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Evans JC, Ezenwa EA, Akinshemoyin Vaughn OL. Assessing the inclusion of women of color in lichen sclerosus treatment studies: a scoping review. Int J Womens Dermatol 2024; 10:e170. [PMID: 39076890 PMCID: PMC11286251 DOI: 10.1097/jw9.0000000000000170] [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: 09/27/2023] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
Background Vulvar lichen sclerosus (VLS) is an underrecognized chronic inflammatory skin condition with significant clinical features and potential for malignant transformation. To date, there are no studies comparing the course of this disease in women of color to other racial groups. Objective The objective of this study was to provide a scoping review examining racial demographic data in VLS treatment studies and specifically assessing for the inclusion of women of color. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a primary literature search was conducted using 4 databases: Ovid Medline(R), Scopus, Cochrane, and Web of Science from all years to December 2022. We included published studies with adult women diagnosed with VLS and containing a treatment arm using topical corticosteroids. Single case reports, literature reviews, systemic reviews, meta-analyses, and reports not available in English were excluded. Results Overall, 1340 nonduplicate studies were assessed for eligibility criteria. In total, 65 publications were included. Only 6 included racial demographic data. Black women made up at most 3.8% of the sample population and Latinx women made up at most 5.7%. Limitations Our review focused on a specific intervention (ie, the use of topical corticosteroids for the treatment of VLS), which may restrict the generalizability of our findings to other interventions. No risk of bias assessment was done due to the scoping nature of the review. Conclusion Women of color are underrepresented in studies of topical corticosteroid use in adult women with VLS. Intentional diversity in recruitment will enable the collection of data that is both more accurate and reflective of a broader spectrum of perspectives and life experiences.
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Affiliation(s)
- Jessica C. Evans
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ekene A. Ezenwa
- Department of Medicine, University of Chicago Section of Dermatology, Chicago, Illinois
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Bartels AK, Fadare O. Nonsclerotic Lichen Sclerosus of Vulva: A Clinicopathologic Analysis. Int J Gynecol Pathol 2024:00004347-990000000-00193. [PMID: 39173138 DOI: 10.1097/pgp.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
The International Society of the Study of Vulvovaginal Diseases (ISSVD) recently defined nonsclerotic lichen sclerosus (NSLS) as a scenario wherein the clinical findings are consistent with lichen sclerosus (LS), but no microscopic evidence of dermal sclerosis is found and recognized 4 histologic subcategories. Herein, we present an institutional experience with NSLS, with an emphasis on frequency, application of the ISSVD categories in routine practice, and clinicopathologic correlation. The authors reviewed clinical and pathologic findings for consecutive vulvar biopsies in which LS was a clinical and/or pathologic consideration. Cases were classified as classical/sclerotic LS (CLS), NSLS (per ISSVD criteria), and "unclassified," the latter of which were cases not classifiable as NSLS or CLS, despite a clinical impression or LS or LS being a significant clinical consideration (ie, "clinical LS"). In clinical LS cases, CLS and NSLS were diagnosed histologically in 61% (182/298) and 15% (44/298), respectively, whereas the remainder were histologically unclassified. The latter group was microscopically heterogeneous, devoid of a consistent pathologic profile, and generally showed absence, focality, minimality, ambiguity, or infrequency of features that would have allowed their categorization into one of the NSLS categories. Among the 4 categories for the categorizable NSLS cases, the "lichenoid dermatitis" pattern (61.4%) was the commonest, followed by dermal fibrosis with acanthosis (22.7%), dermal fibrosis without acanthosis (9.1%), and hypertrophic lichenoid dermatitis (6.8%). The clinical response rates to topical therapies for the NSLS and unclassified groups were 71% and 62%, respectively (P=0.4). Our findings highlight the significance of clinicopathologic correlation in the diagnosis of NSLS. In the setting of clinical LS, some histologic evidence to support that impression is found in most cases when the ISSVD system for diagnosis and classification of biopsies is applied. However, a subset of clinical LS cases are not pathologically classifiable as either CLS or any of the NSLS categories; these display nonspecific histologic features and require future study.
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Affiliation(s)
- Anne K Bartels
- Department of Pathology, University of California San Diego, San Diego, California
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3
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Rees S, Arnold S. Loss, shame and secrecy in women's experiences of a vulval skin condition: A qualitative study. Health (London) 2024:13634593241271041. [PMID: 39129276 DOI: 10.1177/13634593241271041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Vulval lichen sclerosus (LS) is a chronic dermatological condition affecting the anogenital area, causing intense itching, pain and bleeding. It can change the terrain of the vulva, causing loss of vulval anatomy and altered texture and appearance of the skin. There has been little research into how women experience the materialities of a dermatological vulval disease. We aimed to understand experiences of living with LS, using a feminist lens to examine the influence of societal attitudes towards women's bodies and the vulva. We conducted qualitative interviews with 20 women with vulval LS, taking a critical feminist grounded theory approach. While we found that women's experiences of vulval LS symptoms was normalised as a part of womanhood, there was a silencing of speech about the vulva generally, and vulval symptoms more specifically. This caused profound shame and loneliness, and was a barrier to disclosing and seeking help for vulval symptoms, leading to delayed diagnosis and disease progression. Loss of vulval architecture resulted in a loss of (feminine) self and the sense of a body which was whole.
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Mastoraki E, Kravvas G, Dear K, Sim S, James M, Watchorn R, Haider A, Ellery P, Freeman A, Basha M, Edmonds E, Bunker CB. Primary vulval melanoma and genital lichen sclerosus. SKIN HEALTH AND DISEASE 2024; 4:e411. [PMID: 39104656 PMCID: PMC11297432 DOI: 10.1002/ski2.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 08/07/2024]
Abstract
Background Lichen sclerosus (LS) is a chronic, inflammatory skin disease with a predilection for the genitalia. Although, the association between squamous cell cancer and genital LS is well established, a link with genital melanoma has not been thoroughly explored. However, we have recently published a case series of penile melanoma where 9/11 (82%) of patients seen over a 10 year period with penile melanoma were retrospectively found to have histological and/or clinical evidence of genital LS on review. Objectives The aim of this study was to illuminate further the relationship between vulval melanoma and genital LS by reviewing all the cases managed by our hospital and undertaking a literature review. Methods We identified all the cases with a diagnosis of vulval melanoma over a 16-year period (2006-2022) where histology was available. The clinical notes were retrospectively reviewed, and the histological features of all cases were reassessed by two independent mutually 'blinded' histopathologists. We also performed a literature review of genital LS in patients with vulval melanoma. Results A total of 11 patients with vulval melanoma were identified for the review. Histopathological review found evidence of genital LS in seven of them (64%). Genital LS was not documented in any of the original histology reports. Clinical notes and letters were available in nine cases. The literature review identified 12 relevant studies with a total of 18 patients. Twelve cases concerned adult women, and six concerned female children. Conclusion The presence of genital LS in as high as 64% of our vulval melanoma cases might indicate a causative relationship between genital LS and vulval melanoma. The pathogenesis of vulval melanoma remains largely unknown. Although ultraviolet radiation is an important pathogenic factor for cutaneous melanoma, it cannot be a factor in vulval melanoma. While possible mechanisms behind this association remain unclear, it is possible that chronic inflammation from genital LS leads to melanocytic distress and increased mutagenesis.
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Affiliation(s)
- Evanthia Mastoraki
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Georgios Kravvas
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Kate Dear
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Sharmaine Sim
- Department of MedicineUniversity College London Medical SchoolLondonUK
| | - Mariel James
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Richard Watchorn
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Aiman Haider
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Peter Ellery
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Alex Freeman
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Mahfooz Basha
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Emma Edmonds
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Christopher B. Bunker
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
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Meyer-Wilmes P, Wittenborn J, Kupec T, Caspers R, Stickeler E, Iborra S. Patient satisfaction and sexual issues in vulvar lichen sclerosus treatment: a monocentric certified dysplasia unit survey analysis. Arch Gynecol Obstet 2024; 310:507-513. [PMID: 38703281 PMCID: PMC11169031 DOI: 10.1007/s00404-024-07519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Vulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic. METHODS This survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions on general treatment, diagnostic delays, disease education, psychologic and sexual issues, and specific questions regarding the COVID-19 pandemic. The questionnaires were distributed between January 2021 and September 2023. RESULTS This study included 103 patients diagnosed with VLS, who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychologic problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient's perspective (3.83/5 before vs. 3.67/5 after; p = 0.046). There was a general request for booklets to inform and educate the patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation. CONCLUSION This study highlights the need for more effective treatments for VLS and an increased awareness of psychologic and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care with adequate disease education in a team of specialists from various disciplines.
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Affiliation(s)
- Philipp Meyer-Wilmes
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Julia Wittenborn
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Tomáš Kupec
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Rebecca Caspers
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Séverine Iborra
- Department of Gynecology and Obstetrics, Solingen Municipal Hospital gGmbH, Gotenstraße 1, 42653, Solingen, Germany
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6
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Caretto AA, Garganese G, Fragomeni SM, Tagliaferri L, Fionda B, Scambia G, Gentileschi S. Local Perineal Capillary Perforator Flaps: A Minimally Invasive Technique for the Correction of Vulvar Stenosis. J Pers Med 2024; 14:617. [PMID: 38929838 PMCID: PMC11204669 DOI: 10.3390/jpm14060617] [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: 03/25/2024] [Revised: 05/26/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Vulvar stenosis is a debilitating condition that compromises sexual function, urination, and the ability to undergo gynecological examinations. The purpose of this study is to describe the technique of capillary perforator perineal flaps (CPPF) for the correction of vulvar stenosis. METHODS We retrospectively examined patients with vulvar stenosis treated through surgical separation and reconstruction with CPPF. The procedure involved vulvar separation with the creation of a subsequent defect, repaired using a flap, harvested laterally to the labia majora including a capillary perforator and transferred through a subcutaneous tunnel to repair the vulvar defect. The functional outcome was evaluated with the Bradford scale, comparing the preoperative and postoperative scores using the Student's t-test. RESULTS thirteen patients were included, three with stenosis following treatment for vulvar cancer and ten due to lichen sclerosus. In total, we analyzed 29 flaps, with an average size of 15.6 cm2. We always included just one perforator in the flap and no postoperative complications. Stenosis was resolved in all patients, with no recurrences one year after the surgery. The preoperative average severity of the stenosis was 2.3 + 0.6, reducing to 0.3 + 0.4 post-intervention, indicating a significant improvement (p < 0.01). CONCLUSIONS CPPF has proven to be a quick and safe method for the reconstruction of vulvar stenosis.
