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Potapov A, Matveev L, Moiseev A, Sedova E, Loginova M, Karabut M, Kuznetsova I, Levchenko V, Grebenkina E, Gamayunov S, Radenska-Lopovok S, Sirotkina M, Gladkova N. Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study. Int J Mol Sci 2023; 24:13967. [PMID: 37762270 PMCID: PMC10531024 DOI: 10.3390/ijms241813967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Photodynamic therapy (PDT) is a modern treatment for severe or treatment-resistant vulvar lichen sclerosus (VLS). The chronic and recurrent nature of VLS requires control of recurrences at an early stage. In this paper, a non-invasive multimodal optical coherence tomography (OCT) method was used to control for early histological signs of VLS recurrence after systemic PDT using Photodithazine®. To interpret the OCT data, a histological examination was performed before PDT and 3 months after PDT. Two groups of patients were identified: with early histological signs of VLS recurrence (Group I, n = 5) and without histological signs of VLS recurrence (Group II, n = 6). We use structural OCT, OCT angiography, and OCT lymphangiography throughout 6 months after PDT to visually assess the skin components and to quantitatively assess the dermis by calculating the depth-resolved attenuation coefficient and the density of blood and lymphatic vessels. The OCT data assessment showed a statistically significant difference between the patient groups 3 months after PDT. In Group II, all the studied OCT parameters reached maximum values by the 3rd month after PDT, which indicated recovery of the skin structure. At the same time, in Group I, the values of OCT parameters did not approach the values those in Group II even after 6 months. The obtained results of multimodal OCT can be used for non-invasive control of early histological recurrence of VLS after systemic PDT and for adjusting treatment tactics in advance, without waiting for new clinical manifestations of the disease.
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Affiliation(s)
- Arseniy Potapov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Lev Matveev
- Institute of Applied Physics Russian Academy of Sciences, 603950 Nizhny Novgorod, Russia; (L.M.); (A.M.)
| | - Alexander Moiseev
- Institute of Applied Physics Russian Academy of Sciences, 603950 Nizhny Novgorod, Russia; (L.M.); (A.M.)
| | - Elena Sedova
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
| | - Maria Loginova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
- Center of Photonics, Lobachevsky State University of Nizhny Novgorod, 603022 Nizhny Novgorod, Russia
| | - Maria Karabut
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Irina Kuznetsova
- Department of Obstetrics and Gynecology, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, 603126 Nizhny Novgorod, Russia
| | | | - Elena Grebenkina
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
- Kstovo Central District Hospital, 607650 Kstovo, Russia
| | - Sergey Gamayunov
- Nizhny Novgorod Regional Oncologic Hospital, 603126 Nizhny Novgorod, Russia
| | - Stefka Radenska-Lopovok
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Marina Sirotkina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 603950 Nizhny Novgorod, Russia; (A.P.); (N.G.)
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Lichen Sclerosus: A Current Landscape of Autoimmune and Genetic Interplay. Diagnostics (Basel) 2022; 12:diagnostics12123070. [PMID: 36553077 PMCID: PMC9777366 DOI: 10.3390/diagnostics12123070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Lichen sclerosus (LS) is an acquired chronic inflammatory dermatosis predominantly affecting the anogenital area with recalcitrant itching and soreness. Progressive or persistent LS may cause urinary and sexual disturbances and an increased risk of local skin malignancy with a prevalence of up to 11%. Investigations on lipoid proteinosis, an autosomal recessive genodermatosis caused by loss-of-function mutations in the extracellular matrix protein 1 (ECM1) gene, led to the discovery of a humoral autoimmune response to the identical molecule in LS, providing evidence for an autoimmune and genetic counterpart targeting ECM1. This paper provides an overview of the fundamental importance and current issue of better understanding the immunopathology attributed to ECM1 in LS. Furthermore, we highlight the pleiotropic action of ECM1 in homeostatic and structural maintenance of skin biology as well as in a variety of human disorders possibly associated with impaired or gained ECM1 function, including the inflammatory bowel disease ulcerative colitis, Th2 cell-dependent airway allergies, T-cell and B-cell activation, and the demyelinating central nervous system disease multiple sclerosis, to facilitate sharing the concept as a plausible therapeutic target of this attractive molecule.
