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%).     

Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus

Vulval lichen sclerosus is an uncommon skin condition that can usually be managed with topical corticosteroids to maintain remission. However, there is a subset of patients in whom it remains recalcitrant despite treatment with super‐potent topical corticosteroids. We report a case series of four patients undergoing fractional carbon dioxide laser resurfacing and one with ablative carbon dioxide laser for severe, hyperkeratotic vulval lichen sclerosus not responding to super‐potent topical corticosteroids. In these patients, carbon dioxide laser was successful in achieving remission. Their vulval lichen sclerosus was subsequently able to be maintained with topical corticosteroid treatment.     

Vulval lichen sclerosus and lichen planus

Lichen sclerosus (LS) and lichen planus (LP) are both immunologically mediated diseases with a preference for the genitalia. The basic principles of management of vulval LS and vulvovaginal LP are the same and involve explanation of the disease, emphasizing the chronic nature of the condition and outlining treatment options. The main difference between the two conditions is that LP has a propensity to involve the mucous membranes including the mouth and vagina which are rarely affected in LS. First‐line treatment for LS is a super‐potent topical corticosteroid ointment which has a high response rate. Erosive vulvovaginal LP is more challenging to treat. Second‐line therapies include topical calcineurin inhibitors and systemic agents. There is limited evidence for systemic treatments for both conditions. The risk of vulval squamous cell carcinoma (SCC) is increased in both LP and LS, and it is not known how treatment affects this risk. We recommend teaching self‐examination and longitudinal evaluation.     

Localized lichen sclerosus with nail loss

A 52-year-old woman who developed a pale sclerotic second left toe with loss of the nail plate is described. Biopsy showed changes of lichen sclerosus. There were no other skin or genital lesions present.     

Clinical and dermoscopic changes of vulvar lichen sclerosus after topical corticosteroid treatment

With the aim to assess changes in both clinical and dermoscopic features of vulvar lichen sclerosus (VLS) after a treatment with topical corticosteroid, 29 VLS patients treated with mometasone furoate 0.1% ointment for 12 weeks were evaluated for symptoms, objective signs and dermoscopic variables at baseline and treatment completion. Numeric scores were assigned to each parameter. Mean itching and burning values had decreased significantly at the 12‐week control visit compared with baseline, as well as values referring to pallor, hyperkeratosis and purpuric lesions. Among the dermoscopic variables, the vessel score increased while the scores of patchy, structureless, whitish areas, whitish background, purpuric globules and scales decreased significantly after treatment. Scores referring to gray‐blue dots, comedo‐like openings and structures like ice slivers did not change significantly throughout the treatment. Based on these findings, dermoscopic features may change, even significantly, with topical corticosteroids and may be useful for monitoring the response to treatment.     

73例女性硬化性苔藓临床及病理分析

 目的:分析73例女性硬化性苔藓患者的临床表现及组织病理特征。方法:回顾性分析本科诊治的73例女性硬化性苔藓患者的临床资料。结果：73例患者中,50岁以上者34例（46.58%）,14～50岁者28例（38.36%）,小于14岁者11例（15.07%)。皮损好发于外阴部位。基本病理改变为角化过度、基底层空泡变性、真皮浅层水肿,伴胶原均质化透明样变性,其下方常有不同程度的淋巴细胞及组织细胞浸润。结论:临床表现及组织病理学检查为诊断本病的依据,可根据组织病理表现选择相应的治疗。医务人员应加强对早期硬化性苔藓的认识,减少误诊率,并根据疾病时期选择相应的治疗。     

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。     

Extragenital bullous lichen sclerosus: A case report and literature review

Lichen sclerosus (LS) is a chronic dermatosis characterized by atrophic white papules or plaques, most commonly occurring on the anogenital skin. Blisters have been rarely described developing in the background of extragenital LS. A 74-year-old woman with a 4-year history of sclerotic patches on the trunk showed a flaccid bulla on the lower back for 3 months. The histopathological finding of the skin biopsy was consistent with the diagnosis of bullous LS. In this paper, we present this uncommon case, review the literature on extragenital bullous LS, discuss the pathogenesis, and provide some treatment options for the case.     

Successful treatment of vulvar lichen sclerosus in a child with low-concentration topical tacrolimus ointment

Lichen sclerosus is a chronic inflammatory skin disorder that has a predilection for the anogenital area. Topical corticosteroid is occasionally effective; however, continuous treatment is often required and recurrence after its stoppage is frequent. Herein, we report a case of vulvar lichen sclerosus in a 5-year-old girl, which was refractory to topical corticosteroids. After 14 weeks of treatment with 0.03% tacrolimus ointment once daily, the lesions completely resolved without side-effects. Of interest, the number of milia within the plaque of lichen sclerosus was reduced in tandem with the improvement of lichen sclerosus. This is the first report of topical low-concentration tacrolimus treatment showing a dramatic effect in the treatment of childhood vulvar lichen sclerosus.     

Genital verrucous carcinoma is associated with lichen sclerosus: a retrospective study and review of the literature

Background The association of lichen sclerosus (LS) with genital squamous cell carcinoma is well recognized. However, the relationship between LS and verrucous carcinoma remains unclear. Objective To evaluate the associations of genital and perianal verrucous carcinomas with LS. Methods We conducted a retrospective study on patients with a genital or perianal verrucous carcinoma and reviewed their histopathology specimens and clinical notes. We also conducted a literature review. Results We identified a total of 13 patients (including 6 women and 7 men) with a genital or perianal verrucous carcinoma. All 5 women with vulval verrucous carcinoma had coexisting LS (5/5), and 1 man with penile verrucous carcinoma had coexisting LS (1/3). In contrast, no coexisting LS was found in all 5 cases of perianal verrucous carcinoma (0/5). Half of the cases of verrucous carcinoma with coexisting LS had recurrences (3/6), while no recurrences were found in those without coexisting LS (0/7). Conclusions Our study and review of the literature demonstrate that vulval verrucous carcinoma is strongly associated with LS. In contrast, perianal verrucous carcinoma is not associated with LS. When genital verrucous carcinoma is diagnosed, it is important to consider LS as a potential concomitant diagnosis and offer appropriate treatments and close follow‐up to detect recurrence of verrucous carcinoma.     

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。     

Diagnosis and treatment of oral lichen sclerosus in a pediatric patient

Lichen sclerosus is an uncommon chronic inflammatory disease, which rarely affects the oral mucosa. Here, we describe the occurrence of oral lichen sclerosus with gingival destruction in a 12‐year‐old female patient. After diagnostic confirmation by histopathology, intralesional injection of corticosteroid was performed, producing satisfactory remission of the lesion.     

硬化性苔藓合并扁平苔藓、硬斑病一例并文献复习

硬化性苔藓(LS),扁平苔藓(LP)和硬斑病是三种病因不明的皮肤病,已有多篇任意两种疾病合并的报道,但患者同患LS、LP和硬斑病少见,目前未见国内有相关报道。本文报道1例LS合并LP和硬斑病,并对国外已报道的7例病例进行回顾性分析。结果示8例患者中男2例,女6例,平均年龄(60.3±15.1)岁。8例患者的LS与硬斑病同时发生或硬斑病发病早于LS,同一皮损的病理切片同时具有LS与硬斑病的特征,LP发病可早于或晚于LS和硬斑病;8例患者皮损主要表现为生殖器外LS、泛发型硬斑病、经典或糜烂型LP;6例有免疫相关异常指标,4例合并其他自身免疫性疾病。