Anogenital Lichen Sclerosus Research Articles

Treatment of lichen sclerosus with hydroxychloroquine: a Mayo Clinic experience.

There is a dearth of studies investigating the efficacy of hydroxychloroquine in the treatment of either anogenital lichen sclerosus or extragenital lichen sclerosus, a condition that, if left untreated, could lead to a greater degree of scarring and malignant transformation. This study aims to analyze the demographic characteristics, clinicopathological features, treatment response, and outcomes of patients diagnosed with either anogenital or extragenital lichen sclerosus who received hydroxychloroquine therapy. A retrospective analysis was conducted involving 70 patients diagnosed with lichen sclerosus who underwent treatment with hydroxychloroquine at our institution between 2018 and 2023. Among the cohort, 67 patients were female, and 3 were male. Extragenital lichen sclerosus was diagnosed in 23 patients, with 16 exhibiting concomitant morphea overlap. Itching was the predominant clinical presentation (67%). A notable proportion of patients (36%) had a connective tissue disorder, prompting hydroxychloroquine therapy. Among the 30 patients treated solely for lichen sclerosus, 21 demonstrated response and 9 had no response. From a broader comparison of response to hydroxychloroquine, the overall anogenital response rate was 84.6% as opposed to 50% in extragenital lichen sclerosus. The median time to initial response was 4 months. Adverse effects, predominantly mild, were observed in 10 (14.3%) patients. This study is constrained by its retrospective nature and reliance on data from a single center, resulting in a limited sample size. Hydroxychloroquine demonstrates promise as a therapeutic option for anogenital lichen sclerosus because of its favorable response rates and low incidence of adverse effects. However, further investigations, including larger-scale or prospective studies, are imperative to ascertain its definitive efficacy.

41 Photodynamic therapy using nano-encapsulated peptides in the complex treatment of anogenital lichen sclerosus

41 Photodynamic therapy using nano-encapsulated peptides in the complex treatment of anogenital lichen sclerosus

Anogenital Lichen Sclerosus: Clinical Considerations and Management

Anogenital Lichen Sclerosus: Clinical Considerations and Management

Extragenital Lichen Sclerosus: A Retrospective Study of 17 Patients.

Introduction:Lichen sclerosus is a chronic inflammatory and atrophic dermatosis affecting preferentially the anogenital region. However, the cutaneous involvement remains less known and studied.Methods:We collected 17 patients to study the clinical and therapeutic features of cutaneous lichen sclerosus.Results:We noticed that the frequency of extragenital involvement in our series is high (about 40%). There is a female predominance (76%), with two infantile cases presenting a severe involvement. On the other hand, the absence of sclerosis, in early forms, does not eliminate the diagnosis. Moreover, breast involvement was frequent (41%) and atypical locations, such as the face, were reported. There was an equal frequency between the diffuse and the localized forms. A genital involvement must imperatively be sought.Conclusions:Our series mention the frequency of isolated cutaneous lichen sclerosus. Clinical presentation can be misleading in the early forms because of lack of sclerosis, variability of localizations, variability of severity, and the absence of anogenital lichen sclerosus.

Diagnosis and management of cutaneous and anogenital lichen sclerosus: recommendations from the Italian Society of Dermatology (SIDeMaST).

Lichen sclerosus (LS) is a disabling chronic inflammatory disease of skin and genital mucous membrane causing itch, pain, dysuria and restriction of micturition, and significant sexual dysfunction and dyspareunia both in women and men. If left untreated, LS is associated with a high degree of sclerosis and scarring, as well as with an elevated risk of cancer in the genital area. Although a central role of autoimmunity is suggested, the pathogenesis of LS is still not clearly understood and the disease remains difficult to treat. The goals of treatment of LS are to alleviate symptoms and discomfort, prevent anatomical changes and prevent malignant transformation. This guideline has been developed by an Italian group of experts. It summarizes evidence-based and expert- based recommendations. The highest level of evidence favors the use of topical high potency corticosteroids; second- and third-line treatments include topical calcineurin inhibitors and topical retinoids, respectively. Surgical treatment has become the treatment of choice in male genital LS with persistent phimosis not responsive to medical treatment. The aim of this paper is to offer evidence-based and easily applicable recommendations for the management of LS.

Anogenital lichen sclerosus et atrophicus lesions in a case series of cancer patients on immunotherapy.