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3
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Shim TN, Harwood CA, Marsh SG, Gotch FM, Quint W, de Koning MN, Francis N, Jameson C, Freeman A, Minhas S, Dinneen M, Muneer A, Bunker CB. Immunogenetics and human papillomavirus (HPV) in male genital lichen sclerosus (MGLSc). Int J STD AIDS 2020; 31:1334-1339. [PMID: 33081649 DOI: 10.1177/0956462420949395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BackgroundThe pathogenesis of male genital lichen sclerosus (MGLSc) is controversial. Incriminated factors include infection with human papillomavirus (HPV) and autoimmunity (e.g. Human Leukocyte Antigen [HLA]). To address the roles of HLA and HPV in MGLSc we studied adult Caucasian males with a clinical and histological diagnosis of MGLSc. The men in the study attended two specialised Male Genital Dermatoses Clinics between July 2011 and September 2012 and were selected and phenotyped from the clinical records. DNA was extracted from blood and paraffin-embedded biopsy sections, for HLA and HPV typing, respectively. HLA allele frequencies were compared with those derived from the UK-based Caucasian population. Eighty-eight cases of MGLSc were identified. HPV DNA was detected in 33/88 (37.5%) cases of MGLSc. HPV16 was the most prevalent type found: 11/88 (12.5%) MGLSc. No statistically significant HLA associations were established but HLA-B*35, -B*51, -C*15, -DRB1*04, -DRB1*10 (predisposition) and -DQA1*01 (protection) were revealed as alleles of interest. HPV16-associated MGLSc cases showed no statistically significant association with HLA genotype. The relationship between HPV and MGLSc suggests a passenger effect rather than a pathogenic role. HLA is not associated with MGLSc nor co-existent HPV16.
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Affiliation(s)
- Tang Ngee Shim
- Dermatology Department, University College Hospital, Chelsea and Westminster Hospital, London, UK
| | - Catherine A Harwood
- Center for Cutaneous Research and Cell Biology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steven Ge Marsh
- Anthony Nolan Research Institute, University College London Cancer Institute, London, UK
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | | | - Nick Francis
- Pathology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Charles Jameson
- Pathology Department, University College London Hospital, London, UK
| | - Alex Freeman
- Pathology Department, University College London Hospital, London, UK
| | - Suks Minhas
- Andrology Centre and the Institute of Urology, University College London Hospital, London, UK
| | - Michael Dinneen
- Urology Department, Chelsea and Westminster Hospital, London, UK
| | - Asif Muneer
- Andrology Centre and the Institute of Urology, University College London Hospital, London, UK
| | - Christopher B Bunker
- Dermatology Department, University College Hospital, Chelsea and Westminster Hospital, London, UK
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4
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Structured analysis of histopathological characteristics of vulvar lichen sclerosus in a juvenile population. Hum Pathol 2020; 106:23-31. [PMID: 32971127 DOI: 10.1016/j.humpath.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022]
Abstract
Genital lichen sclerosus (LS), a chronic noninfectious dermatosis, is not rare in pediatric dermatology. The histopathological diagnosis in children and adults in both genital and nongenital LS is considered to be the same and encompasses a broad range of possible characteristics. Clinical manifestations and treatment options of genital LS in children are different depending on gender. The vast majority of boys are treated with circumcision, making for a larger amount of information on the histopathology of genital LS in boys, whereas substantial information on the histopathology of juvenile vulvar LS is lacking. In girls, vulvar LS almost always persists beyond puberty and, therefore, presents a particular challenge to clinicians and cause for concern for the patient. Vulvar LS in childhood and adolescence (juveniles) is underreported, and there are uncertainties with regard to the long-term course of the disease when it occurs at an age when the vulva is still developing. The present study investigates biopsies of 100 juvenile cases of vulvar LS and analyzes the presence or absence of the most salient histopathological characteristics of LS that are described in the literature. We found that the range of histopathological characteristics known for adult LS are also present in juvenile vulvar LS, even at very young ages, including histopathological features associated with autoimmune disease, in support of the idea of a similar pathogenesis.
