Therapie des Lichen sclerosus et atrophicus vulvae mit dem CO2-Silk-touch-Laser

A 50 year old woman with distinct lichen sclerosus et atrophicus was suffering from severe genital itching, dyspareunia and increasing urinary burning. Therapy attempts with topical glucosteroids and estrogens had been without effort. Treatment with CO2 laser in silk touch mode under insufflation anesthesia to an improvement of her skin lesions and a nearly complete remission of her symptoms.     

Lichen sclerosus

Dialogues in Dermatology, a monthly audio program from the American Academy of Dermatology, contains discussions between dermatologists on timely topics. Commentaries from Dialogues Editor-in-Chief Warren R. Heymann, MD, are provided after each discussion as a topic summary and are provided here as a special service to readers of the Journal of the American Academy of Dermatology.     

Lichen sclerosus

Zusammenfassung Der Lichen sclerosus et atrophicus ist eine chronisch-entzündliche Erkrankung, die bevorzugt das weibliche Geschlecht in der 5. Dekade befällt. Neben der meist befallenen Anogenitalregion tritt ein Lichen sclerosus seltener auch extragenital oder mukosal auf. Durch eine gesteigerte Fibroblastenaktivität entsteht eine zunehmende Sklerose der befallenen Haut. Neuere Befunde lassen den Lichen sclerosus als eine autoantikörpervermittelte, chronisch-entzündliche Dermatose erscheinen. Autoantikörper finden sich gegen das extrazelluläre Matrixprotein-1 bei 80% der untersuchten Patienten. Neben der bewährten Therapie mit potenten Kortikosteroiden gibt es viel versprechende Resultate der Behandlung des Lichen sclerosus mit Calcineurinantagonisten. Ein interdisziplinäres Management sowie eine konsequente Betreuung der Lichen-sclerosus-Patienten können die Klinik und die Lebensqualität günstig beeinflussen.     

Lichen sclerosus

Lichen sclerosus is a chronic skin condition, which offers many challenges to the clinician. It affects men, women and children, and usually occurs in the anogenital area. The clinical signs can be confused with those seen in sexual abuse in children. The underlying cause is unknown; however, there is a strong association with autoimmune disorders, and immunogenetic studies have demonstrated a link with HLA DQ7. Patients suffer significant morbidity as a consequence of the intractable symptoms, physical scarring and psychosexual damage. Support groups may be helpful for some patients. Potent topical corticosteroids have been shown to be effective. There is a 5% incidence of squamous cell carcinoma, and all suspicious lesions should be biopsied. It is unclear whether the risk of malignancy is changed with the use of topical corticosteroids, as there is a potential risk of triggering a latent infection of human papillomavirus. A multidisciplinary approach to care is required and ideally all patients should attend a dedicated clinic and be offered long-term monitoring.     

Lichen sclerosus

Ohne ZusammenfassungHiezu Taf. XXXIV.     

Lichen sclerosus

Lichen sclerosus (LS) is an inflammatory skin disease predominantly affecting the anogenital region. If untreated, progressive sclerosis results in scarring with distortion of the normal architecture. LS occurs more commonly in women than men but may occur in all age groups, including adolescents and prepubertal children. Its exact prevalence is unknown, but estimates range from 1:60 to 1:1000. In this article, LS is discussed in detail with respect to disease management in adults and children, risk of malignancy, and association with other diseases.     

Lichen sclerosus

Ohne Zusammenfassung     

Lichen sclerosus.

Lichen sclerosus is a skin condition affecting all areas of the body at all ages and in both sexes. It appears to be a histologic and clinical entity, although in very many respects it is close to lichen planus and morphea. Its cause and pathogenesis are not established, but a link with autoimmune disease is recognized. Its predilection for the anogenital area in women has led to an unfortunate dichotomy between dermatologists and gynecologists. This was a potent source of confusion for many years but has now been resolved with a the recent formulation of a classification acceptable to the ISSVD (representing gynecologists, dermatologists, and pathologists) and the ISGyP (see Appendices). It is hoped that management will now be more logical, with the mainstay being emollients and topical corticosteroids, and that the vulvectomies sometimes performed for benign disease have become a thing of the past. There is almost certainly an increased risk of malignancy in lichen sclerosus, albeit at present an unquantifiable one, and for that reason patients should be kept under review.     

Lichen sclerosus in childhood

Lichen sclerosus in childhood involves predominantly the genital area, often with purpura and erosions, which raises concerns of sexual abuse. Potent topical corticosteroids give a good clinical response over several months, although maintenance with weaker formulations is usually required. The long-term prognosis remains uncertain.     

Lichen sclerosus und Vulvaatrophie

Ohne ZusammenfassungMit 5 Textabbildungen.     

Lichen sclerosus und Vulvakarzinom

Genital lichen sclerosus in women is a clinically and histologically well defined disease. In addition to the classical atrophic form, there is a hypertrophic variant, which is characterised histologically by squamous cell hyperplasia. The aetiology is unknown but an autoimmune pathogenesis seems most likely. Infectious or hormonal influences do not play a major role. We describe a squamous cell carcinoma of the vulva with a co‐existing lichen sclerosus. This case raises again the question of a precancerous potential of lichen sclerosus. In the dermatological literature, only a few cases with association of lichen sclerosus and squamous cell carcinoma are known. This is in contrast to gynaecological literature, where a high number of squamous cell carcinomas has been described. Gynaecologists search for the histological findings of lichen sclerosus adjacent to squamous cell carcinoma. Such an attempt is not valid without the clinical signs of lichen sclerosus, so that indeed classical lichen sclerosus does not seen to be a precancerous lesion. On the other hand, the hypertrophic form of lichen sclerosus seems to be associated with squamous cell carcinoma in about 3 – 5 % of case.     

Lichen sclerosus of the lip

Lichen sclerosus is a chronic inflammatory mucocutaneous disorder predominately affecting prepubertal girls and postmenopausal women. Isolated lichen sclerosus affecting the oral mucosa is exceedingly rare. Only 13 patients with biopsy-proved isolated oral disease have been reported in the literature. We report a 10-year-old Caucasian girl with a well-demarcated 1.5 cm x 1.2 cm atrophic white plaque with a violaceous border and focal telangiectases on the right inferior vermillion lip, extending on to the labial mucosa. No other cutaneous surfaces, including genitalia, were involved. Incisional biopsy of the plaque on the lip revealed a patchy lichenoid infiltrate of lymphocytes associated with sclerosis of the papillary dermis and a thinned epidermis consistent with a diagnosis of lichen sclerosus. Treatment with a short course of high potency topical corticosteroids likely prevented the progression of this lesion.