Extragenital Lichen Sclerosus et Atrophicus

Genital and Extragenital Lichen Sclerosus et Atrophicus: A Case Series Written Using ChatGPT

Background Lichen sclerosus et atrophicus (LSEA) is a chronic inflammatory dermatosis of genital and extragenital sites with a prevalence ranging from 9% in prepubertal patients to 50% in postmenopausal patients. Chat generative pre-trained transformer (ChatGPT) is an artificial intelligence tool designed to assist humans based on supervised and reinforcement techniques. In this study, we aimed to evaluate the characteristics of patients with LSEA using ChatGPT. Methods In this retrospective study, we included all patients who presented to the outpatient dermatology department during 2017-2022 at a tertiary care teaching hospital in South India. Information regarding demographic data, characteristics of LSEA, comorbidities, and associated autoimmune disorders was gathered using a medical chart review. Following data analysis and drafting of the manuscript, the utility of ChatGPT-3 and ChatGPT-4 in finalizing the draft was assessed. Results Of 20 patients diagnosed with LSEA, 16 (80%) and four (20%) patients were females and males, respectively. Of them, 50% of female patients had attained menopause. While 65% of patients had genital LSEA, 30% of patients had extragenital LSEA only, and 5% of patients had both genital and extragenital LSEA. Furthermore, four (20%) patients were prepubertal children. Of four male patients, two (50%) were younger than 18 years of age, and one patient was diagnosed with balanitis xerotica obliterans. The commonest associated features in LSEA included joint involvement (30%), hypertension (25%), and anemia (15%). Rare concomitant disorders included psoriasis, asthma, and basal cell carcinoma over the nose. Conclusions LSEA may be confused with other various dermatoses, such as morphea, vitiligo, and lichen planus. A high index of suspicion is required, especially in children, to diagnose it early and intervene to prevent further complications. Its relationship with autoimmune disorders and comorbidities warrants further large-scale studies. ChatGPT was unreliable in the literature search due to the provision of non-existent citations. ChatGPT-4 was better than ChatGPT-3 since it provided few true publications. ChatGPT was used in this study to summarize the articles identified by the authors during the literature search and to correct grammatical errors in the final draft of the manuscript.

Extragenital lichen sclerosus: a comprehensive review of clinical features and treatment

Lichen sclerosus (LS) is a chronic inflammatory skin disease commonly affecting the anogenital area with less frequent extragenital occurrence. Extragenital LS cutaneous manifestations vary and precipitating factors are not well described. Recent evidence for etiology and clinical associations of extragenital LS provide insight into disease recognition and pathogenesis. Novel diagnostic techniques as well as treatment standardization have the potential to improve management of this rare condition. This review details both past and new insights into the pathogenesis, clinical manifestations, and treatment options of extragenital LS.

Lichen sclerosus: The 2023 update

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.

Extragenital lichen sclerosus: A comprehensive review

Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease of unknown aetiology. About 85% of total cases of LS are genital cases, while extragenital form is seen in only 15-20% of cases. Extragenital LS (EGLS) can occur simultaneously with genital form; however, in 6% of the cases, only extragenital form has been described. Genetic, autoimmune, infectious, environmental and hormonal factors are implicated in its aetiology. Extragenital LS presents as asymptomatic white opalescent papules, which cluster in plaques and slowly progress over time resulting in parchment-like skin usually involving upper trunk, neck and shoulders. Lesions are frequently accompanied by purpura/haemorrhagic spots. The relationship with morphoea has been a topic of debate. Association with several autoimmune diseases has been observed. Diagnosis is usually based on clinical and dermoscopic examination and further supported by histopathological findings. LS needs to be differentiated from several other dermatological conditions such as discoid lupus erythematosus, vitiligo, mycosis fungoides (hypopigmented variant), lichen planus, graft-versus-host disease and morphoea depending upon the stage of the disease. Generally, extragenital LS is believed to lack carcinogenic potential. However, case reports with possible malignant transformation have been described. In this article, the authors have described a concise review of the extragenital form of LS.

