Genital Lichen Planus Research Articles

Sexual Distress and Quality of Life in Women With Genital Erosive Lichen Planus-A Cross-sectional Study.

The study aimed to assess sexual distress and quality of life in women with moderate-to-severe genital erosive lichen planus (GELP). Thirty-six women with GELP were recruited at the Oslo University Hospital in Norway. The diagnosis was confirmed by a dermatologist with experience in vulvovaginal disease and based on characteristic clinical changes in the vulva and/or vagina, and biopsy results if available. Clinical severity was measured using the GELP score with a score ≥5 required for inclusion. Sexual distress was measured using the revised Female Sexual Distress Scale (FSDS-R), and quality of life was measured using the Dermatology Life Quality Index (DLQI). Topical steroid treatment was allowed. The mean FSDS-R score was 22.7 (range 0-45) with 27 women reporting high scores for sexual distress (FSDS-R score >15). The mean DLQI score was 8.8 (range 1-19) with 15 women reporting a moderate impact (DLQI score 6-10), and 12 women reporting a very large impact (DLQI score 11-20) of GELP on their quality of life. No clear correlations were found between disease severity assessed by GELP scores and FSDS-R or DLQI scores. Age was not correlated with FSDS-R or DLQI scores. These results demonstrate that a substantial number of women with GELP experience sexual distress and a reduced quality of life.

Zoon's plasma cell balanitis associated with genital lichen planus.

Zoon's plasma cell balanitis associated with genital lichen planus.

Treatment strategies for erosive genital lichen planus: A systematic review of therapeutic modalities and emerging breakthroughs.

Erosive genital lichen planus (EGLP) is a severe form of lichen planus characterized by painful erosions in the genital area, leading to significant distress and complications. This review aims to provide a thorough examination of EGLP, focusing on its clinical manifestations, diagnostic challenges, and various treatment strategies, with an emphasis on patient-centered care. Adhering to PRISMA guidelines, we conducted a systematic review of 26 studies that explored dermatological treatments for EGLP. Our literature search was comprehensive, covering PubMed, Scopus, and Web of Science. Data were extracted systematically using established tools to ensure a robust analysis of the treatment modalities. EGLP presents with a range of symptoms, including severe pain, itching, and sexual dysfunction. Treatment options include topical corticosteroids, systemic medications, and surgical interventions. Despite the availability of various therapies, many cases are refractory to treatment, resulting in chronic symptoms and reduced quality of life. Emerging therapies show promise but are not yet established as standard practice. Management of EGLP requires a tailored, multidimensional approach. While topical corticosteroids remain essential, the development of new therapies offers hope for improved outcomes. A patient-centered approach is vital to address both the physical and psychosocial impacts of EGLP. Continued research is necessary to refine treatment protocols and enhance patient care.

Distinct Variations in Gene Expression and Cell Composition across Lichen Planus Subtypes.

Lichen planus (LP) is a highly prevalent inflammatory skin disease. While various clinical subtypes have been defined, detailed comparisons of these variants are lacking. This study aimed to elucidate differences in gene expression and cellular composition across LP subtypes. Lesional skin biopsies from 28 LP patients (classical, oral, genital, and lichen planopilaris) and seven non-diseased skin controls (NDC) were analyzed. Gene expression profiling of 730 inflammation-related genes was conducted using NanoString. Immune cell compositions were assessed by multiplex immunohistochemistry. Gene expression profiles revealed unique inflammatory signatures for each LP subtype. Lichen planopilaris exhibited the most divergence, with downregulated gene expression and upregulation of complement pathway genes (C5-7), along with elevated M2 macrophages. Oral and genital LP demonstrated similar profiles with strong upregulation of TNF-related and Toll-like receptor-associated genes. Oral LP showed the highest upregulation of cytotoxicity-associated genes, as well as high numbers of CD8+ IL-17A+ (Tc17) cells (8.02%). Interferon gene signatures were strongly upregulated in oral and classical LP. The study highlights distinct differences in inflammatory gene expression and cell composition across LP subtypes, emphasizing the need for tailored therapeutic approaches.

Genital lichen planus and lichen sclerosus - seemingly similar and yet different

Genital lichen planus and lichen sclerosus - seemingly similar and yet different

Differentiating Fordyce Spots from Their Common Simulators Using Ultraviolet-Induced Fluorescence Dermatoscopy-Retrospective Study.

