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Ertmann RK, Nicolaisdottir DR, Kragstrup J, Overbeck G, Kriegbaum M, Siersma V. The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth. Acta Obstet Gynecol Scand 2022; 102:33-42. [PMID: 36300886 PMCID: PMC9780714 DOI: 10.1111/aogs.14474] [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: 05/22/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim was to investigate whether common pregnancy-related symptoms-nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins-in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. MATERIAL AND METHODS Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015-August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. RESULTS Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications. CONCLUSIONS Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.
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Affiliation(s)
- Ruth Kirk Ertmann
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Dagny Ros Nicolaisdottir
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Jakob Kragstrup
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Gritt Overbeck
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Volkert Siersma
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
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van der Meijden WI, Boffa MJ, Ter Harmsel B, Kirtschig G, Lewis F, Moyal-Barracco M, Tiplica GS, Sherrard J. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2022; 36:952-972. [PMID: 35411963 DOI: 10.1111/jdv.18102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Affiliation(s)
- W I van der Meijden
- Department of Dermatology, Betsi Cadwaladr University Health Board, Bangor, UK
| | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - B Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- Gesundheitszentrum Frauenfeld, Frauenfeld, Switzerland
| | - F Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G-S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Wycombe General Hospital, Bucks, UK
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Chanchlani N, Hodes D. Fifteen-minute consultation: Vulval soreness in the prepubertal girl. Arch Dis Child Educ Pract Ed 2021; 106:333-340. [PMID: 33246924 DOI: 10.1136/archdischild-2019-316905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Neil Chanchlani
- Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK .,Exeter IBD Pharmacogenetics, Exeter, UK
| | - Deborah Hodes
- Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
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Tan X, Ren S, Yang C, Ren S, Fu MZ, Goldstein AR, Li X, Mitchell L, Krapf JM, Macri CJ, Goldstein AT, Fu SW. Differentially Regulated miRNAs and Their Related Molecular Pathways in Lichen Sclerosus. Cells 2021; 10:cells10092291. [PMID: 34571940 PMCID: PMC8465596 DOI: 10.3390/cells10092291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
Lichen sclerosus (LS) is a chronic inflammatory skin disorder with unknown pathogenesis. The aberrant expression of microRNAs (miRNAs) is considered to exert a crucial role in LS. We used the next-generation sequencing technology (RNASeq) for miRNA profiling and Ingenuity Pathway Analysis (IPA) for molecular network analysis. We performed qRT-PCR, miRNA transfection and Matrigel assays for functional studies. We identified a total of 170 differentially expressed miRNAs between female LS and matched adjacent normal tissue using RNASeq, with 119 upregulated and 51 downregulated. Bioinformatics analysis revealed molecular networks that may shed light on the pathogenesis of LS. We verified the expression of a set of miRNAs that are related to autoimmunity, such as upregulated miR-326, miR-142-5p, miR-155 and downregulated miR-664a-3p and miR-181a-3p in LS tissue compared to the matched adjacent normal tissue. The differentially expressed miRNAs were also verified in blood samples from LS patients compared to healthy female volunteers. Functional studies demonstrated that a forced expression of miR-142-5p in human dermal fibroblast PCS-201-010 cells resulted in decreased cell proliferation and migration. These findings suggest that differentially expressed miRNAs may play an important role in LS pathogenesis; therefore, they could serve as biomarkers for LS management.
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Affiliation(s)
- Xiaohui Tan
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Shuyang Ren
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Canyuan Yang
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Shuchang Ren
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | - Melinda Z. Fu
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
| | | | - Xuelan Li
- Department of OB/GYN, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Leia Mitchell
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
| | - Jill M. Krapf
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
- Department of OB/GYN, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Charles J. Macri
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
| | - Andrew T. Goldstein
- The Center for Vulvovaginal Disorders, Washington, DC 20037, USA; (L.M.); (J.M.K.); (C.J.M.)
- Department of OB/GYN, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Correspondence: (A.T.G.); (S.W.F.); Tel.: +1-410-279-0209 (A.T.G.); +1-202-994-4767 (S.W.F.)
| | - Sidney W. Fu
- Departments of Medicine (Division of Genomic Medicine), and of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street, N.W., Ross Hall 402C, Washington, DC 20037, USA; (X.T.); (S.R.); (C.Y.); (S.R.); (M.Z.F.)
- Correspondence: (A.T.G.); (S.W.F.); Tel.: +1-410-279-0209 (A.T.G.); +1-202-994-4767 (S.W.F.)
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Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne) 2021; 8:649402. [PMID: 33898486 PMCID: PMC8058221 DOI: 10.3389/fmed.2021.649402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023] Open
Abstract
Vulvar pruritus is an unpleasant sensation and frequent symptom associated with many dermatologic conditions, including infectious, inflammatory and neoplastic dermatoses affecting the female genitalia. It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis. We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom.