Lichenoid reactions are one of the most frequently observed toxicities with anticancer agents and, recently, a rapid emergence of immunotherapies in oncology has hastened the need to better characterize their unique toxicity profiles, particularly for less common skin toxicities, including anogenital lichen sclerosus et atrophicus (LSA). This case series describes four patients with advanced cancer (one melanoma, two lung cancers, and one kidney tumor) developing LSA lesions while receiving an immunotherapy. Medical records from 2017 to 2020 were retrospectively reviewed. Two patients received pembrolizumab, anti-programmed cell death-1 (PD-1), one nivolumab, anti-programmed cell death-1 (PD-1), and one ipilimumab, an immune checkpoint inhibitor. LSA emerged after a median of 3months (range, 2-4months) from starting immunotherapy. All LSA cases were grade 2. Three cases occurred on the penis and one case on the anus. All patients improved after a specific treatment for LSA, and no LSA-related antineoplastic treatment interruption/life-threatening condition were reported. To date, this is the first case series of LSA lesions associated with immunotherapy. Early LSA recognition and management is helpful in cancer patients on immunotherapy allowing a long survival and treatment response.

Anogenital Lichen Sclerosus: Literature Review and 12-patient Clinical Series in Childre

Anogenital Lichen Sclerosus: Literature Review and 12-patient Clinical Series in Childre

Anogenital lichen sclerosus leading to perianal invasive squamous cell carcinoma

Anogenital lichen sclerosus leading to perianal invasive squamous cell carcinoma

Genital lichen sclerosus et atrophicus in females: An update.

Lichen sclerosus et atrophicus is an acquired chronic inflammatory dermatosis commonly affecting the vulvar and perianal regions. It is associated with an increased risk of vulvar cancer even though it is not a premalignant condition itself. The true precursor of cancer associated with lichen sclerosus (LS) is vulvar intraepithelial neoplasia (VIN), differentiated type. The diagnosis is usually clinical, but in some cases, a biopsy can be performed, especially to exclude VIN or cancer. All females with anogenital LS can be offered clobetasol propionate 0.05% ointment on a regimen for 3 months (once a day for a month, followed by alternative days for a month, and then, twice weekly for a month), combined with a soap substitute and a barrier preparation.

Lichen sclerosus: a clinical study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Lichen sclerosus (LS) is a chronic inflammatory disorder that preferentially affects the anogenital region and rarely extra genital sites. It is more common in women and has a bimodal peak of incidence. The objective of the study was to document the clinical, demographic pattern and associated systemic diseases of lichen sclerosus (LS) among patients attending skin OPD, RIMS, Imphal.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">All patients presenting with signs and symptoms suggestive of lichen sclerosus (LS) were studied for a period of 24 months from March 2014 to February 2016. Clinical examination and relevant investigations including histopathology were performed</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">A total of 54 patients were studied (17 males and 37 females). M:F ratio was 1:2.2. Majority belonged to 25-44 years age group (29.6%). Ano-genital LS comprised 81.4% of the cases. All patients presented with hypopigmented atrophic plaque (100%). The commonest site was prepuce (53.3%) in males and labia majora, labia minora and clitoris (62%) in females. There were 2 cases of balanitis xerotica obliterans (BXO). Ten patients (18.6%) had extragenital LSA and the sites involved were trunk, waist and extremities. Associated systemic diseases were detected in 6 patients. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Lichen sclerosus is not an uncommon disease. Varied presentations ranging from asymptomatic white patch to severe inflammation and scarring were noted. Complications especially with genital involvement can be prevented by early diagnosis and adequate treatment. Screening for associated systemic disease may prove useful.</span></p>

The possible role of human papillomavirus infection in the development of lichen sclerosus.

Lichen sclerosus (LS) is a chronic inflammatory skin disease of unknown origin predominantly affecting the anogenital area that causes pruritus and pain and is associated with an increased risk of malignancy. In some cases, LS vanishes after application of imiquimod, raising the question whether human papillomavirus (HPV) may have an etiopathogenic role in anogenital LS. The databases MEDLINE and Embase were systematically searched using the PRISMA guidelines. Twenty-seven papers were included that reported the prevalence of HPV in LS and in LS associated with neoplasia. HPV was identified in 0-80% (median 22%) of all LS cases. The prevalence of HPV was higher among male patients with LS (median 29%) than among female patients (median 8%). HPV16 was the most prevalent genotype, but the distribution of genotypes indicates that even low-risk HPV can cause LS. The diverging detection rates are probably due to small sample sizes in the reviewed papers and different detection methods. Factors possibly underestimating the prevalence of HPV are a selective search for high-risk HPV, DNA destruction in fixed tissue, focally residing HPV, and possibly a clearing of HPV before the time of biopsy. Seventy-five percent of sexually active people acquire HPV during their lifetime, thus HPV alone is not a cause of LS. Genetic and immunological host factors and viral factors other than type are likely to contribute. Future studies should include patients with a short duration of symptoms, and biopsies should be multiple and fresh.