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Affiliation(s)
- Anna Amelia Caretto
- Unità di Chirurgia Plastica, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Giorgia Garganese
- Unità Ginecologia Oncologica, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Simona Maria Fragomeni
- Unità Ginecologia Oncologica, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Luca Tagliaferri
- Dipartimento Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Bruno Fionda
- Dipartimento Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Giovanni Scambia
- Unità Ginecologia Oncologica, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Stefano Gentileschi
- Unità di Chirurgia Plastica, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Facoltà di Medicina e Chirurgia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, 00168 Roma, Italy
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7
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Boero V, Cetera GE, Caia C, Villa S, Montemurro T, Brambilla M, Monti E, Iorio M, Somigliana E, Vercellini P, Prati D. Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study. Arch Gynecol Obstet 2024; 309:2719-2726. [PMID: 38523203 DOI: 10.1007/s00404-024-07424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Owing to the evidence that as many as 30-40% of patients with vulvar lichen sclerosus (VLS) fail to report a remission of symptoms with first-line corticosteroid treatment (TCS), especially as what regards dyspareunia, we aimed to analyze patients' satisfaction following vulvar injection of autologous platelet-rich plasma (PRP). This is intended as an adjunctive treatment, to be used following TCS, and appears to promote tissue repair. It may also possibly have immunomodulatory proprieties. MATERIALS AND METHODS Patients with VLS were considered eligible for this pilot study if, despite having been treated with a 3-month TCS regimen, they reported a persistence of symptoms. PRP was produced in a referral center using a manual method and a standardized protocol. Each patient received three treatments 4 to 6 weeks apart. RESULTS A total of 50 patients with a median age of 53 years [IQR 38-59 years] were included in the study. 6 months after the last injection of PRP all patients were either satisfied or very satisfied with the treatment (100%; 95% CI 93-100%). Median NRS scores for itching, burning, dyspareunia and dysuria were significantly reduced (p < 0.05) and FSFI, HADS and SF-12 questionnaires revealed a significant improvement in sexual function, psychological wellbeing and quality of life (p < 0.05). The number of patients reporting the need for maintenance TCS treatment was reduced by 42% (p < 0.001) and an improvement in vulvar elasticity and color was reported in all patients. CONCLUSION Following standard medical therapy, PRP may be effective not only in improving symptoms, but also in restoring function.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Gynecology Unit, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Villa
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Montemurro
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Service, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Iorio
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Gynecology Unit, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Cao Y, Qu Z, Sun X, Cui G, Wei H, Wang Z, Lin X. Evaluation of the therapeutic effects of Photodynamic Therapy in vulvar lichen sclerosus and impact on patient quality of life and sexual funtion. Photodiagnosis Photodyn Ther 2024:104226. [PMID: 38825158 DOI: 10.1016/j.pdpdt.2024.104226] [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: 05/07/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Vulvar lichen sclerosus (VLS) is often associated with irritable symptoms of itching, burning pain and can lead to scarring, architectural changes and sexual dysfunction as well as a decline in quality of life.The etiology of the disease is unknown. This study sought to assess the therapeutic effects of Photodynamic Therapy (PDT) in VLS, and improvment of patient quality of life and sexual funtion. METHODS From January 2022 to April 2023, a total of 65 patients with vulvar sclerosi (VLS) were treated with PDT in our hospital. All 65 patients were divided into two groups: early-stage group and late-stage group. The Cattaneo scoring method, the Dermatology Life Quality Index (DLQI) and the Female Sexual Function Index (FSFI) scores were used to evaluate the clinical effectiveness of the treatment on patients' symptoms and clincal signs, quality of life as well as sexual function before and at 6-month after treatment. RESULTS The total effective rate of early-stage patients was significantly greater than that of late-stage patients at 6-month after PDT treatment (90.91% [40/44] vs 76.19% [16/21], p <0.05). At 6-month follow-up, the symptoms and clinical signs of patients in early-stage group were significantly improved compared with baseline, the average scores of itching, skin elasticity, whitening and lesion range were significantly lower than the scores before treatment (p <0.05). In late-stage group, The decrease in scores of itching, whitening and lesion range at the 6-months follow-up is significant(p <0.05), but skin elasticity (p=0.0625). On post-treatment follow-up examination, FSFI score was seen to have significantly improved in early-stage patients(from a median score of 17.45 to 21.1, p<0.05); DLQI also significantly improved after treatment (from a median score of 7 to 4, p<0.05). In late stage patients, The DLQI score improved significantly after treatment (from a median score of 18 to 15, p<0.05). However, the improvement in sexual function is not statistically significant (pre-treatment: median=10.55, post-treatment: median=10, p=0.1865). CONCLUSION Photodynamic therapy can effectively improve most symptoms and clinical signs, as well as quality of life of patients with VLS, especially for earlly stage patients. Moreover, improvement in sexual function is observed in early stage patients after PDT treatment. This study suggests that early and timely PDT treatment are recommended to achieve better results.
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Affiliation(s)
- Yanxia Cao
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Zhongyu Qu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xiangqin Sun
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Guoying Cui
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Hao Wei
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Zhifeng Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xueyan Lin
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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9
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Del Papa J, Pucchio AC, Schneider M, Wang A. Perineural Inflammation as a Novel Feature in Lichen Sclerosus: A Case Series of Histologic and Clinical Features. Am J Dermatopathol 2024; 46:287-291. [PMID: 38457688 DOI: 10.1097/dad.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Lichen sclerosus (LS) is a frequently encountered inflammatory skin disorder characterized by whitened, atrophic patches that can cause pain and pruritus. The underlying cause of this condition remains unknown. Primarily affecting the genital area, this condition carries an increased risk of developing cutaneous cancers and frequently co-occurs with autoimmune disorders. Our retrospective study aimed to explore histologic features of LS, with a particular focus on a newly established finding and its potential implications. We examined 53 histologic cases of LS collected over 2 years. Experienced pathologists evaluated and reached a consensus on the assignment of histologic features. Patient charts were manually reviewed to gather relevant demographic and clinical data. Statistical analysis was performed using IBM SPSS Statistics (2021). Of the 53 total patients identified as meeting criteria for inclusion in this study, only 8 (15%) were male. Eight cases (15%) demonstrated perineural inflammatory infiltrate. Notably, half of all samples from male patients exhibited perineural inflammatory infiltrate. A statistically significant increase ( P < 0.01) in the presence of dermal plasma cells was identified in cases with perineural inflammation versus cases without this feature. The findings of our study highlight the recurrent nature of perineural inflammation in LS, providing valuable insights into this condition. Furthermore, we observed a notable correlation between perineural inflammation, male patients, and the presence of dermal plasma cells. These discoveries contribute to a better understanding of the underlying mechanisms of LS and suggest avenues for future research into the condition.
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Affiliation(s)
- Joshua Del Papa
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Aine Celestina Pucchio
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Mark Schneider
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
| | - Ami Wang
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and
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10
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Azevedo MSSD, Chambo Filho A, Diniz LM, Quimquim JB, Souza VWL, Moura LAD. Prevalence of the association of vulvar lichen sclerosis with Hashimoto's thyroiditis. An Bras Dermatol 2024; 99:445-447. [PMID: 38521705 DOI: 10.1016/j.abd.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 03/25/2024] Open
Affiliation(s)
| | - Antônio Chambo Filho
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Department of Gynecology and Obstetrics, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | - Lucia Martins Diniz
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Internal Medicine (Dermatology), Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | | | - Vickie White Loureiro Souza
- Gynecology and Obstetrics, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Luana Amaral de Moura
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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11
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Rees S, Arnold S, Kherlopian A, Fischer G. Attitudes Toward Proactive Topical Corticosteroid Use Among Women With Vulval Lichen Sclerosus. J Low Genit Tract Dis 2024; 28:183-188. [PMID: 38518216 DOI: 10.1097/lgt.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Some practitioners are adopting proactive topical corticosteroid (TCS) therapy for vulval lichen sclerosus (VLS). We sought to understand patient attitudes toward proactive TCS therapy for VLS in a context in which proactive therapy is adopted. METHODS Four online focus group discussions with 12 participants. Data analysis was informed by social constructionist grounded theory. RESULTS All participants had accepted a proactive regimen. Three themes were developed from the analysis: "Coming to accept proactive therapy," "Motivators to maintaining a proactive regimen," and "The importance of a routine that fits me." Within each theme are subthemes illustrating different dimensions of the theme. CONCLUSIONS Accepting proactive TCS therapy for VLS requires incorporating regular TCS use into a patient's identity, unlearning previous understandings regarding the safety of long-term TCS use, and adopting a regimen that fits within patients' lives and minimizes the loss of autonomy.
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Affiliation(s)
- Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Susanne Arnold
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Gayle Fischer
- Sydney Medical School, University of Sydney, Sydney, Australia
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Qu Z, Lin X, Liu M, Wang J, Wang F, Zhang B, Shen L, Wang Z. Clinical efficacy analysis of 5-aminolevulinic acid photodynamic therapy for vulvar lichen sclerosus. Photodiagnosis Photodyn Ther 2024; 46:104035. [PMID: 38442799 DOI: 10.1016/j.pdpdt.2024.104035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The purpose of this study is to analyze the efficacy of photodynamic therapy in the treatment of vulvar lichen sclerosus who do not respond to topical glucocorticoid therapy, analyze whether there are factors that affect the efficacy, and identify adverse reactions to the treatment. METHOD This retrospective study included 42 patients with vulval lichen sclerosis treated with ALA-PDT. Basic data of all patients were collected, and the clinical symptoms and signs of the patients before treatment were evaluated. After one year of treatment, the clinical efficacy was evaluated and analyzed whether there were any factors that affected the treatment effect. RESULT One year after the ALA-PDT treatment, the clinical effective rate was 64.29 % (27/42), the general effective rate was 19.05 % (8/42), the ineffective rate was 4.76 % (2/42), and the recurrence rate was 11.90 % (5/42). There was no correlation between menopause, number of births given, body mass index, duration of disease, treatment times and treatment effect. For patients with severe itching and atrophy, PDT was less effective. Adverse effects were minimal and no structural complications were reported. CONCLUSION ALA-PDT can obviously alleviate itching in VLS patients, improve skin elasticity, skin color and reduce lesion area. ALA-PDT for VLS has a low recurrence rate and few side effects.
