女阴硬化性苔藓皮损黑素细胞和表皮厚度分析

【摘要】 目的 研究女阴硬化性苔藓（VLS）皮损黑素细胞密度及表皮厚度的变化。方法 2018年6 - 12月于北京医院皮肤科收集15例成年VLS患者外阴皮损组织,根据病理表现皮损分为初期组7例、后期组8例,免疫荧光染色,通过图像分析软件计算黑素细胞密度,测量表皮全层和细胞层厚度。以中国医学科学院整形外科医院行外阴整形手术的15 例成年女性的正常外阴皮肤作为对照组。结果 初期组表皮黑素细胞密度为0.170 ± 0.071,后期组为0.110 ± 0.035,较对照组降低（0.275 ± 0.036,F = 36.426,P＜0.001）。初期组表皮全层厚度为（203.682 ± 137.997） μm,后期组为（150.020 ± 70.914） μm,对照组为（194.030 ± 82.996） μm,3组间差异无统计学意义（F = 0.738,P = 0.487）。表皮细胞层厚度初期组与对照组间差异无统计学意义（P = 0.899）,后期组低于对照组（P = 0.003）。结论 VLS初期及后期皮损表皮黑素细胞密度均降低;初期皮损表皮全层厚度及细胞层厚度均无明显改变,但后期细胞层厚度减少。     

外阴硬化性苔藓的皮肤镜特征分析

目的 探讨外阴硬化性苔藓的皮肤镜特征。方法 回顾性分析2015年8月至2017年6月在北京协和医院皮肤科门诊就诊并行皮肤镜及皮肤组织病理检查的17例外阴硬化性苔藓患者的75处皮损的皮肤镜特征。结果 外阴硬化性苔藓皮损75处常见的皮肤镜特征为黄白色无结构区67处占89.3%,紫红色小球、斑片58处占77.3%,褐色或蓝灰色色素结构37处占49%,亮白色条纹30处占40%,不规则分布的点状21处占28%、线状44处占58.7%、发夹样5处占6.7%、逗号样10处占13%及树枝状血管15处占20%。3处（4%）皮肤镜下可见到玫瑰花瓣征,3处（4%）粉刺样开口,1处（1%）角栓。结论 外阴硬化性苔藓在皮肤镜下具有黄白色无结构区、紫红色小球、斑片、色素结构、多种形态血管等特征性表现。     

女阴硬化性苔藓诊疗专家共识

女阴硬化性苔藓是一种反复发作的慢性炎症性疾病,几乎各年龄阶段均可发生,绝经期、围绝经期和青春期前女性更常见。典型损害为象牙白/瓷白色硬化萎缩斑,晚期可发生外阴、尿道、肛门结构畸变,造成性生活、排尿及排便困难。中国医疗保健国际交流促进会皮肤科分会组织多位专家在借鉴国内外临床研究和诊疗指南的基础上,补充了中国专家的经验和观...     

卤米松治疗女阴硬化性苔藓52例疗效观察

目的 探讨0.05％卤米松乳膏治疗女阴硬化性苔藓的疗效和安全性.方法 采用开放性、非对照性研究,纳入52例女性外阴硬化性苔藓患者,外用卤米松乳膏,2次/d,频次逐渐递减,于治疗第2和第8周结束时进行疗效和安全性评价;第16周观察结束最后1次随访时了解复发情况.结果 治疗2、8周后瘙痒的视觉模拟评分均值分别为138±1....     

硬化性苔藓64例临床及病理学特征分析

回顾性分析我院皮肤科2016年1月1日至2020年6月30日经组织病理学确诊的64例硬化性苔藓(LS)患者的临床及病理资料,平均年龄(36.84±17.84)岁;男女比例1∶2.5。外阴组患者25例(39%),非外阴组39例(61%),两组性别、年龄差异无统计学意义。非外阴组患者临床误诊率(38.5%)高于外阴组(12%),差异有统计学意义(P=0.022);外阴组患者比非外阴组患者更易出现瘙痒,组织病理学中更容易出现表皮增生、嗜酸粒细胞浸润及毛细血管扩张,两组比较差异有统计学意义(P值分别为0.048、<0.001、0.021及0.035)。9例患者行皮肤镜检查,镜下均见黄白色无结构区及毛细血管扩张,6例见毛囊角栓,7例见亮白色条束。本研究显示非外阴部位的LS并不少见,且更容易出现误诊,皮肤镜检查具有一定辅助诊断作用。     