Fordyce spots (FS) are heterotopic sebaceous glands affecting mostly oral and genital mucosa, commonly misdiagnosed with sexually transmitted infections. In a single-center retrospective study, we aimed to assess the ultraviolet-induced fluorescencedermatoscopy (UVFD) clues of Fordyce spots and their common clinical simulants: molluscum contagiosum, penile pearly papules, human papillomavirus warts, genital lichen planus, and genital porokeratosis. Analyzed documentation included patients' medical records (1 September-30 October 2022) and photodocumentation, which included clinical images as well as polarized, non-polarized, and UVFD images. Twelve FS patients were included in the study group and fourteen patients in the control group. A novel and seemingly specific UVFD pattern of FS was described: regularly distributed bright dots over yellowish-greenish clods. Even though, in the majority of instances, the diagnosis of FS does not require more than naked eye examination, UVFD is a fast, easy-to-apply, and low-cost modality that can further increase the diagnostic confidence and rule out selected infectious and non-infectious differential diagnoses if added to conventional dermatoscopic diagnosis.

Pediatric lichen planus: A single-center retrospective review of 26 patients with follow up.

Pediatric lichen planus (LP) is rare with variable prevalence and atypical presentations compared to adults. Data on LP are lacking for the pediatric population in the United States. We present demographics, presentations, and treatments for a pediatric LP cohort. We reviewed 26 patients diagnosed with LP at 20 years or younger. Treatment responses were defined as no response, partial response, and complete response. Demographics included 54% females and median diagnosis age of 16 years (range 6-20). Most patients presented with cutaneous LP (65%), with fewer having associated oral (23%), nail (7.7%), or genital (3.8%) involvement. Some had cutaneous-only LP (38%) or strictly mucosal LP (oral-only 19% and genital-only 15%). LP lesions were pruritic (50%), painful (19%), and/or asymptomatic (35%). Complete/partial responses occurred with medium-potency topical corticosteroids in cutaneous (n=7; 64%), oral (n=3; 75%), and genital LP (n=3; 100%), with high/ultra-high potency topical corticosteroids in oral LP (n=6; 86%), and with topical calcineurin inhibitors in genital LP (n=2; 100%). Side effects were clobetasol-related oral candidiasis and biopsy-related penile depressed scar. Most patients with available follow-up achieved remission (n=17; 81%). Pediatric LP usually presents in adolescence with cutaneous involvement and is symptomatic. However, patients frequently can have oral, genital, or nail lesions or may be asymptomatic, so they need thorough examinations and follow-up. Long-term remission is common due to treatment or natural disease course. Medium-potency corticosteroids are recommended for cutaneous, oral, and genital LP. Various other local and systemic therapies exist with successful treatment responses.

Local management strategies for inflammatory vaginitis in dermatologic conditions: Suppositories, dilators, and estrogen replacement

Prevalence of vaginal involvement in erosive lichen planus and pemphigus vulgaris has been reported in over 58% and up to 44% of patients, respectively.1Khurana A. Tandon S. Marfatia Y.S. Madnani N. Genital lichen planus: an underrecognized entity.Indian J Sex Transm Dis AIDS. 2019; 40: 105-112Crossref PubMed Google Scholar,2Kavala M. Topaloğlu Demir F. Zindanci I. et al.Genital involvement in pemphigus vulgaris (Pv): correlation with clinical and cervicovaginal Pap smear findings.J Am Acad Dermatol. 2015; 73: 655-659Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar While most dermatologists are comfortable utilizing ultrapotent steroids on the vulva, less are comfortable with managing vaginal inflammation. Here, we highlight 3 local strategies to target inflammatory vaginal dermatoses and prevent scarring (Fig 1). We recommend starting with 25-mg hydrocortisone acetate suppositories, available as rectal suppositories. Patients should be counseled to use vaginally instead of rectally. Suppositories are initiated nightly for 2 to 4 weeks and decreased to every other night, or 2 to 3 times per week depending on disease control. Patients should be evaluated monthly, and suppositories should be tapered to the lowest dose/frequency that maintains disease remission.2Kavala M. Topaloğlu Demir F. Zindanci I. et al.Genital involvement in pemphigus vulgaris (Pv): correlation with clinical and cervicovaginal Pap smear findings.J Am Acad Dermatol. 2015; 73: 655-659Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar If more potent suppositories are required, hydrocortisone can be compounded at doses of 100 to 200 mg. When prescribing suppositories, we recommend candidal prophylaxis, with topical antifungals 2 to 3 times per week or oral fluconazole 150 to 200 mg weekly. Insertion of dilators 3 times, weekly, to prevent adhesions. Dilators can be ordered online and come in sets of varying sizes. Patients should use the largest dilator comfortable, and vaginal moisturizers and lubricants can be utilized. Estrogen deficiency should be considered in postmenopausal patients as this can contribute to vaginal inflammation. Local estrogen therapy includes a ring, tablet, or cream. Generally, vaginal cream tends to have the least pain with insertion and is used nightly for 2 weeks with decrease to maintenance 1 to 3 times per week. None disclosed.

The impact of genital lichen sclerosus and lichen planus on quality of life: A review.