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5
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Virgili A, Borghi A, Cazzaniga S, Di Landro A, Naldi L, Minghetti S, Verrone A, Stroppiana E, Caproni M, Nasca MR, D'Antuono A, Papini M, Di Lernia V, Corazza M. New insights into potential risk factors and associations in genital lichen sclerosus: Data from a multicentre Italian study on 729 consecutive cases. J Eur Acad Dermatol Venereol 2016; 31:699-704. [PMID: 27515901 DOI: 10.1111/jdv.13867] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited data are available on risk factors associated with lichen sclerosus and no data are available on gender differences in genital lichen sclerosus (GLS). OBJECTIVE This multicentre study aimed at identifying potential risk factors for GLS, through data collection from a large, mixed-sex sample of patients comparing gender-related differences in relation to data from the general population. METHODS This was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was collected: demographic data, anthropometric measures, comorbidities, family history of LS, clinical features and symptoms related to GLS. RESULTS Overweight and obesity, blood hypertension, hypothyroidism and an educational attainment equal or above upper secondary school level were more frequent among the study patients than among the general Italian population. Moreover, a family history of GLS was reported more frequently than expected among GLS patients. These factors were similar in males and females. The disease tended to occur later in females than in males. CONCLUSIONS Our findings suggest that metabolic factors, and possibly a sedentary lifestyle, may play a role in GLS pathogenesis in genetically predisposed patients, and that risk profile is similar in males and females despite some difference in the onset of symptoms.
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Affiliation(s)
- A Virgili
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - A Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | | | | | - L Naldi
- Centro Studi GISED - FROM, Bergamo, Italy.,UO di Dermatologia, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | - S Minghetti
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - A Verrone
- Dermosifilopatia 2, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - E Stroppiana
- Dermosifilopatia 2, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Caproni
- Malattie Rare Dermatologiche e Immunopatologia Cutanea, U.O. Dermatologia I ASF-Università di Firenze, Firenze, Italy
| | - M R Nasca
- UOC Dermatologia, P. O. G. Rodolico Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Catania, Italy
| | - A D'Antuono
- Dermatologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - M Papini
- Clinica Dermatologica di Terni, Dipartimento di Specialità Chirurgiche e Biomediche, Università degli Studi di Perugia, Perugia, Italy
| | - V Di Lernia
- Struttura Semplice di Dermatologia Immunologica e Pediatrica, Arcispedale Santa Maria Nuova - IRCCS Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - M Corazza
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
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Tong LX, Sun GS, Teng JMC. Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options. Pediatr Dermatol 2015; 32:593-9. [PMID: 25940739 DOI: 10.1111/pde.12615] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lichen sclerosus (LS) is a rare, chronic, inflammatory disease of the skin that primarily affects postmenopausal women but may occur in men and children as well. Approximately 7% to 15% of cases are believed to occur in children. The epidemiologic data for LS have been limited and treatment options are not well studied, particularly in children. We reviewed new developments available in the current literature on the epidemiology and management of LS for children.
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Affiliation(s)
- Lana X Tong
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Grace S Sun
- Department of Dermatology, Stanford University, Palo Alto, California
| | - Joyce M C Teng
- Department of Dermatology, Stanford University, Palo Alto, California
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7
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Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper S, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2015. [PMID: 26202852 DOI: 10.1111/jdv.13136] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lichen sclerosus (LS) is an inflammatory skin disease that usually involves the anogenital area. All patients with symptoms or signs suspicious of lichen sclerosus should be seen at least once initially by a physician with a special interest in the disease in order to avoid delay in diagnosis, as early treatment may cure the disease in some and reduce or prevent scarring. The diagnosis is made clinically in most cases. Biopsies should only be performed under certain circumstances. The gold standard for treatment remains potent to very potent topical steroids; however, mild and moderate disease in boys and men may be cured by circumcision. Certain triggers should be avoided. http://www.euroderm.org/images/stories/guidelines/2014/S3-Guideline-on-Lichen-sclerosus.pdf http://www.awmf.org/fachgesellschaften/mitgliedsgesellschaften/visitenkarte/fg/deutsche-gesellschaft-fuer-gynaekologie-und-geburtshilfe-dggg.html.