Koebnerization of Lichen Sclerosus Et Atrophicus at Insulin Injection Sites - A Rare Case with Dermoscopic Features

Lichen sclerosus et atrophicus (LSEA), also known as lichen sclerosus (LS), is a disabling, cosmetically disfiguring condition predominantly affecting the anogenital region of pre- and postmenopausal females. Extragenital LS is relatively less common and occurs predominantly on the trunk and neck. Koebnerization or isomorphic phenomenon is reported occasionally in LS after trauma like radiotherapy. A few case reports describe koebnerization of LS at injection sites. We describe the first such case in India of LS koebnerizing at insulin injection sites with dermoscopic features.

Lichen sclerosus: the role of oxidative stress in the pathogenesis of the disease and its possible transformation into carcinoma

Lichen sclerosus (LS) is an autoimmune chronic inflammatory disease usually involving the anogenital skin of both sexes; more rarely LS exclusively involves extragenital areas. As a chronic inflammatory disease, in most cases, LS evolves and progresses causing scleroatrophy of the skin or scars which may cause stenosis in the affected areas. A few LS patients are at risk of developing squamous cell carcinoma in their lifetime, but appropriate long-term treatment diminishes the possibility of a malignant evolution. Oxidative stress (OS) has been proven to play a role not only in the pathogenesis of LS, but also in the development and progression of the disease. OS, by causing DNA damage and lipid peroxidation, contributes directly to the possible malignant transformation of LS. Moreover, the increase in oxidative DNA damage is associated with mutations in tumor suppressor genes. Considering the role that OS plays in LS, therapeutic use of antioxidants appears to be rational and possible, in association with other treatments. Antioxidants would counteract the oxidative DNA damage, which is the most important factor for the progression of LS and its malignant transformation.

Male and female genital lichen sclerosus. Clinical and functional classification criteria

Introduction

Lichen sclerosus (LS) is a chronic inflammatory disease affecting mainly the genital mucous membranes in both sexes. In the past, different terms were used to describe the disease, rendering a unique and specific clinical classification impossible.

Aim

New therapeutic approaches are being defined, which may contribute to a proper clinical management, however, a stage classification is essential to better define appropriate treatment for every stage of the disease.

Material and methods

One hundred and fifteen patients (50 women and 65 men) with a diagnosis of LS were enrolled between January 2014 and September 2016. All patients underwent cutaneous biopsy to confirm the clinical diagnosis of LS. Clinical and symptomatological parameters were used in order to put the patients into the correct stage of LS. The Dermatology Life Quality Index (DLQI) was used to classify patients based on subjective symptoms. Different cutaneous alterations and structural modifications of the genital mucosa were also taken into consideration in order to assign every patient to a specific stage.

Conclusions

Lichen sclerosus is clinically described differently in females and in males and every form of LS is put into one of two stages according to the degree of severity: early and late stages. Within the clinical practice, it is useful to screen patients for groups of early or late forms of the disease in order to obtain a uniform subdivision of patients: those who may benefit from localized treatments, require a systemic drug and must undergo physical treatments (surgical, stem cells infiltrations).

Folliculocentric Lichen Sclerosus et Atrophicus in a 10-Year-Old Girl

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory scarring disease with a predilection for the anogenital area; however, 15%-20% of LSA cases are extragenital. The folliculocentric variant is rarely reported and less well understood. The authors report a rare case of extragenital, folliculocentric LSA in a 10-year-old girl. The patient presented to the dermatology clinic for evaluation of an asymptomatic eruption of the arms and legs, with no vaginal or vulvar involvement. Physical examination revealed the presence of numerous 2-4 mm, mostly perifollicular, hypopigmented, slightly atrophic papules and plaques. Many of the lesions had a central keratotic plug. Cutaneous histopathological examination showed features of LSA. Based on clinical and histological findings, folliculocentric extragenital LSA was diagnosed.