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Affiliation(s)
- Zhongyu Qu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xueyan Lin
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ming Liu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Jia Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Fei Wang
- Department of Eastern Hospital Emergency Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Bei Zhang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Liang Shen
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Zhifeng Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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13
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Xie X, Wu K. Advances in the pathogenesis of vulvar lichen sclerosus. Mol Biol Rep 2024; 51:396. [PMID: 38453810 DOI: 10.1007/s11033-024-09318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
Vulvar lichen sclerosus (VLS) is a chronic non-neoplastic skin lesion characterized by vulvar itching, pain, atrophy, whitening of the skin and mucous membranes, and gradual atrophy and disappearance of the labia minora, which can eventually lead to vulvar scarring, causing functional impairment and seriously affecting the patient's physical and mental health. VLS can occur at any age, however, its pathogenesis and etiology are not fully understood. Considerable progress has been made in related research on genetic susceptibility factors, autoimmune disorders, collagen metabolism abnormalities, and their triggering factors in disease formation and progression. This article reviews the etiology of vulvar lichen sclerosus.
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Affiliation(s)
- Xingkui Xie
- Department of Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Kejia Wu
- Center for Reproductive Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.
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14
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Jerkovic Gulin S, Liljeberg L, Seifert O. The impact of genital lichen sclerosus in men and women on quality of life: a prospective cohort study. Int J Womens Dermatol 2024; 10:e131. [PMID: 38240010 PMCID: PMC10796136 DOI: 10.1097/jw9.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Background Genital lichen sclerosus (LS) is a chronic inflammatory skin disorder that affects both sexes of all ages. The clinical characteristics include erosions, redness, and white plaques with atrophic skin, with symptoms such as pruritus, pain, dysuria, and dyspareunia. Objective This prospective cohort study aimed to assess quality of life (QoL) in men and women with genital LS, both before and after treatment, using the Dermatology Quality of Life Index (DLQI) questionnaire. Methods Patients diagnosed with genital LS were enrolled continuously in the study and were asked to complete the DLQI questionnaire before treatment and again after individualized treatment 12 weeks apart. Results This study included 136 patients (48 females and 88 males) diagnosed with genital LS, with a median age of 62 years (range 18-86). The results showed a statistically significant decrease (P < .001) in DLQI score before treatment (median 6.0 [interquartile range (IQR), 1.0-11.0]) compared to after treatment (median 2.0 [IQR, 0.0-4.0)]. In males and females, the median DLQI scores before treatment were 3.0 (IQR, 0.0-10.0) and 8.0 (IQR, 4.5-11.5), respectively, and after treatment were 1.0 (IQR, 0.0-3.0) and 4.0 (IQR, 0.0-9.0), respectively. Females scored significantly higher (P < .001) than males. Limitations The study's limited generalizability stems from a small sample size of 136 patients, potentially restricting the application of findings to a broader population with genital lichen sclerosus. Additionally, the 12-week follow-up period may not adequately capture the long-term effects of interventions on quality of life. Reliance on self-reported data through the DLQI questionnaire introduces the possibility of bias, as participants may not accurately represent their symptoms and quality of life. The absence of a control group hinders the ability to attribute observed changes solely to the treatment, and the lack of detail on specific interventions makes it challenging to assess the effectiveness of individualized treatment approaches. The wide age range among participants (18-86 years) introduces potential confounding variables, as different age groups may respond differently to treatment. Conclusion The study findings confirmed that individuals with genital LS experience a small decline in QoL, as observed in both males and females. This study also highlights that effective management of genital LS can significantly improve QoL in both sexes.
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Affiliation(s)
- Sandra Jerkovic Gulin
- Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, The Faculty of Medicine and Health Sciences Linkoping University, Linköping, Sweden
| | - Linnea Liljeberg
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, The Faculty of Medicine and Health Sciences Linkoping University, Linköping, Sweden
| | - Oliver Seifert
- Department of Dermatology and Venereology, Ryhov County Hospital, Sjukhusgatan, Jönköping, Sweden
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, The Faculty of Medicine and Health Sciences Linkoping University, Linköping, Sweden
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Wei D, Luo C, Chen Y, Li J, Niu X. A large sample-based case-control study of related risk factors of two types of lichenoid vulvar disease (LVD). Eur J Obstet Gynecol Reprod Biol 2024; 293:15-20. [PMID: 38100936 DOI: 10.1016/j.ejogrb.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The purpose of this study is to identify the associated factors of two types of lichenoid vulvar disease (LVD) and to compare the differences in related factors between the different pathological types of lichenoid vulvar disease (LVD). METHODS The study conducted at the West China second Hospital of Sichuan University included a total of 1770 patients with biopsy-confirmed vulvar lichen simplex chronicus (VLSC)and vulvar lichen sclerosus(VLS), along with 1209 patients with normal vulvovagina as control. Further pathological subtype analysis was carried out on 163 cases of vulvar lichen simplex chronicus and 51 cases of vulvar lichen sclerosus. In addition, Univariate chi-square test and multivariate logistic regression were used to analyze the lichenoid vulvar disease group and vulvovaginal normal control group. RESULTS Univariate analysis revealed that there were statistically significant differences (P < 0.05) in factors between the LVD group and the control group, except for living type, sleep habit, history of drinking, and allergic diseases. There was no significant difference in late sleep, spicy diet, and coffee intake in the factors of life and eating habits and the concomitant disease factors. Furthermore, univariate analysis showed that except for eating seafood, humid living environment, residence, caffeinated drinks, hypertension, and vaginitis, there were statistical differences in the related factors of LVSC. CONCLUSION The incidence about lichenoid vulvar disease is influenced by various factors such as dietary habits, living environment, mental stress, concomitant diseases, hormone levels and so on, and there were no significant differences in these factors between VLS and VLSC except for income, work stress, systemic immune diseases, and menopause.
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Affiliation(s)
- Dongmei Wei
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Can Luo
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Yueyue Chen
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Jijie Li
- Medical Records Management Department, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Xiaoyu Niu
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
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16
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Popa A, Dumitrascu MC, Petca A, Petca RC, Sandru F. Vulvar Lichen Sclerosus: Navigating Sex Hormone Dynamics and Pioneering Personalized Treatment Paradigm. J Pers Med 2024; 14:76. [PMID: 38248777 PMCID: PMC10817476 DOI: 10.3390/jpm14010076] [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: 12/14/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Vulvar lichen sclerosus (VLS) is a frequently overlooked inflammatory disorder affecting the skin and mucous membranes of the vulva. With a propensity for atrophy, severe scarring, functional impairment, and malignant evolution, VLS is a disease that recurs frequently; early diagnosis, rapid treatment, and ongoing patient follow-up are essential. Potent topical corticosteroids (TCSs) are now widely recognized as the most effective treatment for achieving remission in VLS, but considering the potential complications of long-term treatment with potent TCSs, understanding the evolution of VLS during puberty becomes particularly crucial in determining the necessity for aggressive or more conservative therapeutic interventions. Emerging treatments, including PRP (platelet-rich plasma), stem cell therapy, and energy-based lasers like fractional CO2 and Nd-YAG, are being investigated to identify more effective VLS treatments than ultrapotent topical corticosteroids. However, more research is needed to assess the efficacy and safety of these new medicines. Topical clobetasol 0.05% ointment daily for 4-12 weeks is the gold standard for treating VLS. This article is a narrative review of the English-language medical literature from 2017 to November 2023, following three main sections concerning VLS: studies of the evolution amid pubertal hormonal changes; studies of the outcomes of personalized conventional therapies; and studies addressing the spectrum of innovative modalities for VLS.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Vladulescu D, Scurtu LG, Simionescu AA, Scurtu F, Popescu MI, Simionescu O. Platelet-Rich Plasma (PRP) in Dermatology: Cellular and Molecular Mechanisms of Action. Biomedicines 2023; 12:7. [PMID: 38275368 PMCID: PMC10813350 DOI: 10.3390/biomedicines12010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Platelet-rich plasma (PRP) therapy has gained attention in the scientific field due to its potential regenerative effects and great benefit-risk ratio. This review extensively explores the most studied mechanisms of this therapy according to the etiopathogenesis of skin diseases: cellular proliferation, matrix formation, regulation of inflammation, angiogenesis, collagen synthesis, and the remodeling of new tissue. Moreover, it draws on newly reported and lesser-known effects of PRP: its anti-apoptotic effects, immunological suppression, decrease in melanin synthesis, anti-microbial effects, overexpression of miR-155, antioxidant effects, and their involved pathways. This work aims to provide a complete update for understanding PRP's benefits and clinical relevance in wound healing, alopecia, pigmentary disorders, scars, rejuvenation, lichen sclerosus, and other inflammatory dermatoses, based on the current evidence. Furthermore, recent reports with novel indications for PRP therapy are highlighted, and new potential pathways correlated with the pathogenesis of skin diseases are explored.
