vulvo-vaginal lichen planus is a condition which imposes a significant burden of symptoms and sequale. There is a paucity of knowledge and evidenced-based management with significant diagnostic delay prior to appropriate treatment being common. There remains great variability in clinician practice in the context of limited knowledge. This clinical review presents current evidence on the clinicopathological features, practical assessment and management options. Learning points include characterization of this chronic, burdensome clinical entity that has no standardized diagnostic or management protocols. We provide practical clinical conclusions based on current knowledge and identify areas for future research to improve patient outcomes.
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Affiliation(s)
- Ritika Dubey
- Northern Sydney Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gayle Fischer
- Northern Sydney Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
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Abstract
Vulval lichen planus–lichen sclerosus overlap is an emerging observation. Few clinical reports exist with no reviews of literature. We present a focused update of this phenomenon and discuss a clinical case. We report a 63-year-old woman with a 20-year history of ulcerative vulvo-vaginitis, initially diagnosed as benign mucous membrane (cicatricial) pemphigoid. This led to prolonged treatment with oral corticosteroids with minimal improvement in symptoms. Subsequent complications of long-term use of systemic corticosteroid ensued. A clinico-pathological diagnosis of severe erosive lichen planus was made on clinical findings and on non-specific biopsy changes of ulceration and inflammation. Treatment with topical clobetasol propionate 0.05% ointment twice daily led to dramatic improvement of ulceration, easing of discomfort and marked improvement in quality of life. Clinical examination revealed Wickham’s striae on the labia majora supporting the diagnosis. Six years after commencement of topical clobetasol, white plaques were noticed on the labia majora, perineum and peri-anal region consistent with lichen sclerosus, confirmed by repeat vulval skin biopsy and on vulvectomy. This case highlights the challenge of diagnosis of extensive vulvo-vaginal ulceration and the necessity to re-examine a previous diagnosis if there is poor response to treatment.
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Affiliation(s)
- Matthew Howard
- Department of Medicine, St Vincent’s Hospital, Melbourne, Australia
| | - Anthony Hall
- School of Medicine, Deakin University, Geelong, Australia
- Skin and Cancer Foundation (Inc), Carlton, Australia
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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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Quality of Life and Sexual Distress in Women With Erosive Vulvovaginal Lichen Planus. J Low Genit Tract Dis 2017; 21:145-149. [DOI: 10.1097/lgt.0000000000000282] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Distinguishing Erosive Lichen Planus From Differentiated Vulvar Intraepithelial Neoplasia. J Low Genit Tract Dis 2016; 20:174-9. [DOI: 10.1097/lgt.0000000000000179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Simpson RC, Murphy R, Bratton DJ, Sydes MR, Wilkes S, Nankervis H, Dowey S, Thomas KS. Systemic therapy for vulval Erosive Lichen Planus (the 'hELP' trial): study protocol for a randomised controlled trial. Trials 2016; 17:2. [PMID: 26729245 PMCID: PMC4698814 DOI: 10.1186/s13063-015-1133-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Erosive lichen planus affecting the vulva (ELPV) is a relatively rare, chronic condition causing painful raw areas in the vulvovaginal region. Symptoms are pain and burning, which impact upon daily living. There is paucity of evidence regarding therapy. A 2012 Cochrane systematic review found no randomised controlled trials (RCTs) in this field. Topically administered corticosteroids are the accepted first-line therapy: however, there is uncertainty as to which second-line treatments to use. Several systemic agents have been clinically noted to show promise for ELPV refractory to topically administered corticosteroids but there is no RCT evidence to support these. The 'hELP' study is a RCT with an internal pilot phase designed to provide high-quality evidence. METHODS/DESIGN The objective is to test whether systemic therapy in addition to standard topical therapy is a beneficial second-line treatment for ELPV. Adjunctive systemic therapies used are hydroxychloroquine, methotrexate, mycophenolate mofetil and prednisolone. Topical therapy plus a short course of prednisolone given orally is considered the comparator intervention. The trial is a four-armed, open-label, pragmatic RCT which uses a blinded independent clinical assessor. To provide 80 % power for each comparison, 96 participants are required in total. The pilot phase aims to recruit 40 participants. The primary clinical outcome is the proportion of patients achieving treatment success at 6 months. 'Success' is defined by a composite measure of Patient Global Assessment score of 0 or 1 on a 4-point scale plus improvement from baseline on clinical photographs scored by a clinician blinded to treatment allocation. Secondary clinical outcomes include 6-month assessment of: (1) Reduction in pain/soreness; (2) Global assessment of disease; (3) Response at other affected mucosal sites; (4) Hospital Anxiety and Depression Scale scores; (5) Sexual function; (6) Health-related quality of life using 'Short Form 36' and 'Skindex-29' questionnaires; (7) Days of topical steroid use; (8) Treatment satisfaction; (9) Discontinuation of medications due to treatment failure; (10) Per participant cost of intervention in each treatment group. Adverse events will also be reported. DISCUSSION 'hELP' is the first RCT to address second-line treatment of ELPV. The trial has encountered unique methodological challenges and has required collaborative efforts of the UK Dermatology Clinical Trials Network alongside expert clinicians. TRIAL REGISTRATION CURRENT CONTROLLED TRIALS ISRCTN 81883379 . Date of registration 12 June 2014.
