LICHEN SCLEROSUS OF THE VULVA IN PATIENTS WITH LIMITED SCLERODERMA

Abstract

Modern literature information on the etiopathogenetic prevalence of lichen sclerosus has been presented by the authors; clinical manifestations and classification of the disease have been outlined; diagnosis and treatment issues have been discussed in the article. 3 clinical cases of genital lesions in the form of lichen sclerosus in patients with limited scleroderma have been described. In our opinion, lichen sclerosus is one of the forms of limited scleroderma.
 Purpose. To investigate the conditions for the diagnosis and treatment of genital lesions in the form of lichen sclerosus in patients with limited scleroderma.
 Methods. The first line of therapy for lichen sclerosus is the use of super-powerful topical glucocorticoids. Clobetasol propionate 0.05% is to be used for 3 months (1 month daily, then every other day for a month, then 2 times a week for a month). After 3 months of treatment, if a positive effect is declared, maintenance therapy is recommended once a week. Topical calcineurin inhibitors are recommended as a second-line therapy. Effective and safe excipients are emollients that moisturize the skin and mucous membranes, prevent transdermal fluid loss, and reduce subclinical inflammation. The possibility of using triamcinolone (1-2 mg) onto pathologically altered tissue in women with lichen sclerosus where there are hyperkeratotic sites resistant to GCS can be considered after exclusion of intraepithelial neoplasia or malignant transformation. The effectiveness of physiotherapeutic methods, such as low-intensity helium-neon laser radiation in the red or infrared range, treatment with sunlight and radiation generated by medical equipment, photodynamic therapy has been described.
 Results. One of the important measures is the elimination of irritating factors, as well as careful care of the vulva and the treatment of secondary infection. It consists in adherence to a diet (exclusion of spicy, salty, sweet foods, caffeine-containing products, alcohol) and intimate hygiene rules (limitation / exclusion of soap-containing products, deodorants, synthetic underwear, pads, tampons). The underwear should not be very tight. In addition, patients should exclude mechanical irritation of the affected area, including shaving. With extreme manifestation of itching, it is recommended to prescribe desensitizing therapy and sedatives.
 Conclusions. Clinical cases of practical interest in connection with the clinical manifestations of limited scleroderma on the skin and genitals have been considered. Frequent lesions of the genital organs in the form of a typical clinic of lichen sclerosus in women suffering from limited scleroderma, the similarity of their clinic, histological picture and pathogenesis have been noted. All this gives a reason to consider lichen sclerosus as a manifestation of limited scleroderma.