Background:Lichen sclerosus (LS) and lichen planus (LP) are inflammatory diseases that demonstrate genital and extra-genital manifestations. Genital involvement may result in pruritus, sexual dysfunction, pain, and irritation. It is intuitive that the severity of symptoms may result in functional impairment and emotional distress, leading to a reduction in quality of life (QoL).Objective:Investigate the current literature on the impact of genital LS and LP on QoL.Methods:A literature review was performed using PubMed and results were summarized. Articles published between 1994 and 2020 were screened and reviewed by both the authors.Results:These diseases have been assessed with dermatological assessments, such as the Skindex-29 and the Dermatology Life Quality Index, general health surveys such as the Short Form-12 questionnaire, and mental health instruments including the Beck Depression Inventory, and others; these instruments consistently demonstrate impaired QoL. It follows that treatment may reduce these symptoms. Interventions, such as photodynamic therapy, have demonstrated improvement in the depressive symptoms that impact QoL. Although both females and males experience a reduction in QoL related to these diseases, they experience the symptomatology differently. Through interviewing, male patients were more likely to report no symptoms compared with female patients, while female patients were also more likely to report worse QoL in the work-school domain of the Dermatology Life Quality Index as compared with male patients.Limitations:Few studies have addressed the effect of disease severity or treatment on QoL.Conclusions:Understanding how genital LS and LP contribute to reduced QoL for patients is critical for health care providers to better prioritize treatment strategies. Future prospective studies should investigate how QoL correlates with disease severity and response to treatment.

ORO-GENITAL LICHEN PLANUS: REPORT OF TWO CASES

We report 2 cases of lichen planus affecting oral and genital mucosa. A 47-year-old male patient presented with striated keratotic white plaques located in bilateral buccal mucosa, tongue, and upper and lower lip mucosa. Erosion and desquamation in the upper and lower gingiva associated with diffuse white striae were also observed. The patient also had striated lesions on the penile mucosa and scalp ulcers. A 58-year-old female patient with a diagnosis of genital and perianal lichen planus displayed keratotic white plaques on bilateral buccal mucosa and erosion throughout the upper gingiva associated with diffuse white striae. After clinical and histopathologic analyses, the definitive diagnosis for the 2 cases was oro-genital lichen planus. The patients were treated with topical dexamethasone and psychological support management. The patients are in clinical and psychological follow-up without exacerbation of the oral lesions.

Genital lichen planus: Adding to the review of an "underrecognized entity".

Genital lichen planus: Adding to the review of an "underrecognized entity".

Quality of Life and Psychopathology in Lichen Planus: A Neglected Disease Burden.

The disease burden of lichen planus and its impact on patients’ quality of life have not been well studied. The aim of this mono-centre cross-sectional study was to investigate these factors. From June to September 2020, an anonymous survey was posted to 253 patients, who were diagnosed with lichen planus in our outpatient clinic from January 2018 to June 2020. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI), the EuroQol 5-dimension 3-level score, and further quality of life indicators. Beck Depression Inventory II was used to evaluate symptoms of depression. A total of 100 patients completed and returned the survey. Lichen planus affected quality of life in 78% of cases. DLQI was higher for multiple localizations (r = 0.454, p < 0.001). Patients with genital lichen planus had a significantly higher DLQI (mean ± standard deviation (SD) 8.68 ± 6.96) than patients who were not affected in the genital area (5.01 ± 5.49; p = 0.009). DLQI was also significantly higher for ungual lichen planus (9.83 ± 7.6; not affected: 5.65 ± 5.84; p-value 0.039), and for cutaneous LP (mean 8.1, SD 6.22; not affected: 5.63 ± 6.12; p-value 0.045). Twenty-nine percent of patients had mild to moderate symptoms of depression, and 6% had severe symptoms of depression. Depression and reduced quality of life are an undetected and relevant burden affecting patients with lichen planus.

Apremilast for genital erosive lichen planus in women (the AP-GELP Study): study protocol for a randomised placebo-controlled clinical trial