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Affiliation(s)
- G Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.,Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - K Becker
- (representing the Deutsche Gesellschaft für Kinderchirurgie), Office for Paediatric surgery, Bonn, Germany
| | - A Günthert
- (representing the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG), Deptartment of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - D Jasaitiene
- (representing the Lithuanian Association of Dermatovenereologists), Department of Skin and Venereal Diseases of Republican Hospital of Panevezys, Panevezys, Lithuania
| | - S Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - K K Rall
- Research Centre and Department for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S Riechardt
- (representing the Deutsche Gesellschaft für Urologie), Department of Urology and paediatric Urology, University of Hamburg, Hamburg, Germany
| | - F Casabona
- Dirigente Medico, S. C. Chirurgia Plastica, Chirurgia Plastica Rigenerativa, Ospedale Andrea Gallino, Genova-Pontedecimo, Italy
| | - J Powell
- Department of Dermatology, Hampshire Hospitals foundation Trust, Hampshire, UK
| | - F Brackenbury
- (patient representative) www.lichensclerosus.org, Association for Lichen Sclerosus and Vulval Health, Oxford, UK
| | - R Erdmann
- (development of the search strategy and performance of the literature search), Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - M Lazzeri
- Centro Chirurgico Toscano, Arezzo, Italy
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - F Wojnarowska
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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8
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Haefner HK, Pearlman MD, Barclay ML, Selvaggi SM. Lichen sclerosus in pregnancy: presentation of two cases. J Low Genit Tract Dis 2015; 3:260-3. [PMID: 25950672 DOI: 10.1046/j.1526-0976.1999.34008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Numerous skin diseases occurring in the pregnant patient have been reported. Some of these diseases are unique to pregnancy and some, including vulvar varicosities, vulvar edema, postpartum labial adhesions, and hematomas, are a result of physiological changes of pregnancy or the birth process. In addition, a variety of viral and bacterial infectious diseases of the vulva may occur during pregnancy. Vulvar neoplasms may also be found in pregnancy. In two patients, ages 27 and 31, lichen sclerosus first was diagnosed during their initial prenatal visits. Only one of the patients was symptomatic. The symptomatic patient used topical steroids for relief of vulvar itching. Two patients with lichen sclerosus of the vulva in pregnancy are reported, with emphasis on the diagnosis and treatment of this condition.
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Affiliation(s)
- H K Haefner
- *Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI †Department of Anatomic Pathology, Loyola University Medical Center, May wood, IL
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9
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Clinical recommendation: pediatric lichen sclerosus. J Pediatr Adolesc Gynecol 2014; 27:111-6. [PMID: 24602304 DOI: 10.1016/j.jpag.2013.11.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/25/2013] [Accepted: 11/11/2013] [Indexed: 11/20/2022]
Abstract
Lichen sclerosus is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, labial adhesions, and loss of pigmentation. Treatment includes topical anti-inflammatory agents and long-term follow-up as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with history of lichen sclerosus. These recommendations are intended for pediatricians, gynecologists, nurse practitioners and others who care for pediatric/adolescent girls in order to facilitate diagnosis and treatment.
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10
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Origoni M, Gelardi C, Salvatore S, Candiani M. Lichen sclerosus of the vulva. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Lansdorp C, van den Hondel K, Korfage I, van Gestel M, van der Meijden W. Quality of life in Dutch women with lichen sclerosus. Br J Dermatol 2013; 168:787-93. [DOI: 10.1111/bjd.12137] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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12
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Sherman V, McPherson T, Baldo M, Salim A, Gao XH, Wojnarowska F. The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study. J Eur Acad Dermatol Venereol 2010; 24:1031-4. [PMID: 20202060 DOI: 10.1111/j.1468-3083.2010.03572.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V Sherman
- Department of Dermatology, Churchill Hospital, Oxford, UK.
