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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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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] [MESH Headings] [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
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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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The Immunogenetics of Morphea and Lichen Sclerosus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:155-172. [DOI: 10.1007/978-3-030-92616-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects. Biomedicines 2021; 9:biomedicines9080950. [PMID: 34440154 PMCID: PMC8394941 DOI: 10.3390/biomedicines9080950] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.
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Treatment with Theresienöl - a new option in the management of vulvar leukoplakia. MENOPAUSE REVIEW 2021; 20:72-75. [PMID: 34321984 PMCID: PMC8297633 DOI: 10.5114/pm.2021.106220] [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: 12/12/2020] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
Introduction The term vulvar leukoplakia encompasses a variety of non-inflammatory diseases that lead to skin discoloration of the external genitalia and white colouration. Most commonly, these are vulvar lichen sclerosus (VLS) and squamous cell hyperplasia of the vulva (SCHV). They have similar aetiology, clinical presentation, and treatment but different anatomical pathology. Aim of the study The study aims to determine the effect of Theresienöl herbal oil treatment in patients with clinically proven diagnosis of VLS and SCHV. Material and methods This prospective study includes 17 patients with a diagnosis of VLS and SCHV, who underwent a 3-month treatment course with Theresienöl herbal oil. All patients were followed up for 1 year after therapy initiation, and the effect of treatment was reported using a visual analogue scale (VAS) for genital itching. Results The median age of patients enrolled was 60.6 years (range 42–74); 2 patients dropped out due to failure to attend follow-up visits. The mean score of the VAS taken at the beginning of treatment was 1.65 (0–5); at the 3rd month the mean score was 9 (8–10) and it remained similar at the 12th month – 8.67 (7–10). Conclusions Theresienöl herbal oil treatment of vulvar leukoplakia is effective and safe, but studies should be continued.
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Yordanov A, Tantchev L, Kostov S, Slavchev S, Strashilov S, Vasileva P. Vulvar leukoplakia: therapeutic options. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:135-139. [PMID: 33100949 PMCID: PMC7573333 DOI: 10.5114/pm.2020.99570] [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: 03/02/2020] [Accepted: 05/10/2020] [Indexed: 11/20/2022]
Abstract
Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy. This requires the use of alternative therapeutic options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and, as a last resort, surgical removal of affected tissues. Surgical treatment should be avoided, despite the malignant potential, because of recurrence risk in both diseases New therapeutic approaches are coming into effect in gynaecological practice due to potential risks of the above-mentioned methods. Platelet-rich plasma therapy, ablative and non-ablative laser treatment, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional medications. A number of them are still in their initial phase of application and time will tell their effectiveness.
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Affiliation(s)
- Angel Yordanov
- Department of Gynaecological Oncology, Medical University of Pleven, Bulgaria
| | - Latchezar Tantchev
- Obstetrics and Gynaecology Clinic, Acibadem City Clinic Hospital “Tokuda”, Sofia, Bulgaria
| | - Stoyan Kostov
- Department of Gynecology, Medical University of Varna, Bulgaria
| | | | - Strahil Strashilov
- Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University of Pleven, Bulgaria
| | - Polina Vasileva
- Department of Obstetrics and Gynaecology, Medical University of Pleven, Pleven, Bulgaria
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Li Y, Shi J, Tan W, Ma Q, Wu X, Gao H. Prospective observational study of the efficacy of mixed methylene blue compound injection for treatment of vulvar non‐neoplastic epithelial disorders. Int J Gynaecol Obstet 2019; 148:157-161. [PMID: 31628667 DOI: 10.1002/ijgo.13007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/25/2019] [Accepted: 10/17/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Yanli Li
- Maternal and Child Health Hospital of Hubei Province Wuhan China
| | - Jie Shi
- Maternal and Child Health Hospital of Hubei Province Wuhan China
| | - Wenfu Tan
- Maternal and Child Health Hospital of Hubei Province Wuhan China
| | - Quanfu Ma
- Maternal and Child Health Hospital of Hubei Province Wuhan China
| | - Xufeng Wu
- Maternal and Child Health Hospital of Hubei Province Wuhan China
| | - Han Gao
- Maternal and Child Health Hospital of Hubei Province Wuhan China