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Affiliation(s)
- Denisa Vladulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
| | - Lucian G. Scurtu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
| | - Anca Angela Simionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Francesca Scurtu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Marco I. Popescu
- Faculty of Medicine, “Titu Maiorescu” University, 040441 Bucharest, Romania
| | - Olga Simionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
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Gil-Villalba A, Ayen-Rodriguez A, Naranjo-Diaz MJ, Ruiz-Villaverde R. Laser Therapy for Vulvar Lichen Sclerosus, a Systematic Review. Life (Basel) 2023; 13:2146. [PMID: 38004286 PMCID: PMC10672171 DOI: 10.3390/life13112146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Lichen sclerosus (LS) is a chronic inflammatory disease that mainly affects the anogenital area, with a higher incidence in post-menopausal women. In the long term, it can lead to loss of vulvar architecture or progress to squamous cell carcinoma. The evidence-based treatment involves high-potency topical corticosteroids in long regimens. However, second-line treatments are not well-established, including laser therapy. This current study aims to assess the level of evidence supporting this therapy. We conducted a search for primary-level studies published before April 2023 through MEDLINE/PubMed, Embase, Web of Science, Scopus, and CENTRAL, with no restrictions on the publication language or date. The methodological quality and risk of bias of the included studies were evaluated using the updated Cochrane Collaboration's tool for assessing risk of bias (RoB-2). Six studies (177 patients) met our eligibility criteria. Laser therapy was compared to topical corticosteroid treatment in five out of six studies. No significant histological differences were found, except for an increase in collagen production in the laser group. A greater reduction in itching, pain, and dyspareunia at 1 and 3 months of treatment in the laser group, as well as in the Skindex-29 at 6 months, was reported. Patient satisfaction was significantly higher among those who received laser therapy. Tolerability was excellent. No significant differences were observed in any of the previous aspects in the study compared to the placebo. In conclusion, there is not enough evidence to recommend laser therapy as a standalone treatment.
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Boero V, Brambilla M, Di Loreto E, Cetera GE, Cipriani S, Boggio F, Monti E, Libutti G, Caia C, Parazzini F. Fat Grafting in Vulvar Lichen Sclerosus: Long Term Follow-Up. J Low Genit Tract Dis 2023; 27:365-372. [PMID: 37551790 DOI: 10.1097/lgt.0000000000000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The rationale for the use of autologous fat grafting in the treatment of vulvar lichen sclerosus (VLS) consists in reduction of inflammation, regeneration of tissues, volume increase, and pain fiber control. The main outcome of this study was the evaluation of patients' satisfaction after treatment. Secondary outcomes included modifications in symptoms, psychosexual wellbeing, vulvar hydration, and histology after surgery. METHODS Eligible for this study were women aged 18-85 years with a histological diagnosis of VLS who underwent at least one autologous vulvar fat grafting at the authors' center, between 2010 and 2019. In 2021, all women underwent a clinical reevaluation, comprehensive of vulvoscopy, vulvar biopsy, and handing out of validated questionnaires. RESULTS Overall, 88.7% of patients declared themselves very satisfied/satisfied with the procedure. All symptoms were improved postsurgery; in particular, the difference was statistically significant for pruritus, burning, and dyspareunia ( p < .05). Sexual function was also improved at time of reevaluation, as were depressive and anxiety symptoms ( p < .05). No cases of vulvar intraepithelial neoplasia or cancer occurred during follow-up and vulvar architecture remained stable, although patients reported a significantly reduced need for topical steroids ( p < .0001). Lastly, in postoperative biopsies, inflammatory infiltrate was stable or reduced, and the distribution of elastic fibers was comparable or restored in most patients. CONCLUSIONS Patient satisfaction with fat grafting is detectable up to 11 years after surgery, and as such, it may represent a valid therapeutic option in selected cases of VLS.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Service, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Sonia Cipriani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Francesca Boggio
- Department of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Giada Libutti
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
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Brandon A, Joshi T, Ahmed Z, Tahir M, Phung T, Pierce JY, Knowles K. A Rare Presentation of Lichen Sclerosus Involving the Vaginal Canal After Radiation Therapy: A Case Report and Review of the Literature. Cureus 2023; 15:e47077. [PMID: 38021954 PMCID: PMC10644119 DOI: 10.7759/cureus.47077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Vaginal lichen sclerosus (LS) is an extremely rare entity. Classically, LS is referred to as a chronic, inflammatory skin disease with a distinct predilection for the anogenital skin that is observed in post-menopausal women and typically manifests clinically as white, atrophic plaques. Here, we report a case of a 61-year-old patient who presented for a follow-up visit three years after vaginal brachytherapy as an adjuvant treatment for endometrial adenocarcinoma. This lesion was biopsied and confirmed to be vaginal LS on histological analysis. While LS has been previously observed to impact mucosal areas outside of the anogenital region, such as the mouth, reported cases of vaginal LS are very rare in the literature. Our case highlights both the underrecognized location of this disease as well as radiation as a potential risk factor.
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Affiliation(s)
- Arcole Brandon
- Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Tanvi Joshi
- Obstetrics and Gynaecology, University of South Alabama College of Medicine, Mobile, USA
| | - Zan Ahmed
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
| | - Muhammad Tahir
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
| | - Thuy Phung
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
| | - Jennifer Y Pierce
- Obstetrics and Gynaecology, University of South Alabama College of Medicine, Mobile, USA
| | - Kurt Knowles
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
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Erceg Ivkošić I, Fureš R, Ćosić V, Mikelin N, Bulić L, Dobranić D, Brlek P, Primorac D. Unlocking the Potential of Mesenchymal Stem Cells in Gynecology: Where Are We Now? J Pers Med 2023; 13:1253. [PMID: 37623503 PMCID: PMC10455325 DOI: 10.3390/jpm13081253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Stem cells, with their remarkable capacity for differentiation into diverse cell types, are vital for the development as well as maintenance of health and homeostasis. Two unique abilities set them apart from other cells: self-renewal and the capacity for differentiation. They play important roles in embryogenesis, development, regeneration, and various other processes. Over the last decade, there has been increased interest in their potential use in the treatment of numerous diseases and disorders across multiple fields of medicine in acute, chronic, innate, and acquired diseases. Stem cells are key to maintaining the body's homeostasis and regulating growth and tissue functions. There are several types of stem cells-embryonic, adult, and human-induced pluripotent cells. Currently, mesenchymal stem cells are of great interest due to their regenerative, immunomodulatory, analgesic, and antimicrobial (anti-inflammatory) effects. Recent studies have shown the potent regenerative effect of stem cell therapy in gynecologic diseases such as infertility, Asherman syndrome, lichen sclerosus, polycystic ovary syndrome, premature ovarian insufficiency, genitourinary syndrome of menopause, and rectovaginal fistulas. Moreover, the successful isolation of oogonial stem cells could lead to a revolution in the field of gynecology and the potential treatment of the conditions discussed. This review aims to provide a better understanding of the latest therapeutic options involving stem cells and raise awareness of this promising yet not widely known topic in gynecology and medicine in general.
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Affiliation(s)
- Ivana Erceg Ivkošić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia (L.B.)
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Rajko Fureš
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Gynecology and Obstetrics, Zabok General Hospital and Croatian Veterans Hospital, 49210 Zabok, Croatia
| | - Vesna Ćosić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Poliklinika Ćosić, d.o.o., 35000 Slavonski Brod, Croatia
| | - Nika Mikelin
- Health Center of the Zagreb County, 10000 Zagreb, Croatia
| | - Luka Bulić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia (L.B.)
| | | | - Petar Brlek
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia (L.B.)
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Dragan Primorac
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia (L.B.)
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- School of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT 06516, USA
- Medical School, University of Split, 21000 Split, Croatia
- Eberly College of Science, The Pennsylvania State University, University Park, State College, PA 16802, USA
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Medical School REGIOMED, 96 450 Coburg, Germany
- Medical School, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
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22
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Preti M, Borella F, Ferretti S, Caldarella A, Corazza M, Micheletti L, De Magnis A, Borghi A, Salvini C, Gallio N, Pasquero G, Vieira-Baptista P, Selk A, Benedetto C, Rosso S. Genital and extragenital oncological risk in women with vulvar lichen sclerosus: A multi-center Italian study. Maturitas 2023; 175:107767. [PMID: 37302181 DOI: 10.1016/j.maturitas.2023.04.010] [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: 12/12/2022] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023]
Abstract
Vulvar lichen sclerosus is a chronic inflammatory disease involving vulvar skin. The risk of developing invasive vulvar cancer for women with LS is reported in the literature, but the risk of extra-vulvar tumors has been under-investigated. This multicentric study aims to estimate the risk of developing cancers in a cohort of women with a diagnosis of vulvar lichen sclerosus. METHODS A cohort of women diagnosed with and treated for vulvar lichen sclerosus in three Italian gynecological and dermatological clinics (Turin, Florence, and Ferrara) was retrospectively reviewed. Patient data were linked to cancer registries of the respective regions. The risk of subsequent cancer was estimated by dividing the number of observed and expected cases by the standardized incidence ratio. RESULTS Among 3414 women with a diagnosis of vulvar lichen sclerosus corresponding to 38,210 person-years of follow-up (mean 11.2 years) we identified 229 cancers (excluding skin cancers and tumors present at the time of diagnosis). We found an increased risk of vulvar cancer (standardized incidence ratio = 17.4; 95 % CL 13.4-22.7), vaginal cancer (standardized incidence ratio = 2.7; 95 % CL 0.32-9.771), and oropharyngeal cancer (standardized incidence ratio = 2.5; 95 % CL 1.1-5.0), and a reduced risk of other gynecological tumors (cervical, endometrial, ovarian) and breast cancer. CONCLUSIONS Patients with vulvar lichen sclerosus should undergo annual gynecological check-up with careful evaluation of the vulva and vagina. The increased risk of oropharyngeal cancer also suggests the need to investigate oropharyngeal cavity symptoms and lesions in patients with vulvar lichen sclerosus.
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Affiliation(s)
- Mario Preti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy.
| | - Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, and Local Health Authority, 44121 Ferrara, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical, and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Leonardo Micheletti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Angelina De Magnis
- Department of Gynecology and Obstetrics, University of Florence, Florence, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Camilla Salvini
- Dermatology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Niccolò Gallio
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Giorgia Pasquero
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Pedro Vieira-Baptista
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Amanda Selk
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U, City of Health and Science University Hospital, Turin, Italy
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23
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Rees S, Owen C, Baumhauer C, Hillman S. Vulval lichen sclerosus in primary care: thinking beyond thrush and genitourinary symptoms of the menopause. Br J Gen Pract 2023; 73:234-236. [PMID: 37105742 PMCID: PMC10147430 DOI: 10.3399/bjgp23x732861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/10/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol
| | | | | | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry
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24
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Abstract
IMPORTANCE AND OBJECTIVES Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women. METHODS This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia. FINDINGS Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists. CONCLUSIONS Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.