Surgical treatment of disabling conditions caused by anogenital lichen sclerosus in women: An account of surgical procedures and results, including patient satisfaction, benefits, and improvements in health-related quality of life

Anogenital lichen sclerosus (LS), a chronic dermatitis that causes scarring and introital stenosis, may prevent sexual intercourse and reduce health-related quality of life (QoL). Surgery can restore the anatomy, allowing patients to resume their sexual lives. This study investigates outcomes in women treated with local skin flaps. Thirty-eight consecutive LS-verified patients, surgically treated for debilitating conditions between 1990 and 2013, were retrospectively evaluated. A survey measured patient satisfaction, benefits, and health-related QoL, and the patients were also evaluated by a long-term clinical follow-up. In total, 33 patients (87%) experienced dyspareunia, 24 of whom could not perform coitus. At mean short-term follow-up (10.0 months), only five patients (15%) reported dyspareunia; for seven patients, the outcome was unknown. The survey response rate was 87%, and the mean time from treatment to response was 7.6 years. Twenty of 24 patients reported dyspareunia. Seventy-five percent of patients with preoperative dyspareunia reported a surgical benefit, 74% were satisfied/very satisfied with the cosmetic and overall results, respectively, and 58% reported that surgery had improved their sexual lives. The mean long-term clinical follow-up was 8.4 years. The follow-up rate was 78%. The main reason for recurrent dyspareunia was minor LS relapse (50%); these patients were still able to have coitus, and dyspareunia was reported as considerably minor compared to before surgery; 38% had more severe LS relapse, resulting in apareunia. Surgery for LS sequelae provides acceptable short-term functional results, enabling patients to resume coitus, with high patient satisfaction reported. However, the chronic relapsing nature of LS consequently provides varying and often short-term coital improvements following surgery.

Vulvar Lichen Sclerosus et Atrophicus.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis characterized by ivory-white plaques or patches with glistening surface commonly affecting the vulva and anus. Common symptoms are irritation, soreness, dyspareunia, dysuria, and urinary or fecal incontinence. Anogenital lichen sclerosus (LS) is characterized by porcelain-white atrophic plaques, which may become confluent extending around the vulval and perianal skin in a figure of eight configuration. Thinning and shrinkage of the genital area make coitus, urination, and defecation painful. LS is not uncommon in India and present as an itchy vulvar dermatosis which a gynecologist may mistake for candidal vulvovaginitis. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. There is no curative treatment for LS. Various medications available only relieve the symptoms. Chronic nature of the disease affects the quality of life. Proper and regular follow-up is required as there are chances of the development of squamous cell carcinoma.

Lichen Sclerosus-Presentation, Diagnosis and Management.

Lichen sclerosus is a chronic inflammatory skin disease. It is thought to be underdiagnosed and undertreated. If it is not treated, lichen sclerosus is associated with a greater degree of scarring and an elevated risk of cancer in the genital area. This review is based on pertinent articles published up to October 2015 that were retrieved by a selective search in PubMed, Embase, and the Cochrane Library and on the European S3 guideline for lichen sclerosus. Lichen sclerosus is mainly found in the anogenital area but can also be generalized. Extragenital involvement is reportedly present in 6% to 20% of patients. Neighboring mucous membranes, such as the vaginal or oral mucosa, are not typically affected. The disease is more common in women than in men, and occurs more often in adults than in children. About 10% of patients have other family members with the same condition. Anogenital lichen sclerosus often causes itching and pain. Functional impairment due to fissures and scars can arise over the course of the condition. The treatment of first choice is the local application of high-potency corticosteroids as early as possible (1/A). For boys and men in whom the condition does not remit after steroid treatment, circumcision is indicated (3/D). Anogenital itching and clinical features such as erythema, white skin changes (such as hyperkeratosis and sclerosis), and fissures should arouse suspicion of lichen sclerosus. The diagnosis should be confirmed with a skin biopsy, and early, thorough treatment should be initiated. In this way, a mutilating disease course can be averted, and the risk of cancer can be lessened.

Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus

Obstet Gynecol Surv 2016;71(4):221–222 Anogenital lichen sclerosus (LS) is a chronic inflammatory dermatosis that can cause scarring of genitalia including narrowing of the introitus and clitoral phimosis.

Motives for Vulvar Surgery of Women with Lichen Sclerosus.