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Affiliation(s)
- Rosalind C Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Ruth Murphy
- Nottingham University Hospitals, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK.
| | - Daniel J Bratton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Aviation House, 125, Kingsway, London, WC2B 6NH, UK.
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Aviation House, 125, Kingsway, London, WC2B 6NH, UK.
| | - Sally Wilkes
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Shelley Dowey
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
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Tadakamadla J, Kumar S, Johnson NW. Quality of life in patients with oral potentially malignant disorders: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:644-55. [PMID: 25956217 DOI: 10.1016/j.oooo.2015.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 12/12/2022]
Abstract
There is a paucity of literature on quality of life (QoL) in patients with oral potentially malignant disorders (OPMDs) despite these conditions being relatively common, chronic, and potentially debilitating. The aim of this paper is to systematically review the literature on QoL in patients with OPMDs. A search from electronic databases PUBMED, MEDLINE, and CINAHL Plus retrieved 180 titles after removing duplicates, and a further 4 papers were identified by hand searching. Study of the abstracts identified 25 truly relevant articles, which were studied in full. Of these, 14 met our strict inclusion criteria. Most studies were cross-sectional; most were from Europe and have evaluated QoL in patients with oral lichen planus (OLP). The findings differ but, overall, do not provide evidence that patients with OPMDs have a poorer QoL compared with healthy patients. Several things may explain this apparently surprising conclusion. First, the quality of most articles was moderate or weak; second, most studies assessed QoL only in patients with OLP and cannot be generalized to all patients with OPMDs; last, direct comparisons between patients with OPMD and healthy controls were rarely included. The validity of the QoL instrument used for patients with OLP was frequently inadequate.
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Affiliation(s)
- Jyothi Tadakamadla
- Population and Social Health Research Programme, Menzies Health Institute Queensland, School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia.
| | - Santhosh Kumar
- Population and Social Health Research Programme, Menzies Health Institute Queensland, School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Newell W Johnson
- Professor of Dental Research, Population and Social Health Research Programme, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Day T, Bohl TG, Scurry J. Perianal lichen dermatoses: A review of 60 cases. Australas J Dermatol 2015; 57:210-5. [DOI: 10.1111/ajd.12308] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Tania Day
- Maternity and Gynaecology; John Hunter Hospital; Newcastle New South Wales
- University of Newcastle; Newcastle New South Wales
| | | | - James Scurry
- University of Newcastle; Newcastle New South Wales
- Anatomical Pathology; Pathology North, Hunter New England; Newcastle New South Wales
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Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best Pract Res Clin Obstet Gynaecol 2014; 28:946-58. [PMID: 25132276 DOI: 10.1016/j.bpobgyn.2014.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 01/09/2023]
Abstract
Vulvar dermatoses are inflammatory conditions responsible for chronic or recurrent itching and soreness. The lesions are either circumscribed to the vulva or associated with extragenital localizations which may help to assess the diagnosis. They should be differentiated from infectious or neoplastic diseases which may have clinical similarities. As opposed to the majority of all dermatoses that have a benign and regular course, lichen sclerosus or lichen planus could exceptionally foster the occurrence of an epithelial cancer precursor which may evolve to squamous cell carcinoma. Topical corticosteroids are the mainstay treatment of vulvar dermatosis. We do not know if the treatment of vulvar lichen sclerosus and vulvar lichen planus prevents squamous cell carcinoma.