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Affiliation(s)
- Lauren F Streicher
- From the Northwestern Medicine Center for Sexual Medicine and Menopause, Northwestern Medicine, Chicago, IL
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25
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Kolesnikova EV, Zharov AV, Todorov SS, Penzhoyan GA, Mingaleva NV. Morphological features of various variants of the course of scleroatrophic lichen of the vulva. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-17-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Relevance. Most of the scientific papers presented in the literature indicate morphological features of the stages of development of sclerotic lichen of the vulva, or in comparison with other vulvar skin lesions. At the same time, data on the features of morphological examination of vulvar biopsies, depending on the clinical variants of the course of sclerotic lichen of the vulva, is currently insufficient. The aim of the study - to determine the presence or absence of distinctive morphological features of the sclerotic lichen of the vulva, depending on the clinical variants of its course. Materials and Methods. The study included 292 patients with sclerotic lichen of the vulva (20-70 years old). Based on the scale of assessment of objective and subjective clinical signs of sclerotic lichen of the vulva developed by us, 3 clinical groups: 101 patients with an atrophic variant of the course, 154 with a sclerosing variant and 37 patients with a scleroatrophic variant of the course of sclerotic lichen of the vulva. In addition to clinical laboratory, instrumental and immunological studies, all patients underwent incisional biopsy of the vulva followed by morphological examination of biopsies. Results and Discussion. The features of the results of morphological examination of various clinical variants of the course of sclerotic lichen of the vulva are described and presented in the form of images. The characteristic morphological signs for each clinical group, as well as common signs characteristic of all variants of the course of this pathology, were revealed. Morphological examination of vulvar tissues is informative only to confirm the diagnosis of «Sclerotic lichen of the vulva», to determine the stage of the disease, as well as to exclude the malignant process, while for a clear differentiation of variants of the clinical course of sclerotic lichen of the vulva, conventional morphological examination is not enough, which requires further studies using immunohistochemical and molecular genetic methods. Conclusion. The revealed differences in morphological parameters of various variants of the course of sclerotic lichen of the vulva are insufficiently specific, which excludes the possibility of accurate morphological verification of the variants of the course of sclerotic lichen of the vulva and confirms the expediency of using clinical classification of variants of the course of sclerotic lichen of the vulva based on objective and subjective clinical signs.
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26
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Salgado HC, Drumond DG, Pannain GD, de Melo E Costa LG, Sampaio FS, Leite ICG. Randomized clinical trial with fractional CO 2 laser and Clobetasol in the treatment of Vulvar Lichen Sclerosus: a clinic study of feasibility. BMC Res Notes 2023; 16:33. [PMID: 36894959 PMCID: PMC9999649 DOI: 10.1186/s13104-023-06300-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES The main objective of the study was to describe and compare the feasibility of using fractional CO2 laser to the usual treatment with Clobetasol. Randomized clinical trials brought together 20 women from a Brazilian university hospital, 9 of them were submitted to Clobetasol treatment and 11 to laser therapy. Sociodemographic data were obtained and quality of life parameters, vulvar anatomy, self-perception and histopathological analysis of vulvar biopsies were evaluated. Evaluations were made before the beginning of the treatment, during its implementation, right after its completion (3 months), and 12 months after. The SPSS 14.0 software was used, obtaining descriptive measurements. The level of significance adopted was 5%. RESULTS The clinical/anatomical characteristics of the vulva did not differ between the treatment groups, as much before as after its performance. There was no statistically significant difference between the treatments performed regarding the impact on the life quality of the patients. A higher satisfaction degree with the treatment was obtained with the patients in the Laser group in the third month of evaluation. Laser therapy also revealed higher occurrence of telangiectasia after treatment completion. Fractional CO2 laser has proven to be well accepted and is a promising therapeutic option. Registration number and name of trial registry The institutional review board status was approved by the Research Ethics Committee of HU/ UFJF under advisory number 2881073 and registered in the Brazilian Clinical Trials, with consent under registration RBR-4p9s5y. Access link: https://ensaiosclinicos.gov.br/rg/RBR-4p9s5y.
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Affiliation(s)
| | - Denise Gasparetti Drumond
- Department of Surgery Medical School, Federal University of Juiz de Fora, Juiz de Fora, MG, 36036-110, Brazil
| | - Gabriel Duque Pannain
- Medical Residency, Institute of Medical Assistence to State Public Servants, São Paulo, SP, 04039-000, Brazil
| | | | - Fernanda Souza Sampaio
- Gynecology Service, University Hospital of the Federal University of Juiz de Fora, Juiz de Fora, MG, 36036-110, Brazil
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27
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Lichen Sclerosus. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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28
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Li L. Clinical efficacy evaluation of crisaborole ointment in the treatment of vulvar leukoplakia. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:97-100. [PMID: 36820717 PMCID: PMC9937623 DOI: 10.1590/1806-9282.20220801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical efficacy of crisaborole ointment in the treatment of vulvar leukoplakia. METHODS A prospective, randomized controlled clinical trial was conducted, and a total of 100 patients with vulvar leukoplakia were divided into the observation group (n=50) treated with crisaborole ointment and the control group (n=50) treated with vitamin E. The symptom improvement and vulvar leukoplakia score after 2 weeks of treatment were analyzed, and the clinical efficacy of vulvar leukoplakia was evaluated by referring to the Guidelines for Clinical Research of New Drugs of Traditional Chinese Medicine (2018 Edition). RESULTS After 2 weeks of treatment, the overall score of lesions in the observation group decreased, and the total treatment efficiency of patients in the observation group was 92% (46/50), which was significantly higher than that of 52% (26/50) in the control group P<0.05). CONCLUSION Crisaborole ointment can effectively treat vulvar leukoplakia, improving the symptoms and pathological changes of the vulvar skin.
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Affiliation(s)
- Lijun Li
- Jiangxi Maternal and Child Health Hospital, Department of Gynaecology – Nanchang, China.,Corresponding author:
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29
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Jia R, Wu C, Tang X, He M, Liu X, Su C, Li C. Comparison of the efficacy of focused ultrasound at different focal depths in treating vulvar lichen sclerosus. Int J Hyperthermia 2023; 40:2172220. [PMID: 36710083 DOI: 10.1080/02656736.2023.2172220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of focused ultrasound (FU) at different focal depths in treating vulvar lichen sclerosus (VLS). METHODS A retrospective study was conducted on 84 patients with VLS. Among them, 43 cases were treated with FU at a focal depth of 2.5 mm and 41 cases at a focal depth of 4.0 mm. Therapeutic time, treatment energy, postoperative efficacy, complications and recurrence rates were compared. RESULTS No statistically substantially differences in age, disease course, history of immune system diseases, lesion size and severity of symptoms were found between the two groups. All patients successfully received FU therapy. No significant difference in curative rate was observed between the two groups at 3, 6 and 12 months after FU therapy. At 12 months after FU therapy, the recurrence rate of the experimental group (FU treatment at 2.5 mm focal depth) was lower than the control group (FU treatment at 4.0 mm focal depth) (7.0% vs 24.4%, p = 0.027). The experimental group was treated for a shorter period of time [22.69 ± 0.64 (min) vs 24.93 ± 0.72(min), p = 0.022] and at a lower dose[5,026.05 ± 148.00(J) vs 5,484.26 ± 160.60(J) p = 0.039]. CONCLUSION Compared with that at the routine focal depth (4.0 mm), FU therapy at a low treatment depth (2.5 mm) can achieve a similar therapeutic effect but lower recurrence rate, therapeutic time and treatment energy. This work provides insight into the optimization of clinical protocols.
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Affiliation(s)
- Ru Jia
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Can Wu
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Xiaoxu Tang
- Chongqing Ronghai Engineering Research Center of Ultrasound Medicine Co., Ltd., Chongqing, China
| | - Miaomiao He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xinglin Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chang Su
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chengzhi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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30
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Tedesco M, Garelli V, Elia F, Sperati F, Biondi F, Mosiello L, Morrone A, Migliano E. Efficacy of injecting hybrid cooperative complexes of hyaluronic acid for the treatment of vulvar lichen sclerosus: A preliminary study. J Cosmet Dermatol 2023; 22:449-457. [PMID: 35238456 PMCID: PMC10107117 DOI: 10.1111/jocd.14896] [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: 12/27/2021] [Revised: 01/24/2022] [Accepted: 02/17/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Lichen sclerosus is a chronic relapsing inflammatory skin disease, which involves most commonly the anogenital region. The gold standard in treatment is ultra-potent topical steroids (clobetasol propionate): it aims at controlling the symptoms, stopping further scarring and distortion, and reducing the risk of cancer. OBJECTIVES The aim of this preliminary study is to evaluate the efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid (HCC) for the treatment of vulvar lichen sclerosus (VLS). METHODS Twenty female adult patients (range: 21-78 years), aged over 18, with histopathological diagnosis of lichen sclerosus and good general conditions were enrolled. Patients underwent HCC infiltration every month, for 3 times. Patients were evaluated at baseline (T0) and after one (T1) and six months (T2) after treatment. During every visit, each patient was studied clinically and with videothermography. Itching, burning sensation, pain, and dyspareunia were reported by patients at T0, T1, and T2. The effectiveness of the treatment on patients' quality of life and sexual function was evaluated using the Dermatology Life Quality Index (DLQI) and the Female Sexual Function Index (FSFI) at T0 and at T2. RESULTS The results of this preliminary study are very promising, in fact, all patients had a significant reduction in most symptoms after 1 and 6 months of HCC treatment. The reduction of patients with itching (p value ≤ 0.001), pain (p value = 0.031), and burning sensation (p = 0.004) at 6 months is significant. The analysis of DLQI scores revealed a significant improvement in patients' quality of life. At baseline, the average score of DLQI (±SD) was 5.89 ± 3.68 while at follow-up it was 3.42 ± 2.36 (p = 0.002). CONCLUSIONS Our preliminary study has demonstrated the validity and tolerability of HCC infiltrations in patients with VLS, and the effectiveness of HCC in reducing symptoms and, thus, to improve sexuality and patient quality of life.