【开放获取】儿童外阴硬化性苔藓79例皮肤镜特征分析

【摘要】 目的 探讨儿童外阴硬化性苔藓的皮肤镜特征。方法 回顾2019年1月至2021年5月昆明市儿童医院79例外阴硬化性苔藓初诊及复诊时的皮肤镜特征。结果 外阴硬化性苔藓女性患儿79例,年龄2.4 ~ 12岁,发病年龄（5.6 ± 2.12）岁,病程（14.23 ± 12.36）个月,其中30例规律复诊及治疗。初诊329处皮损中,149处（45.3％）可见特征性血管形态,包括线状血管（129处）、点状血管（25处）、盘绕状血管（19处）、发夹样血管（12处）等;207处（62.92%）可见退行性结构及色素异常,包括蓝灰色色素结构（136处）、褐色色素结构（51处）、胡椒粉样模式（15处）等;280处（85.1％）见黄白色无结构区,97处（29.5％）毛囊角栓,66处（20％）紫红色小球、斑片等。复诊238处皮损中,100处（42％）可见特征性血管形态,其中线状血管87处、树枝状血管21处、点状血管4处,未见发夹样血管;154（64.70%）处见退行性结构及色素异常,其中褐色色素结构93处、蓝灰色色素结构57处、胡椒粉样模式4处;165处（69.3％）见黄白色无结构区,62处（26.1％）毛囊角栓,8处（3.4％）紫红色小球、斑片。复诊皮损中观察到的蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及点状血管、发夹样血管、盘绕状血管比例均低于初诊（均P < 0.05）,而褐色色素结构高于初诊（均P < 0.05）。结论 儿童硬化性苔藓皮肤镜下黄白色无结构区具较高特异性,监测镜下褐色色素结构及蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及血管结构等特征可反映疗效,在辅助诊断及随访观察中有一定应用价值。     

外阴硬化性萎缩性苔藓伴先天性皮肤异色症1例

报告1例外阴硬化性萎缩性苔藓伴先天性皮肤异色症。患者女性，17岁，因外阴白斑伴瘙痒8年就诊。皮损主要表现为外、会阴及肛周有呈哑铃状角化白色斑片，胸背及双上肢伸侧有网状色素沉着斑，伴毛细血管扩张和轻度萎缩性白斑，家庭中有皮肤异色症患者。组织病理改变符合硬化性萎缩性苔藓。     

光动力治疗外阴硬化性苔藓的临床疗效

目的 了解光动力在外阴硬化性苔藓(VLS)中的治疗价值.方法 收集2015年1月-2018年9月本院经治VLS患者100例.根据抽签法将患者分为观察组(50例)与对照组(50例).对照组仅给予复方丙酸氯倍他索软膏应用.观察组给予光动力联合复方丙酸氯倍他索软膏.光动力治疗结束12周后对2组分别进行患者症状自评及手持式皮肤...     

女阴硬化性萎缩性苔藓与相关癌基因的研究进展

女阴硬化性萎缩性苔藓是较为常见的一种慢性皮肤黏膜病变,部分患者未经治疗可发展为外阴鳞癌,是一种癌前病变.近年来的研究发现女阴硬萎可能与多种癌基因、抑癌基因突变及其表达异常存在着密切联系.     

女阴硬化性苔藓99例临床分析

目的了解女性外阴硬化性苔藓的临床特征并探讨其治疗策略。方法回顾性分析99例就诊于本院皮肤科外阴门诊的女阴硬化性苔藓患者的临床资料。结果 99例患者的平均年龄为(56.42±11.53)岁,45岁以上的患者占88.89%。89.90%的患者伴中重度瘙痒,64.65%的患者存在不同程度的性生活障碍。损害累及小阴唇/阴道口部位的占85.86%、大阴唇为72.73%、阴蒂为57.58%。阴唇萎缩发生率为57.58%,以小阴唇为主。外用激素治疗的有效率为89.29%,但停药后皮损均于6个月内复发,维持治疗者仅3例复发。结论本病多见于围绝经期和绝经期女性;主要表现为瘙痒和性生活障碍,晚期常发生小阴唇萎缩;糖皮质激素局部治疗疗效高,维持治疗可减少复发。     