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14
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15
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Affiliation(s)
- Isabel Val
- Institute of Gynecology, Department of Gynecology and Obstetrics, Federal University of Rio de Janeiro, Brazil.
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16
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Gao XH, Barnardo MCMN, Winsey S, Ahmad T, Cook J, Agudelo JD, Zhai N, Powell JJ, Fuggle SV, Wojnarowska F. The Association Between HLA DR, DQ Antigens, and Vulval Lichen Sclerosus in the UK: HLA DRB1*12 and its Associated DRB1*12/DQB1*0301/04/09/010 Haplotype Confers Susceptibility to Vulval Lichen Sclerosus, and HLA DRB1*0301/04 and its Associated DRB1*0301/04/DQB1*0201/02/03 Haplotype Protects from Vulval Lichen Sclerosus. J Invest Dermatol 2005; 125:895-9. [PMID: 16297186 DOI: 10.1111/j.0022-202x.2005.23905.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lichen sclerosus (LS) is considered to have an immunogenetic background. Several small studies, using serological typing, have reported that HLA-DR11, DR12, and DQ7 were increased in LS, with DR17 less frequent. This study aimed to validate and detect new HLA-DR and DQ associations with LS in females and its characteristic clinical parameters. The cases, 187 female LS patients, and 354 healthy controls were all UK North Europeans. PCR-sequence specific primers method was applied to genotype the HLA-DR, DQ polymorphisms that correspond to 17 serologically defined DR and seven DQ antigens. Statistical analysis was performed with two-tailed Fisher's exact test with Bonferroni adjustment (p value after Bonferrroni adjustment, Pc). We found increased frequency of DRB1*12 (DR12) (11.2%vs 2.5%, pc < 0.01) and the haplotype DRB1*12/DQB1*0301/04/09/010 (11.2%vs 2.5%, p < 0.001, pc < 0.05), and a lower frequency of DRB1*0301/04 (DR17) (11.8%vs 25.8%, pc < 0.01) and the haplotype DRB1*03/DQB1*02DRB1*0301/DQB1*0201/02/03 (11.2%vs 24.6%, pc < 0.0001) in patients compared with controls. HLA DR and DQ antigens were not associated with time of onset of disease, site of involvement, structural changes of genitals, and response to treatment with potent topical steroids. In conclusion, HLA-DR and DQ antigens or their haplotypes appear to be involved in both susceptibility to and protection from LS.
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Affiliation(s)
- Xing-Hua Gao
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China.
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17
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Abstract
Lichen sclerosus is a chronic disorder of the skin and mucosal surfaces, and is most commonly seen on the female genital skin. It also occurs on other areas of the body. Any age group may be affected, although it is seen more often in elderly women. The exact cause of lichen sclerosus is unknown. There have been reports of family members with lichen sclerosus; thus it may have a genetic link. There is also the possibility of an autoimmune connection. Currently, ultra-potent topical corticosteroids are the medical treatment of choice. Other treatments that have been utilized for this condition include testosterone, progesterone, tacrolimus, surgery, and phototherapy. Surgery should be reserved for symptomatic patients who fail to respond to multiple medical treatments, as there is a high recurrence rate following surgery. The risk of developing squamous cell carcinoma of the vulva approaches 5% in women with vulvar lichen sclerosus, and therefore close surveillance by the healthcare provider and patient is needed. This review discusses the history, clinical features, pathophysiology, and treatment of lichen sclerosus of the vulva, as well as pregnancy issues and sexual function in patients with this condition. In addition, problems specific to children with lichen sclerosus are reviewed.
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Affiliation(s)
- Yolanda R Smith
- Department of Obstetrics and Gynecology, The University of Michigan Hospitals Health Systems, Ann Arbor, Michigan 48109-0276, USA.