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Affiliation(s)
| | - Jeanne Wendling
- Department of Dermatology, Hôpital Tarnier Cochin, 89 rue d'Assas, 75006 Paris, France
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Helgesen ALO, Gjersvik P, Peng Q, Vasovic V, Pripp AH, Jebsen P, Tanbo T, Warloe T. Biodistribution of protoporphyrin IX in female genital erosive lichen planus after topical application of hexaminolevulinate. Photodiagnosis Photodyn Ther 2014; 11:113-7. [DOI: 10.1016/j.pdpdt.2014.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
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Simpson RC, Thomas KS, Leighton P, Murphy R. Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise. Br J Dermatol 2014; 169:337-43. [PMID: 23521206 PMCID: PMC3838629 DOI: 10.1111/bjd.12334] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2013] [Indexed: 12/01/2022]
Abstract
Background There is no defined set of criteria for diagnosing erosive lichen planus affecting the vulva (ELPV) and there is geographical variation in management. Objectives To reach consensus on clinicopathological diagnostic criteria for ELPV. Methods This was a three-stage international electronic-Delphi exercise with a subsequent formal feedback process. In the first two rounds participants were asked to rate the importance of a list of clinicopathological criteria. Responses from round 1 were summarized and presented in round 2, along with additional criteria suggested by participants. In round 3, participants were asked to rate the items that had reached consensus as ‘essential’ or ‘supportive’ features in diagnosing ELPV. Consensus was defined as being reached if 75% of participants agreed on the importance of an item. Results A total of 73 experts representing dermatology, gynaecology, histopathology and genitourinary medicine participated; 69 (95%) completed all three rounds. Consensus was achieved for the following ‘supportive’ diagnostic criteria: (i) well-demarcated erosions/erythematous areas at the vaginal introitus; (ii) presence of a hyperkeratotic border to lesions and/or Wickham striae in surrounding skin; (iii) symptoms of pain/burning; (iv) scarring/loss of normal architecture; (v) presence of vaginal inflammation; (vi) involvement of other mucosal surfaces; (vii) presence of a well-defined inflammatory band involving the dermoepidermo junction; (viii) presence of an inflammatory band consisting predominantly of lymphocytes; and (ix) signs of basal layer degeneration. It was suggested that at least three supportive features should be present to make a diagnosis of ELPV, although this number is subject to further discussion. Conclusions This study has identified a diagnostic dataset for ELPV that can be adopted into clinical practice and clinical trials.
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Affiliation(s)
- R C Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, UK.
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Comment on “Management of Vulvovaginal Lichen Planus. J Low Genit Tract Dis 2014; 18:E23-4. [DOI: 10.1097/lgt.0b013e318293b90c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kolios AGA, Marques Maggio E, Gubler C, Cozzio A, Dummer R, French LE, Navarini AA. Oral, esophageal and cutaneous lichen ruber planus controlled with alitretinoin: case report and review of the literature. Dermatology 2013; 226:302-10. [PMID: 23948733 DOI: 10.1159/000349980] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 02/07/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Therapy-resistant lichen planus (LP) can be a challenging condition for dermatologists. There are some case reports about successful treatments with alitretinoin of cutaneous and oral, but not of esophageal LP. OBJECTIVE We present the unique case of a patient with cutaneous, oral and esophageal LP which was refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide); because of systemic side effects the patient did not tolerate systemic acitretin dosed up to 25 mg daily. METHODS Oral alitretinoin was used at a dose of 30 mg daily. RESULTS Both oral and skin changes as well as dysphagia completely resolved within 4 weeks without any severe side effects and the drug was used for 6 months. No papules, intraoral striae or dysphagia recurred during the 6 months of treatment. After 4 months the patient relapsed with mucosal patches so that a second cycle was initiated for 6 months where oral LP lesions resolved after 4 weeks also (with sporadic mild headache). CONCLUSION Further studies are needed to better understand the impact of alitretinoin in LP. Our observation suggests alitretinoin as a new, well-tolerated treatment option for esophageal LP after failed response to conventional treatments.
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Affiliation(s)
- Antonios G A Kolios
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
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Simpson R, Thomas K, Murphy R. Vulval erosive lichen planus: a qualitative investigation of U.K. clinician views and principles of management. Br J Dermatol 2013; 169:226-7. [DOI: 10.1111/bjd.12373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R.C. Simpson
- Centre of Evidence Based Dermatology; University of Nottingham; King's Meadow Campus; Lenton Lane Nottingham U.K
| | - K.S. Thomas
- Centre of Evidence Based Dermatology; University of Nottingham; King's Meadow Campus; Lenton Lane Nottingham U.K
| | - R. Murphy
- Department of Dermatology; Nottingham University Hospitals; Queen's Medical Centre Campus; Derby Road Nottingham U.K
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Transient liver hypoxia after liver hilus dearterialization. ScientificWorldJournal 1979; 2014:742826. [PMID: 24672362 PMCID: PMC3929580 DOI: 10.1155/2014/742826] [Citation(s) in RCA: 212] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/20/2013] [Indexed: 02/06/2023] Open
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations.
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