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Affiliation(s)
- Haya S Raef
- Tufts University School of Medicine, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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Tran DA, Tan X, Macri CJ, Goldstein AT, Fu SW. Lichen Sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci 2019; 15:1429-1439. [PMID: 31337973 PMCID: PMC6643151 DOI: 10.7150/ijbs.34613] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022] Open
Abstract
Lichen sclerosus (LS) is an inflammatory dermatosis with a predilection for anogenital skin. Developing lesions lead to vulvar pain and sexual dysfunction, with a significant loss of structural anatomical architecture, sclerosis, and increased risk of malignancy. Onset may occur at any age in both sexes, but typically affects more females than males, presenting in a bimodal fashion among pre-pubertal children and middle-aged adults. A definitive cure remains elusive as the exact pathogenesis of LS remains unknown. A general review of LS, histologic challenges, along with amounting support for LS as an autoimmune disease with preference for a Th1 immune response against a genetic background is summarized. In addition to the classically referenced ECM1 (extracellular matrix protein 1), a following discussion of other immune and genetic targets more recently implicated as causative or accelerant agents of disease, particularly miR-155, downstream targets of ECM1, galectin-7, p53, and epigenetic modifications to CDKN2A, are addressed from the viewpoint of their involvement in three different, but interconnected aspects of LS pathology. Collectively, these emerging targets serve not only as inherently potential therapeutic targets for treatment, but may also provide further insight into this debilitating and cryptic disease.
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Affiliation(s)
- Davis A. Tran
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Xiaohui Tan
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Charles J. Macri
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrew T. Goldstein
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
- Center for Vulvovaginal Disorders, Washington, DC
| | - Sidney W. Fu
- Department of Medicine (Division of Genomic Medicine), and Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
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García F, Rodríguez CA, Palomo ML, Català P, Fernández S, Huerta I, Velasco S, Nieto C. Efficacy, acceptability and tolerability of Zelesse® for the treatment of non-specific vulvovaginitis in paediatric patients: The NINESSE Study. J Int Med Res 2018; 46:3583-3595. [PMID: 29877120 PMCID: PMC6136015 DOI: 10.1177/0300060518775566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the efficacy, tolerability and acceptability of Zelesse®, an intimate hygiene wash solution, in the relief of the symptoms and signs of non-specific vulvovaginitis in paediatric patients. Methods The NINESSE Study was a prospective, observational, multicentre study involving females aged 2-8 years who attended paediatric offices with symptoms suggestive of non-specific vulvovaginitis. They were administered Zelesse® as a single treatment for 15 ± 5 days. Pruritus, burning, dysuria, erythema, leucorrhoea and oedema were evaluated before and after treatment. Results A total of 71 paediatric patients were enrolled in the study (mean ± SD age, 4.5 ± 1.9 years). The most significant effects were observed for pruritus and burning, where 98.4% (62 of 63) and 96.9% (63 of 65) of the patients improved after treatment, respectively. Zelesse® demonstrated a beneficial effect on dysuria, erythema, leucorrhoea and oedema. The effects on the symptoms and signs were observed within the first week of treatment; although 44.9% (31 of 69) of patients experienced improvements after 2-3 days. Zelesse® was well accepted and tolerated by most patients. No serious adverse events were reported. Conclusions Zelesse® was very effective for the relief of the symptoms and signs of non-specific vulvovaginitis, in particular pruritus, burning and erythema, in females aged 2-8 years.
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Affiliation(s)
- Fátima García
- 1 Private Paediatrics Office, Hospital Virgen del Mar, Madrid, Spain
| | | | | | - Pere Català
- 4 Private Paediatrics Office, Centro Médico Medinfant, Barcelona, Spain
| | - Santiago Fernández
- 5 Private Paediatrics Office, Clínica Pediátrica Fernández Cebrián, Ourense, Spain
| | - Ibone Huerta
- 6 Medical Department, ITF Research Pharma S.L.U., Madrid, Spain
| | - Syra Velasco
- 6 Medical Department, ITF Research Pharma S.L.U., Madrid, Spain
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Abstract
Pruritus in pregnancy can be a source of significant discomfort in the pregnant patient. Some cases are associated with pregnancy-specific dermatoses, although some patients experience a flare of a preexisting dermatosis. Severe pruritus may be a manifestation of a pregnancy-specific dermatosis associated with increased fetal risks and complications. Early accurate diagnosis and appropriate management are important. Examination often reveals important clinical findings, aiding accurate diagnosis. Pemphigoid gestationis often presents with periumbilical involvement, whereas polymorphic eruption of pregnancy spares the umbilicus and presents in the striae distensae. Intrahepatic cholestasis of pregnancy is associated with intense pruritus of the palms.
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Affiliation(s)
- Mark A Bechtel
- Division of Dermatology, Ohio State University College of Medicine, 540 Officenter Place, #240, Gahanna, OH 43230, USA.
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Agarwal MD, Resnick EL, Mhuircheartaigh JN, Mortele KJ. MR Imaging of the Female Perineum. Magn Reson Imaging Clin N Am 2017; 25:435-455. [DOI: 10.1016/j.mric.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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van der Meijden WI, Boffa MJ, Ter Harmsel WA, Kirtschig G, Lewis FM, Moyal-Barracco M, Tiplica GS, Sherrard J. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2017; 31:925-941. [PMID: 28164373 DOI: 10.1111/jdv.14096] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022]
Abstract
Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners. Women with these conditions are best managed by a multidisciplinary approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - W A Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- University Hospital of Tübingen, Tübingen, Germany
| | - F M Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London and Frimley Health NHS Trust, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Churchill Hospital, Oxford, UK
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