Women with lichen sclerosus (LS) may experience (superficial) dyspareunia or the inability to have vaginal intercourse due to painful fissures and narrowing of the vaginal introitus. A surgical procedure may contribute to the relief of these sexual pain problems. It is unknown what motives women have to undergo surgery in order to regain the ability to have sexual intercourse. Such knowledge can offer important insights that are indispensable when discussing the option of vulvar surgery with patients with LS and might prevent potential patient dissatisfaction. This study's purpose is to examine why women with LS decide to undergo vulvar surgery in order to restore intercourse. Nineteen women with anogenital LS participated in audiotaped qualitative individual interviews, in which their motives for undergoing vulvar surgery to restore intercourse were explored retrospectively. Interview data were analyzed using the constant comparative method. Three main motives for wanting to undergo surgery in order to restore intercourse were found. These were the desire to be a "normal" woman, the desire to sexually satisfy the male partner, and the desire to regain the experience of intimacy and sexual enjoyment. Another reason for surgery was to reduce daily life LS symptoms. The sexual pain complaints prevented the women from living up to their norms about heterosexuality and gender roles. Being unable to have intercourse led women to feel inadequate as a woman and as a sexual partner. Women with LS may opt for surgery to restore their identity as a "normal" woman and sexual partner, to regain the experience of coital intimacy, and to be less bothered by LS symptoms in daily life. The present findings point to the importance of a thorough couple-based sexual history in which women's motives for and expectations of vulvar surgery will be explored in order to facilitate a good decision and to increase treatment satisfaction.

A Health Care Disciplines Project: Establishment of a Specialized Clinic for the Management of Ano-Genital Lichen Sclerosus in a Tertiary Health Care Center in Iraq

Executive SummaryLichen Sclerosus (LS) is a chronic dermatologic condition that mainly affects the genital region, and treatment is mainly with topical medications. However, the disease can have serious complications (including cancer) with profound consequences on the patient’s health, sexual and social life. This part of the project aims to establish a first-of-its-kind specialized clinic (in the largest health care institute in Iraq) for the optimal management of LS and reduction of its complications. Furthermore, this clinic will contribute to the medical community and the medical literature. The project will target a population of 50 patients over a period of 13 months divided into three phases: Phase-1 will focus on securing funds and creating the clinic space, phase-2 will invest in training the medical team, patient enrolment-education and patient management, and phase-3 will focus on patients’ follow-up and project evaluation. The project evaluation will run along all three stages (for analysis and stakeholders’ engagement), which will assess: The reduction in patient expenditure and overall cost on the health care system; the level of activity-success of the clinic; and the possibility of project replication in Iraq and other countries (with similar settings). The main obstacles are: Funding issues; political-financial corruption; and Iraqi society religious-social beliefs that can interfere with female patients’ enrollment. However, effective management of each problem will be deployed. In addition, benefits (especially cost reduction in the long term) will justify such a promising project. By creating an active-successful clinic and using a professional team, the project will: Increase patient-public awareness of LS; effectively treat patients; reduce complications; and improve the patient's quality of life. Collectively, in the long term, this will reduce patient expenditure and the overall cost of the health care system.Keywords: Lichen Sclerosus, Ano-genital, females, Health Care Disciplines, Specialized Clinic.

Extensive anogenital lichen sclerosus with vaginal stenosis: A case report

Lichen sclerosus (LS) is an acquired, chronic, inflammatory, fibrotic and atrophic disease, usually affecting skin, particularly genital region. It affects women, with a median age of 50years. No etiological factor is actually known. Here we have described a case of a woman affected by extensive anogenital lichen sclerosus complicated with vaginal stenosis.

A Dutch Cohort Study Confirms Familial Occurrence of Anogenital Lichen Sclerosus

Background: Lichen sclerosus is a chronic inflammatory disease mainly affecting the anogenital site chiefly in postmenopausal women with an increased risk of anogenital cancer. Its aetiology is unknown; evidence is accumulating that genetic factors increase the risk of LS in families. Objective: To evaluate the familial occurrence of anogenital lichen sclerosus in a cohort of Dutch individuals with lichen sclerosus. Method: To evaluate the familial occurrence of genital LS a questionnaire was given to individuals with confirmed LS attending an annual LS meeting asking for LS in family members with an option of a “certain”, “likely”, “not known”, “definitely not” diagnosis of LS. Results: One hundred and seventeen of 170 individuals returned questionnaires with information on 555 relatives. Ten individuals (8.6%) stated that they had at least one family member with LS diagnosed by a physician. Thirty-five (30%) attendees had family members with possible LS. Anogenital cancer was reported by one individual and in 2 of the 10 families with familial LS (20%). Conclusions: 8.6 % of patients with LS had family members with LS. Those families may be at increased risk of developing genital carcinoma in LS lesions.

Diagnosis and Treatment of Lichen Sclerosus

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.