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Affiliation(s)
- Marinella Tedesco
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Valentina Garelli
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Fulvia Elia
- Radiology and Diagnostic Imaging Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistical and Bioinformatic, Scientific Direction, SanGallicano Dermatological Institute IRCCS, Rome, Italy
| | - F Biondi
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - L Mosiello
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Director San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Emilia Migliano
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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31
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Smith AB, Muhammad NI, Cigna ST, Krapf JM. A systematic review of sexual health consequences among women with lichen sclerosus. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Introduction
Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affecting the vulva. Studies have shown high rates of sexual dysfunction in patients with LS; however, the sexual effects of the condition are poorly acknowledged.
Objectives
We sought to identify sexual health consequences among women with vulvar LS through systematic review of available literature.
Methods
A systematic review of the literature was conducted to find reports on sexual health consequences among women with LS. PubMed, MEDLINE, and Scopus were queried. Included articles were observational studies evaluating women with LS and their sexual health and randomized controlled trials or comparative studies utilizing a validated sexual health measure before intervention among the same population. Articles must have been written in English and published from January 1991 to April 2022.
Results
The search produced 683 references, including 32 articles that met criteria for full-text review and 20 reported studies that met inclusion criteria. Two studies investigated the impact of LS on interpersonal relationships, 6 studies evaluated sexual symptoms, 16%-60% reported sexual dysfunction, and 22%-56.7% reported dyspareunia. Also described were decreased sexual frequency and satisfaction, negative impact on sexual relationships, and feelings of inadequacy. Eight publications evaluated the Female Sexual Function Index (FSFI); all described studies that demonstrated a central tendency less than 26.55. Four publications evaluated the Female Sexual Distress Scale (FSDS); all demonstrated average scores greater than 12. Two publications evaluated the Female Genital Self-Image Scale (FGSIS), both found decreased scores compared to controls. Four publications evaluated the Dermatology Life Quality Index (DLQI); impact on quality of life was small to very large, with sexual difficulties affecting most study patients. One publication evaluated the Vulvar Quality of Life Index (VQLI); sexuality was the second highest-scoring subgroup.
Conclusions
Sexual health consequences of LS include sexual pain, dysfunction, and distress; negative genital self-image; and negative impact on sexual relationships. Women with LS experience a negative impact on quality of life, particularly related to sexual functioning.
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Affiliation(s)
- Alyssa B Smith
- Department of Obstetrics and Gynecology,The George Washington University School of Medicine and Health Sciences , Washington. DC, United States
| | | | - Sarah T Cigna
- Department of Obstetrics and Gynecology,The George Washington University School of Medicine and Health Sciences , Washington. DC, United States
| | - Jill M Krapf
- Department of Obstetrics and Gynecology,The George Washington University School of Medicine and Health Sciences , Washington. DC, United States
- Center for Vulvovaginal Disorders , Washington, DC, United States
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32
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Wang Y, Hao J, Liu J. High-frequency ultrasound assessment of vulvar lichen sclerosus treated with photodynamic therapy. Photodiagnosis Photodyn Ther 2023; 41:103277. [PMID: 36621633 DOI: 10.1016/j.pdpdt.2023.103277] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with vulvar lichen sclerosus (VLS) are faced with a decreased quality of life and an increased risk of vulvar malignancy. 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) can serve as an alternative for refractory VLS patients. However, high-frequency ultrasound (HFUS) has never been introduced in the ALA-PDT outcome assessment for VLS patients. METHODS A prospective study was conducted. Refractory VLS patients received two treatment courses of ALA-PDT (3 times of remedies at 2-week intervals for each course), and underwent clinical, HFUS and histopathological assessment. Statistical analysis comparing parameters at baseline and after ALA-PDT was performed. RESULTS Thirty-one VLS patients were included. Both subjective symptoms (itch and burning pain) and objective severity (lesion size and hypopigmentation) were relieved significantly after ALA-PDT treatment. Hypoechoic dermal band (HDB) thickness revealed by HFUS decreased progressively with successive ALA-PDT treatment, and the reduction value had a positive correlation with the reduction of inflammatory infiltration depth in histopathology. Collagen homogenization depth decrease was also noticed. Besides, adverse effects were recorded, mainly as mild and transient post-treatment edema and pain. CONCLUSIONS ALA-PDT is an effective and safe therapeutic option for refractory VLS patients. HFUS can act as a complement to the non-invasive treatment monitoring for its objectivity, quantifiability and precision in the distinct vertical perspective.
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Affiliation(s)
- Yukun Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Center for Translational Medicine, Beijing 100730, China
| | - Jianchun Hao
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing 100022, China
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Center for Translational Medicine, Beijing 100730, China.
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33
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De Luca DA, Papara C, Vorobyev A, Staiger H, Bieber K, Thaçi D, Ludwig RJ. Lichen sclerosus: The 2023 update. Front Med (Lausanne) 2023; 10:1106318. [PMID: 36873861 PMCID: PMC9978401 DOI: 10.3389/fmed.2023.1106318] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.
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Affiliation(s)
- David A De Luca
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Cristian Papara
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Hernán Staiger
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Alharbi A, Khobrani A, Noor A, Alghamdi W, Alotaibi A, Alnuhait M, Haseeb A. Risk of Lichen Sclerosus and Lichen Planus in Patients Receiving Immune Checkpoint Inhibitors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:580. [PMID: 36612904 PMCID: PMC9819784 DOI: 10.3390/ijerph20010580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) are recommended for various types of cancer. On the other hand, these ICIs may cause immune-related adverse events (irAEs). Lichen sclerosus (LS) and lichen planus (LP) are two distinct phenotypes of irAEs that occur in a subset of patients treated with ICIs. These adverse effects have a detrimental effect on the patient's quality of life and treatment phases; however, the clinical evaluation and assessment of LS and LP remain uncertain. This study aims to assess and evaluate the risk of LS and LP associated with the use of ICIs via a systematic review of the literature and the USA FDA Adverse Events FAERS database. METHOD The study searched electronic databases such as PubMed, Medline, Cochrane, and Google Scholar for case reports on immune-checkpoint-inhibitor-associated lichen sclerosus and lichen planus published in English between inception and 31 December 2021. The FDA's adverse event reporting system (FAERS) database was also analyzed. RESULTS Thirty-eight case reports and two retrospective studies with a total of 101 patients, in addition to the FAERS data, were evaluated. More cases involved lichen planus (78.9%) than lichen sclerosis (21%). Nivolumab and pembrolizumab were most frequently reported with LS and LP, among other ICIs. Thirty-six out of thirty-eight patients with LS or LP experienced complete remission, while two patients experienced partial remission. Most of the cases had an excellent response to corticosteroids (92.1%), while the remainder had moderate (5.2%) and poor (2.6%) responses. Additionally, the reporting odds ratio (ROR) of the FAERS database indicated a favorable association for ICIs, the risk of LP, and LS. A stronger association was uniquely found between nivolumab and pembrolizumab. CONCLUSION There have been published case reports for these adverse events. Healthcare providers should be aware of the possibility of lichen sclerosis and lichen planus developing in patients receiving ICIs which could necessitate hospitalization or discontinuation. Regulatory agencies are advised to monitor the risks as a potential safety signal.
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Affiliation(s)
- Ahmad Alharbi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Qassim Health Cluster, Ministry of Health, Buraidah 52385, Saudi Arabia
| | - Attiah Khobrani
- Pharmaceutical Care Services, King Abdullah Medical City, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Afnan Noor
- Pharmaceutical Care Department, King Faisal Specialist Hospital & Research Center, Jeddah 22234, Saudi Arabia
| | - Waad Alghamdi
- Pharmacovigilance Directorate, Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Abdulmalik Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Mohammed Alnuhait
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
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Laser Therapy for Recalcitrant Vulvar Lichen Sclerosus: A Review of the Literature. Clin Obstet Gynecol 2022; 65:768-774. [PMID: 35385852 DOI: 10.1097/grf.0000000000000700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vulvar lichen sclerosus (LS) is a chronic vulvar dermatosis potentially impacting quality of life and sexual function. While most women with LS respond to topical corticosteroids and/or calcineurin inhibitors, some require additional therapy. Systemic therapies have been used successfully in oral and vulvovaginal lichen planus with minimal data in the setting of LS. Likewise, while vaginal laser therapy has shown potential benefit for genitourinary syndrome of menopause, there is a paucity of data in the setting of LS. We review retrospective and prospective studies along with randomized controlled trials utilizing vulvovaginal laser for LS therapy.
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Torres A, Zaborek-Łyczba M, Łyczba J, Mertowska P, Mertowski S, Grywalska E. The Importance of Immunological Disorders in the Pathogenesis of Lichen Sclerosus in Pediatric Patients: A Systematic Review. Int J Mol Sci 2022; 23:ijms232214212. [PMID: 36430687 PMCID: PMC9697898 DOI: 10.3390/ijms232214212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Lichen sclerosus (LS) is defined as a chronic mucocutaneous inflammatory disease with a localization predominantly to the anus and genitals (vulvar sclerosus (VLS)). Pediatric lichen sclerosus (LS) is a chronic inflammatory skin condition with predilection for the anogenital area that if untreated can lead to scarring. Vulvar LS is characterized by two peaks in incidence: it occurs in prepubertal girls and in postmenopausal women. To date, several mechanisms and risk factors have been proposed in the pathogenesis of pediatric vulvar LS; however, the etiology of this condition is still not fully understood and constitutes a challenge for scientists and clinicians. The presented research aimed to systematically review the existing literature on the pathogenesis of pediatric LS and to identify possible underlying autoimmune mechanisms and molecular networks. The clinical presentation of pediatric lichen sclerosus and available treatment modalities are also presented to acquaint a broader audience with this underdiagnosed and undertreated condition. As a result of our review, we discuss several potential mechanisms, molecules, and pathways that have been recognized in this disease. The purpose of our review was also to summarize what we can induce in further studies, which will ultimately help to identify the mechanism responsible for the disease and aid in the development of new, more effective treatment strategies for diagnosis and treatment by clinicians and researchers.