Conscious sedation with inhaled 50% nitrous oxide/oxygen premix in photodynamic therapy sessions for vulvar lichen sclerosus treatment

Photodynamic therapy has been described as an effective therapeutic option inselected cases of anogenital lichen sclerosus that are refractory to first-linetreatments. However, procedure-related pain is a limiting factor in patientadherence to treatment. The authors report the case of a 75-year-old woman withhighly symptomatic vulvar lichen sclerosus, successfully treated withphotodynamic therapy. An inhaled 50% nitrous oxide/oxygen premix wasadministered during sessions, producing a pain-relieving, anxiolytic, andsedative effect without loss of consciousness. This ready-to-use gas mixture maybe a well-tolerated and accepted alternative to classical anesthetics inPhotodynamic therapy, facilitating patients'' adherence to illumination ofpain-prone areas.     

The period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus

Background Lichen sclerosus and lichen planus are chronic inflammatory mucocutaneous disorders that may coexist. Objective The aim of this study was to estimate the period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus and to document their clinical characteristics. Methods We report a series of cases of vulvar lichen sclerosus presenting to two dermatologist‐led vulvar clinics in Oxfordshire, England between 1997 and 2007 with coexistent clinical signs of oral lichen planus. Results Thirteen cases with coexistent vulvar lichen sclerosus and oral lichen planus were identified, of which five had oral biopsies. Four oral biopsies showed histological features consistent with lichen planus. One oral biopsy was not diagnostic but compatible with oral lichen planus. No cases of oral lichen sclerosus were identified. The period prevalence of oral lichen planus was 6 per 1000 cases of vulvar lichen sclerosus. Conclusion The period prevalence of oral lichen planus in women with vulvar lichen sclerosus (0.6%) is similar to that reported for oral lichen planus in the general population (1–2%).     

Human papillomavirus infection in vulvar lesions of lichen sclerosus et atrophicus

Summary Human papillomaviruses (HPV) types 6, 11, 16 and 18 infections were investigated in 18 vulvar lesions of lichen sclerosus et atrophicus (LSA) using in situ DNA hybridization and polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded specimens. Four out of 18 specimens were found to be infected with HPV type 16 using the PCR technique. Interestingly, three of these four patients were in a premenopausal state. This difference proved to be the only distinguishing feature in a comparison of HPV type 16-infected patients with non-infected patients. In situ hybridization revealed no positive result in any case and PCR demonstrated no HPV-DNA type 6, 11 or 18. Patients with HPV type 16-infected lesions may be regarded as at risk of developing vulvar cancer. Therefore, long-term follow-up of this subgroup is particularly important.     

Management of sexual dysfunction due to vulvar lichen sclerosus in postmenopausal women

Lichen sclerosus is a chronic skin disease, probably immune‐mediated, with a strong genetic component. It shows a predilection for external genitalia. It is most common in postmenopausal women, although it has been documented at all ages and in both sexes. The exact prevalence of lichen sclerosus is unknown. However, in recent years much progress has been made in defining its etiology and epidemiology, and we now know that it is far more frequent than previously thought. The purpose of this review is to focus more attention on the relationship between LS and sexual dysfunction, and on a few important aspects of managing perimenopausal patients diagnosed with LS. Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant physical and psychological complications. The disease calls for lifetime follow‐up.     

非外阴部位硬化萎缩性苔藓11例临床及反射式共聚焦显微镜特征分析

目的 探讨非外阴部位硬化萎缩性苔藓的临床特点及反射式共聚焦显微镜特征。方法 回顾分析沈阳市第七人民医院皮肤科和中国医科大学附属第一医院皮肤科2010 年10月至2016年10月诊治的11例非外阴部位硬化萎缩性苔藓患者临床及反射式共聚焦显微镜资料。结果 11例中9例为女性,6例发生于颈部。反射式共聚焦显微镜图像显示,表皮萎缩,基底层高反光消失,基底层环状结构缺失,真表皮界限模糊不清,真皮浅层散在高反光类圆形大细胞及少量单一核细胞,胶原均质化并密度增加。结论 非外阴部位硬化萎缩性苔藓在反射式共聚焦显微镜下有特征性表现。