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18
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Oyama N, Chan I, Neill SM, Hamada T, South AP, Wessagowit V, Wojnarowska F, D'Cruz D, Hughes GJ, Black MM, McGrath JA. Autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Lancet 2003; 362:118-23. [PMID: 12867112 DOI: 10.1016/s0140-6736(03)13863-9] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lichen sclerosus is a common acquired inflammatory disorder of skin and mucous membranes. The aetiology is unknown, although HLA-subtype susceptibility and high rates of other autoimmune disorders suggest that autoantibodies to specific mucocutaneous antigens are involved. The clinicopathological similarities between lichen sclerosus and lipoid proteinosis, which results from mutations in extracellular matrix protein 1 (ECM1), suggest this protein as an autoantigen. METHODS We analysed serum autoantibody profiles in 171 individuals (86 with lichen sclerosus, 85 healthy controls) by immunoblotting of extracts from normal human skin and lipoid proteinosis skin (lacking ECM1). We generated a full-length glutathione-S-transferase fusion protein for ECM1 to confirm specific immunoreactivity. We affinity-purified serum from patients with lichen sclerosus and did indirect immunofluorescence microscopy on normal skin with or without preabsorption with recombinant ECM1. FINDINGS By immunoblotting, IgG autoantibodies were found in 20 (67% [95% CI 45-84]) of 30 lichen sclerosus serum samples. The highest titre was 1 in 20. The bands were not detected in ECM1-deficient substrate. These samples, and those from 56 other patients with lichen sclerosus, showed immunoreactivity to the recombinant ECM1 protein (64 of 86 positive; 74% [65-84]). Only six (7% [2-13]) of 85 control serum samples were positive. Affinity-purified IgG from serum of patients with lichen sclerosus labelled skin similarly to a polyclonal antibody to ECM1. The positive staining was blocked by preabsorption with excess recombinant ECM1 protein. INTERPRETATION These findings provide evidence for a specific humoral immune response to ECM1 in lichen sclerosus and offer insight into disease diagnosis, monitoring, and approaches to treatment.
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Affiliation(s)
- Noritaka Oyama
- Department of Immunofluorescence, St John's Institute of Dermatology, Division of Skin Sciences, Guy's, King's, and St Thomas' School of Medicine, St Thomas' Hospital, London, UK
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Powell J, Wojnarowska F, Winsey S, Marren P, Welsh K. Lichen sclerosus premenarche: autoimmunity and immunogenetics. Br J Dermatol 2000; 142:481-4. [PMID: 10735954 DOI: 10.1046/j.1365-2133.2000.03360.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lichen sclerosus is among the most frequently seen paediatric vulval disorders. In adults a strong association between lichen sclerosus and autoimmune diseases, and also with HLA class II locus DQ7, has been well demonstrated in women and a weaker association in men. These associations have not previously been studied in children, although in other autoimmune diseases, the HLA associations have been strongest in children. We performed HLA tissue typing and looked for autoimmune associations in a group of 30 children with vulval lichen sclerosus. HLA DQ7 was present in 66% of female children with lichen sclerosus compared with 31% in controls. Previous studies reported DQ7 in 51% of adult female patients and 45% of male patients. Sixteen per cent of the children were homozygous for DQ7 as opposed to 5% of controls. In the childhood group, only 4% had another autoimmune disease, but 56% of their parents or grandparents did. Age differences make comparison difficult, but the family history of autoimmunity appears to be strong in the early-onset group, in addition to the stronger association with DQ7.