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Affiliation(s)
- Anna Torres
- Department of Pediatric and Adolescent Gynecology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Monika Zaborek-Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jakub Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence:
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
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Tan R, Xiao L, Sun J, Liu M, Zhang X, Chang S. A retrospective study of focused ultrasound versus cryotherapy in treatment of cervical squamous intraepithelial lesions. Int J Hyperthermia 2022; 39:1294-1299. [PMID: 36191925 DOI: 10.1080/02656736.2022.2129104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of focused ultrasound (FUS) therapy and cryotherapy for cervical squamous intraepithelial lesion (SIL). METHODS In this retrospective study, data pertaining to women treated for cervical SIL with FUS therapy or cryotherapy at the Second Affiliated Hospital of Chongqing Medical University between 21 April 2018 and 31 August 2020 were obtained. The patients were followed up after 3-6 and 6-12 months. The proportions of women with no evidence of disease, recurrent disease, clearance of the human papillomavirus (HPV) and adverse effects or complications were determined. RESULTS Of the 250 women with complete data who were included in the study, 144 and 106 received FUS therapy and cryotherapy, respectively. Overall, FUS therapy was observed to be more effective than cryotherapy (91.7 vs. 79.2%, p = 0.005). Statistically significant differences were noted in the treatment efficacy for patients with low-grade SIL (LSIL) (92.3 vs. 80.2%, p = 0.011). However, there were no significant differences in the treatment efficacy for patients with high-grade SIL (HSIL) (88.9 vs. 75.0%, p = 0.390). The recurrence rates in patients with LSIL treated with FUS therapy or cryotherapy showed no significant differences at the 6-12-month follow-up (1.0 vs. 6.0%, p = 0.163). Furthermore, there was no recurrence in patients with HSIL, either in the FUS or cryotherapy group. FUS therapy and cryotherapy resulted in similar HPV clearance at the 3-6-month follow-up (77.1 vs. 64.8%, p = 0.057). No statistically significant differences were observed in the complication rates between the two groups (3.5 vs. 1.9%, p = 0.717). CONCLUSION The results of this study suggest that FUS therapy is superior to cryotherapy in the treatment of cervical LSIL.
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Affiliation(s)
- Rong Tan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linlin Xiao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangchuan Sun
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Maoyu Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoyuan Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shufang Chang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Gutierrez-Ontalvilla P, Giner F, Vidal L, Iborra M. The Effect of Lipofilling and Platelet-Rich Plasma on Patients with Moderate-Severe Vulvar Lichen Sclerosus who were Non-Responders to Topical Clobetasol Propionate: A Randomized Pilot Study. Aesthetic Plast Surg 2022; 46:2469-2479. [PMID: 35048150 DOI: 10.1007/s00266-021-02718-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The first-line treatment for vulvar lichen sclerosus (VLS) is 3 months of topical corticosteroid therapy. However, limited evidence is available concerning the use of fat grafting and platelet-rich plasma as a second-line treatment for patients who do not respond to first-line treatment. METHODS This prospective single-center randomized pilot trial included 20 patients with a clinical and histological diagnosis of moderate to severe VLS. The patients in the treatment group (TG) received two infiltrations (at 3-month intervals) of nanofat mixed with platelet-rich plasma (PRP) into the vulvar area, while the control group (CG) received standard topical corticosteroid therapy. Fat was aspirated from the medial thigh or lower abdomen regions. Microfat was obtained after centrifugation and was emulsified to obtain a nanofat suspension. Treatment efficacy was determined by measuring changes in the vulvar skin elasticity, histopathology, and clinical signs, symptoms, and patient quality of life at after 1 year. RESULTS A total of 19 patients were finally assessed (9 TG and 10 CG). At the end of the study (1 year), there had been no significant improvement in vulvar skin elasticity. However, patients in the TG showed a significant improvement in their symptoms (itching, pain, burning, and dyspareunia) and clinical signs (cervical erosions, fissures, stenosis, and leukoderma). Analysis of skin biopsies revealed a significant decrease in all inflammatory cell types in the TG. No adverse events related to the autologous treatment were recorded. CONCLUSIONS Compared with topical corticosteroids, two infiltrations delivered 3 months apart decreased the inflammation of the vulva and improved most of the clinical signs and symptoms associated with VLS. Nonetheless, no improvement in vulvar skin elasticity was derived from the autologous treatment. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- P Gutierrez-Ontalvilla
- Department of Plastic and Reconstructive Surgery, Hospital University La Fe, Avda Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - F Giner
- Department of Histology, Hospital University La Fe, Valencia, Spain
| | - L Vidal
- Fidia Farmacéutica S.L.U, Barcelona, Spain
| | - M Iborra
- Department of Digestive Medicine, Unit of inflammatory bowel disease, Hospital University La Fe, Valencia, Spain
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Potapov AL, Sirotkina MA, Matveev LA, Dudenkova VV, Elagin VV, Kuznetsov SS, Karabut MM, Komarova AD, Vagapova NN, Safonov IK, Kuznetsova IA, Radenska-Lopovok SG, Zagaynova EV, Gladkova ND. Multiphoton microscopy assessment of the structure and variability changes of dermal connective tissue in vulvar lichen sclerosus: A pilot study. JOURNAL OF BIOPHOTONICS 2022; 15:e202200036. [PMID: 35652856 DOI: 10.1002/jbio.202200036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/17/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
In this article, we offer a novel classification of progressive changes in the connective tissue of dermis in vulvar lichen sclerosus (VLS) relying on quantitative assessment of the second harmonic generation (SHG) signal received from formalin fixed and deparaffinized tissue sections. We formulate criteria for distinguishing four degrees of VLS development: Initial-Mild-Moderate-Severe. Five quantitative characteristics (length and thickness type I Collagen fibers, Mean SHG signal intensity, Skewness and Coherence SHG signal) are used to describe the sequential degradation of connective tissue (changes in the structure, orientation, shape and density of collagen fibers) up to the formation of specific homogeneous masses. Each of the degrees has a characteristic set of quantitatively expressed features. We focus on the identification and description of early, initial changes of the dermis as the least specific. The results obtained by us and the proposed classification of the degrees of the disease can be used to objectify the dynamics of tissue changes during treatment.
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Affiliation(s)
| | | | - Lev A Matveev
- Institute of Applied Physics Russian Academy of Sciences, Nizhny Novgorod, Russia
| | | | - Vadim V Elagin
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Sergey S Kuznetsov
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - Maria M Karabut
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Anastasia D Komarova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - Nailya N Vagapova
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - Ivan K Safonov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Irina A Kuznetsova
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | | | - Elena V Zagaynova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
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[Translated article] RF - Importance of Topical Corticosteroid Treatment for Vulvar Lichen Sclerosus to Prevent Recurrences of Vulvar Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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FR - La importancia del tratamiento con corticoides tópicos en pacientes con liquen escleroso vulvar en la prevención de recurrencias de carcinoma vulvar. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:722-723. [DOI: 10.1016/j.ad.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022] Open
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Krapf JM, Smith AB, Cigna ST, Goldstein AT. Presenting Symptoms and Diagnosis of Vulvar Lichen Sclerosus in Premenopausal Women: A Cross-Sectional Study. J Low Genit Tract Dis 2022; 26:271-275. [PMID: 35533256 DOI: 10.1097/lgt.0000000000000679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/PURPOSE Presenting symptoms of vulvar lichen sclerosus (LS) specific to premenopausal women are not well reported in the literature and may differ from those in postmenopausal women. This study aimed to characterize the presentation of vulvar LS among premenopausal women. MATERIALS AND METHODS An observational web-based study was conducted in premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50 years. Participants completed a 28-question survey evaluating characteristics of symptoms, timing of diagnosis, alternate diagnoses, and presence of concomitant autoimmune conditions. RESULTS Of the 956 responses received, 503 met inclusion criteria of biopsy-confirmed LS and premenopausal status. Average age of symptom onset was 27 years, and average age of diagnosis was 32 years, with a 4-year delay in diagnosis. Symptoms most present were dyspareunia (68%) and tearing with intercourse or vaginal insertion (63%). Symptoms that affect the individual most were also dyspareunia (44%) and tearing with intercourse or vaginal insertion (39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%) and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulvar fissures (72%), and labial resorption (60%), with fissures affecting the individual the most (48%). Sixty-six percent of the respondents initially received an alternative diagnosis, most commonly vulvovaginal yeast infection (49%). Hypothyroidism was the most common concurrent autoimmune condition (10%). CONCLUSIONS Vulvar LS affects premenopausal women, commonly presenting with dyspareunia and tearing with intercourse. This condition should be considered and evaluated in premenopausal women presenting with vulvar symptoms and sexual pain.
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Affiliation(s)
| | - Alyssa B Smith
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sarah T Cigna
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
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van der Sluis N, Scheers EC, Krenning G, van der Lei B, Oonk MH, van Dongen JA. Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: A review on literature. Exp Dermatol 2022; 31:689-699. [PMID: 35276020 PMCID: PMC9314062 DOI: 10.1111/exd.14561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction; however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy-resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms-of-action of fat grafting to treat LS.