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Haefner HK, Welch KC, Rolston AM, Koeppe ES, Stoffel EM, Kiel MJ, Berger MB. Genomic Profiling of Vulvar Lichen Sclerosus Patients Shows Possible Pathogenetic Disease Mechanisms. J Low Genit Tract Dis 2019; 23:214-219. [PMID: 31232912 DOI: 10.1097/lgt.0000000000000482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Vulvar lichen sclerosus (LS) is known to occur in families, suggesting a genetic link. Genomic profiling of patients with vulvar LS was investigated to find underlying pathogenetic mechanisms, with the hope that targeted therapies and future clinical research will arise. METHODS Two unrelated families with vulvar LS were investigated using whole-exome sequencing. Five affected sisters from 1 family were compared with their unaffected paternal aunt (unaffected control). A mother-daughter pair from a second affected family was compared with the first family. The results of the sequencing were compared with population-specific allele frequency databases to prioritize potential variants contributing to vulvar LS development. RESULTS Recurrent germ-line variants in 4 genes were identified as likely to be deleterious to proper protein function in all of the 7 affected patients, but not in the unaffected control. The genes with variants included CD177 (neutrophil activation), CD200 (inhibitory signal to macrophages), ANKRD18A (ankyrin repeat protein, epigenetic regulation), and LATS2 (co-repressor of androgen signaling). CONCLUSIONS Although many providers may see a mother and daughter with vulvar LS, this condition is rarely seen in multiple family members who are available for genetic testing. This is the first report to detail genomic profiling related to a familial association of vulvar LS.
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Affiliation(s)
- Hope K Haefner
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
| | - Kathryn C Welch
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Aimee M Rolston
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
| | - Erika S Koeppe
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Elena M Stoffel
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | | | - Mitchell B Berger
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
- Main Line Health, Philadelphia, PA
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Wu C, Zou M, Xiong Y, Wang L, Chen H, Fan Y, Li C. Short- and long-term efficacy of focused ultrasound therapy for non-neoplastic epithelial disorders of the vulva. BJOG 2017; 124 Suppl 3:87-92. [PMID: 28856863 DOI: 10.1111/1471-0528.14747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- C Wu
- Haifu Hospital of the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - M Zou
- Haifu Hospital of the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Y Xiong
- Haifu Hospital of the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - L Wang
- Haifu Hospital of the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - H Chen
- Haifu Hospital of the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Y Fan
- College of Biomedical Engineering; Chongqing Medical University; Chongqing China
| | - C Li
- College of Biomedical Engineering; Chongqing Medical University; Chongqing China
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杨 欢, 付 贞, 唐 华, 李 成. [Establishment of a SD rat model of vulvar lichen simplex chronicus and detection of the expression of protease activated receptor 2]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:30-35. [PMID: 28109095 PMCID: PMC6765760 DOI: 10.3969/j.issn.1673-4254.2017.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To establish a SD rat model of vulvar lichen simplex chronicus (LSC) and investigate the expression of protease activated receptor 2 (PAR2) in the genital skin. METHODS Seventy female SD rats were randomly divided into group A (blank control group, n=10), group B (with application of acetone solution 3 times per week for 10 weeks, n=10), group C (with chronic mechanical irritation 3 times per week for 10 weeks, n=10), and group D (with topical treatment with 0.5= 7,12-Dimethylbenzanthracene [DMBA] in acetone solution and chronic mechanical irritation 3 times per week for 10 weeks, n=40). The changes of the genital skin changes were observed regularly and the expression of PAR2 in groups A and D was detected with immunohistochemistry, Western blotting and qRT-PCR. RESULTS In group D, LSC occurred in 23 rats (57.5=) at 8 weeks and in 38 rats (95=) at 10 weeks; 8 rats (20=) showed papilloma at 12 weeks. Acetone treatment or chronic mechanical irritation did not cause LSC in the rats. Immunohistochemistry, Western blotting and qRT-PCR showed significantly increased expressions of PAR2 in group D at both the protein and mRNA levels as compared with those in group A (P<0.05). CONCLUSION 0.5= DMBA in acetone solution along with chronic mechanical irritation can induce LSC in female SD rats, and PAR2 is closely related with the occurrence and progression of LSC.
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Affiliation(s)
- 欢 杨
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
| | - 贞花 付
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
| | - 华均 唐
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
| | - 成志 李
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
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