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Affiliation(s)
- J Powell
- Departments of Dermatology and Transplant Immunology, Oxford Radcliffe Hospitals, The Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, U.K
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Abstract
Lichen sclerosis is a chronic inflammatory skin disease that causes substantial discomfort and morbidity, most commonly in adult women, but also in men and children. Any skin site may be affected (and, rarely, the oral mucosa) but lichen sclerosus is most common in the anogenital area, where it causes intractable itching and soreness. In children, the disorder may be confused with changes seen in sexual abuse. Progression to destructive scarring is common. There is increased risk of developing vulval cancer, and there are links with penile cancer. Patients should be kept under long-term review. Lichen sclerosus can occur without symptoms, and the exact prevalence is uncertain. It occurs most commonly in women at times of low sex hormone output. The underlying cause is unknown, but there seems to be a genetic susceptibility and a link with autoimmune mechanisms. The wart virus and the spirochaete borrelia have been suggested but not substantiated as infective triggers. The Koebner phenomenon is known to occur (lichen sclerosus occurs in skin already scarred or damaged), so trauma, injury, and sexual abuse have been suggested as possible triggers of symptoms in genetically predisposed people. The treatment of choice for anogenital lichen sclerosus is potent topical corticosteroid ointment for a limited time. Circumcision may be indicated in men, and surgery may be considered in women, to relieve effects of scarring or to treat coexisting carcinoma. Current research aims to identify a treatable cause of lichen sclerosus, to identify patients at risk of scarring and of malignant disorders, and to find target pathways for therapeutic intervention.
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Affiliation(s)
- J J Powell
- Department of Dermatology, Oxford Radcliffe Hospital, Headington, UK
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Scurry J. Does lichen sclerosus play a central role in the pathogenesis of human papillomavirus negative vulvar squamous cell carcinoma? The itch-scratch-lichen sclerosus hypothesis. Int J Gynecol Cancer 1999; 9:89-97. [PMID: 11240748 DOI: 10.1046/j.1525-1438.1999.99016.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the past decade, two types of vulvar squamous cell carcinoma (SCC) have been delineated, Human papillomavirus (HPV) positive and negative. Clinicopathologic, virologic, cytomorphometric, and genetic differences support the view that these two types of carcinoma are fundamentally different and that HPV-negative carcinoma is not simply carcinoma where viral DNA has not been able to be identified. The traditional view of HPV-negative carcinoma is that it is caused by chronic tissue damage from itching and scratching. However, itching and scratching alone do not explain the close association of carcinoma with lichen sclerosus, nor the absence of such an association with other itchy conditions such as eczema or psoriasis. These observations point to a role for lichen sclerosus in the pathogenesis of vulvar carcinoma. Most observations about the etiology of lichen sclerosus can be grouped into its immunogenetic or genital predisposition, or the Köbner phenomenon. In the itch-scratch-lichen sclerosus hypothesis, lichen sclerosus is postulated to occur as a Köbner phenomenon in women with the susceptible immunophenotype who scratch because of genital irritants such as urine, vaginal secretions and smegma, and psychological factors. Lichen sclerosus, itself a very itchy condition, contributes to a vicious cycle of itching and scratching which leads to superimposed lichen simplex chronicus, squamous cell hyperplasia, and ultimately carcinoma. The itch-scratch-lichen sclerosus hypothesis reconciles the traditional itch-scratch hypothesis with the strong clinicopathologic association of lichen sclerosus with carcinoma.
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Affiliation(s)
- J. Scurry
- Pathology, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Abstract
The incidence of many skin diseases peak in adulthood, and these disorders may be difficult to recognize when they do present in childhood. Their clinical features may be distinct in pediatric patients, and they may be managed differently in children as compared to adults. Therefore, it is important that dermatologists are able to identify "adult" skin disease in the pediatric patient, and know how to appropriately manage these problems in young patients. The epidemiology, clinical features, differential diagnosis, and management of the following "adult" skin diseases in children are reviewed: psoriasis, lichen planus, rosacea, Sweet's syndrome, and mucosis fungoides. Distinctive features of lichen sclerosus and immunobullous diseases in childhood will also be briefly discussed.
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Affiliation(s)
- R Howard
- Division of Pediatric Dermatology, Children's Hospital Oakland, California, USA
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Affiliation(s)
- S H Wakelin
- Department of Dermatology, Amersham Hospital, Bucks, England
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Abstract
Lichen sclerosus in childhood involves predominantly the genital area, often with purpura and erosions, which raises concerns of sexual abuse. Potent topical corticosteroids give a good clinical response over several months, although maintenance with weaker formulations is usually required. The long-term prognosis remains uncertain.
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Affiliation(s)
- G O Fischer
- Department of Dermatology, Children's Hospital, Camperdown, NSW, Australia
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