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Affiliation(s)
- Nanouk van der Sluis
- Department of Plastic SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of Plastic‐, Reconstructive‐ and Hand SurgeryMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Esther C.A.H. Scheers
- Department of Obstetrics and GynecologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Guido Krenning
- Department of Pathology and Medical BiologyUniversity of Groningen and University Medical Center GroningenGroningenThe Netherlands
| | - Berend van der Lei
- Department of Plastic SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Maaike H.M. Oonk
- Department of Obstetrics and GynecologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Joris A. van Dongen
- Department of Plastic‐, Reconstructive‐ and Hand Surgery, Utrecht University Medical CenterUtrecht UniversityUtrechtThe Netherlands
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He S, Jiang J. High-intensity focused ultrasound therapy for pediatric and adolescent vulvar lichen sclerosus. Int J Hyperthermia 2022; 39:579-583. [PMID: 35410566 DOI: 10.1080/02656736.2022.2060528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The study's objective was to retrospectively evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) for vulvar lichen sclerosus (VLS) in pediatric and adolescent patients. METHODS Pediatric and adolescent patients presenting to our hospital from June 2007 to July 2021, with VLS were retrospectively evaluated. The participants' information, including age, symptoms and vulvar examination, were documented, and they were treated with HIFU. The effectiveness of HIFU and its complications were analyzed. RESULTS A total of 36 patients with VLS undergoing HIFU for whom complete follow-up data were available participated in the study. The mean age of the patients at diagnosis was 13.3 ± 4.1 years. All patients successfully underwent HIFU therapy. The mean sonication time was 20.3 ± 8.6 min, and the median treatment energy was 3579.0 J. A few blisters developed in 8 (22.2%) patients and 2 (5.6%) had ulcers. The skin burns were treated medically without scar formation. On average, patients were followed up for 52.0 months after the procedure (a range of 6-175 months). At 6 months after therapy, the total response rate was 91.6%, and 86.6% at 12 months post HIFU. Overall, 16 patients were followed up for more than 5 years. The total response rate was 75%, and the recurrence rate was 12.5%. CONCLUSIONS Based on our results, HIFU was demonstrated to be effective and relatively safe for the treatment of VLS in pediatric and adolescent patients, but it is necessary to pay attention to the possible skin burns.
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Affiliation(s)
- Sili He
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfa Jiang
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
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Early Diagnostics of Vulvar Intraepithelial Neoplasia. Cancers (Basel) 2022; 14:cancers14071822. [PMID: 35406594 PMCID: PMC8997501 DOI: 10.3390/cancers14071822] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The spectrum of vulvar disorders is wide and varies from infections, dermatoses, manifestations of hormonal and systemic conditions to vulvar intraepithelial neoplasia (VIN) and invasive cancer. It is not always possible to distinguish vulvar lesions on the basis of macroscopical aspects and the distribution of changes. For definite diagnosis of a vulvar lesion, a biopsy is needed. However, in practice, the decision to perform a biopsy is often delayed due to a lack of specificity of symptoms at the early stages of the neoplastic disease. The aim of this article is to provide clinicians, both gynecologists and dermatologists, with the main features of vulvar precancerous lesions, in order to recognize and treat them on time, thus preventing vulvar cancer. Clinical appearance of VIN is variable with significant variations present in color, surface, and topography. Evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer appears to be present in a significant percentage of patients. Abstract The spectrum of vulvar lesions ranges from infective and benign dermatologic conditions to vulvar precancer and invasive cancer. Distinction based on the characteristics of vulvar lesions is often not indicative of histology. Vulvoscopy is a useful tool in the examination of vulvar pathology. It is more complex than just colposcopic examination and presumes naked eye examination accompanied by magnification, when needed. Magnification can be achieved using a magnifying glass or a colposcope and may aid the evaluation when a premalignant or malignant lesion is suspected. It is a useful tool to establish the best location for biopsies, to plan excision, and to evaluate the entire lower genital system. Combining features of vulvar lesions can help prediction of its histological nature. Clinically, there are two distinct premalignant types of vulvar intraepithelial neoplasia: HPV-related VIN, more common in young women, multifocal and multicentric; VIN associated with vulvar dermatoses, more common in older women and usually unicentric. For definite diagnosis, a biopsy is required. In practice, the decision to perform a biopsy is often delayed due to a lack of symptoms at the early stages of the neoplastic disease. Clinical evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer may be present.
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Yuan Y, Wang CJ, Li H. Extragenital Bullous Lichen Sclerosus Treated with Fractional CO 2 Laser (FxCO 2) and Wet Dressing of Halcinonide Solution: A Case Report. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:427-431. [PMID: 35300434 PMCID: PMC8921669 DOI: 10.2147/ccid.s355111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
Lichen sclerosis (LS) is an insidious, chronic, relapsing skin disease characterized by atrophic, porcelain-appearing plaques. It usually arises in the anogenital area, but some cases can present in extragenital regions with a variety of presentations, including a bullous variant. Topical corticosteroids are a first-line therapy and are usually the most effective treatment to induce remission of LS. However, there is a subset of patients that does not respond well to topical steroids. Herein, we report an extragenital bullous LS case successfully treated with a fractional CO2 laser (FxCO2) and subsequent wet dressing of halcinonide solution.
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Affiliation(s)
- Yunyan Yuan
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Caroline J Wang
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Houmin Li
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
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Bizoń M, Maślińska D, Sawicki W. Influence of Photodynamic Therapy on Lichen Sclerosus with Neoplastic Background. J Clin Med 2022; 11:jcm11041100. [PMID: 35207373 PMCID: PMC8877107 DOI: 10.3390/jcm11041100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Lichen sclerosus is the most common nonmalignant vulvar disease with morbidity in postmenopausal age. The first line of treatment is corticosteroid therapy. In case of insufficiency, tacrolimus or pimecrolimus can be provided. Photodynamic therapy (PDT) can be used as alternative way of treatment while symptoms recurrent despite other methods. Methods: the analyzed population of 182 women with diagnosis of lichen sclerosus treated using PDT was divided into three groups: patients with neoplastic disease or intraepithelial neoplasia; those with a positive family history of neoplastic disease; and a control group with no neoplastic disease and no familial history of neoplastic diseases. Results: Reduction of vulvar changes was assessed in the whole vulva in the groups as 21.9%, 21.2% and 21.8%, respectively. The most frequent symptom, itching, was reported to decrease in all groups, 39.3%, 35.5% and 42.5%, respectively. Improvement of quality of life was assessed in 91.3% of the whole group, stabilization of lichen sclerosus in 7.1% and progression in 1.6%. Conclusions: Photodynamic therapy gives positive results in most cases. Improvement after PDT is observed in objective vulvoscopic assessment and in subjective patients’ opinions. Neoplastic disease in the past can influence the effectiveness of PDT.
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Affiliation(s)
- Magdalena Bizoń
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warszawa, Poland;
- Correspondence: ; Tel.: +48-697-722-894
| | - Danuta Maślińska
- Department of General and Experimental Pathology, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | - Włodzimierz Sawicki
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warszawa, Poland;
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Tedesco M, Garelli V, Elia F, Sperati F, Morrone A, Migliano E. The efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid for the Treatment of Vulvar Lichen Sclerosus: A Preliminary Study. Dermatol Ther 2022; 35:e15338. [DOI: 10.1111/dth.15338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/30/2021] [Accepted: 01/23/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Marinella Tedesco
- Department of Plastic and Regenerative Surgery San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Valentina Garelli
- Department of Plastic and Regenerative Surgery San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Fulvia Elia
- Radiology and Diagnostic Imaging Unit San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center,Biostatistical and Bioinformatic Scientific Direction,San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Aldo Morrone
- Scientific Director San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Emilia Migliano
- Department of Plastic and Regenerative Surgery San Gallicano Dermatological Institute IRCCS Rome Italy
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49
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Filippini M, Sozzi J, Farinelli M, Verdelli A. Effects of Fractional CO 2 Laser Treatment on Patients Affected by Vulvar Lichen Sclerosus: A Prospective Study. Photobiomodul Photomed Laser Surg 2021; 39:782-788. [PMID: 34878932 DOI: 10.1089/photob.2021.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Fractional carbon dioxide (CO2) lasers are today considered the most effective and efficient treatment for many vulvovaginal disorders, providing mini-invasive procedures without side effects. Previous studies demonstrated the efficacy of fractional CO2 lasers in vulvar lichen sclerosus (VLS), a chronic skin disorder characterized by itching and painful lesions. Complications include pain, sexual and/or urinary dysfunction, with a negative quality of life, and an increased risk of squamous cell carcinoma. A definitive VLS treatment is still lacking. Objectives: This is a prospective, single-center study aimed at evaluating the effect of fractional microablative CO2 laser treatment on women affected by VLS. Materials and methods: Patients with histologically confirmed VLS underwent three fractional microablative CO2 laser treatments, 4 weeks apart, on the genital affected areas. Clinical and VLS-related symptoms, side effects, and patient satisfaction index were assessed and recorded for all the patients using the visual analog scale (VAS). Results: Data from a total of 70 patients were included, paired at different time points and analyzed. VLS-related symptoms and other relevant parameters (pH, vaginal introitus discomfort, dyspareunia, vaginal dryness, itching, and burning) showed a statistically significant improvement (p < 0.001) after the first laser treatment and kept improving after second and third sessions. According to VAS, the two most common symptoms, vaginal introitus discomfort and dyspareunia, went from (mean ± standard deviation) 8.2 ± 2.3 and 8.3 ± 2.2, respectively, at baseline, to 3.6 ± 2.6 and 3.8 ± 2.6, respectively, 1 month after the last treatment. Vaginal dryness, itching, and burning were significantly improved as well. Most patients declared to be very satisfied with the results of the treatment. A total of 62.8% of the women expressed a satisfaction score ≥8 on a scale from 0 to 10. Conclusions: Fractional microablative CO2 laser treatment seems to be safe and effective to treat VLS and improve VLS-related symptoms.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Jessica Sozzi
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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Gerkowicz A, Szczepanik-Kułak P, Krasowska D. Photodynamic Therapy in the Treatment of Vulvar Lichen Sclerosus: A Systematic Review of the Literature. J Clin Med 2021; 10:5491. [PMID: 34884193 PMCID: PMC8658411 DOI: 10.3390/jcm10235491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease involving the genital skin and mucous membrane. Patients exhibit focal atrophy and destructive scarring, with an increased risk of malignant transformation. Due to objective symptoms as well as subjective complaints, patients with VLS experience emotional distress, lowered mood, and sexual dysfunction, which is reflected in impaired health-related quality of life. Thus, the necessity of implementing appropriate therapy at the earliest possible stage of the disease in order to avoid serious complications is highlighted. We presented the systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, and Web of Science databases. We identified a total of twenty relevant studies which indicate that photodynamic therapy (PDT) is a valuable therapeutic modality in the treatment of VLS.
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Affiliation(s)
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (A.G.); (D.K.)
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