BackgroundGenital erosive lichen planus (GELP) is a genital subtype of lichen planus, a chronic autoimmune inflammatory disease of unknown aetiology. In women, GELP is characterised by painful vulvo-vaginal mucosal erosions and scarring, often resulting in poor sexual health and reduced quality of life. Treatment options are limited and often with little effect. Apremilast, a phosphodiesterase 4-inhibitor, has been shown to have a positive effect on psoriasis and other inflammatory skin diseases. We aim to investigate the effect and safety of peroral apremilast in women with GELP in a randomised placebo-controlled double-blinded clinical trial.MethodsWe will recruit 42 adult women with characteristic clinical and/or histological features of moderate-to-severe GELP from a specialised vulva clinic in Oslo, Norway. The patients will be randomised 1:1 to either apremilast 30 mg BID (with an initial dose titration on days 1–6) or a placebo for 24 weeks. The concomitant use of topical corticosteroids will be allowed. The primary end point will be the mean GELP score, a clinical scoring system, at week 24 in the apremilast-treated patients versus the placebo-treated patients. The secondary end points will include the mean GELP score improvement from weeks 0 to 24, patient-reported use of topical steroids, the pain score on a visual analogue scale and the number of patients with GELP score improvements at weeks 16 and 24. The Physician Global Assessment , Patient Global Assessment and selected quality of life and sexual function assessments will be recorded at weeks 0, 16 and 24. The exploratory endpoints include description of immunohistochemical changes before and after apremilast therapy, assessed in vulvar or vaginal biopsies at weeks 0 and 24. Regular follow-ups for possible adverse events will be conducted.DiscussionThe study design is based on experience from studies on apremilast in other inflammatory skin diseases using equivalent apremilast doses for approved indications. The trial may provide evidence for the use of apremilast in women with this burdensome genital dermatosis.Trial registrationClinicalTrials.govNCT0365666. Registered on 4 September 2018.

Male genital lichen planus: A retrospective study of 89 cases

BackgroundUnlike other types of lichen planus (LP), there are no series concerning male genital LP. ObjectiveTo describe the clinical characteristics, diagnosis, and response to treatment of male genital LP. Patients and methodsA retrospective study of male patients with genital LP consulting a dermatologist specialized in anogenital diseases between January 2010 and 2019. Demographic data, history, functional signs, clinical characteristics, pathology, complications, and treatment efficacy were collected. ResultsEighty-nine patients were included at four centers. The median age was 51 years. Most patients were uncircumcised and asymptomatic. In 88.8% of cases, only the genital mucosa was involved. Erythema (71%), papules (21.3%), lacy network (15.7%), atrophic lesions (15.7%), erosions (14.6%), and post-inflammatory hyperpigmentation (2.2%) were less frequently observed. Biopsy results confirmed LP in 61.3% of cases but could not rule out other inflammatory genital dermatoses in other cases. Anatomic complications were observed in 30.3% of patients. Topical corticosteroids (TCS) induced remission in most cases. Tacrolimus efficacy was comparable to that of TCS. ConclusionMale genital LP is a rare inflammatory disorder chiefly affecting uncircumcised men. It is found predominantly on the mucosal component of the penis and presents as non-erosive inflammatory balanitis in most cases, with frequent partial or complete remission on treatment with TCS.

Vulvovaginal lichen planus: A case report

Genital lichen planus (LP) forms a small but significant proportion of non-venereal genital dermatoses. Lesions of vulvovaginal LP are often asymptomatic and may be overlooked on self-examination. Clinical features are very similar to lichen sclerosus which is frequently seen in children whereas mucosal vulval LP commonly affects adult females. Histopathological examination of the lesion is an important diagnostic tool for its early diagnosis as progressive disease poses a risk of scarring. We report a case of vulvovaginal LP in a 56-year-old postmenopausal female presenting with hypopigmented patches on vulva for 10 years.

Diagnosis and Management of Vulvovaginal Lichen Planus.

Genital lichen planus is a debilitating disorder that lacks definitive recommendations regarding diagnosis and treatment. The aim of this study was to present best practices from available evidence for the diagnosis and treatment of genital lichen planus. We conducted a narrative review of the literature on genital lichen planus by searching PubMed using the following search terms: "vulvar lichen planus" OR (vulvar diseases[mesh] OR vulva[mesh]) AND lichen planus[mesh] OR vulvar[ti] AND "lichen planus"[ti]. We included all languages and years in the search. The search resulted in 273 citations that we reviewed for relevancy and selected 60 as the foundation for this review that focuses on genital sites. Diagnosis can be made without biopsy, and when a biopsy is taken, the pathologic findings may be nonspecific. Topical ultrapotent corticosteroids are most commonly used as first-line treatment of genital lichen planus. When patients present with genital lichen planus, a complete review of systems and a thorough physical examination should be performed because of the prevalence of extragenital sites. Treatment of genital disease should start with a topical, ultrapotent steroid, and follow-up visits should occur to ensure improvement and to monitor for adverse drug reactions and malignancy.

VULVOVAGINAL GINGIVAL SYNDROME: A CHALLENGING DIAGNOSIS

Vulvovaginal gingival syndrome is defined as a type of lichen planus involving the oral cavity causing desquamative gingivitis with the presence of erythema, pain, halitosis, and bleeding and provoking intensive erythema, pain, loss of the labia minora, vaginal stenosis, and sexual activity impairment due to inflammation and atrophy. A 45-year-old Caucasian woman visited the oral medicine clinic complaining gingival bleeding, lip sores, and severe pain. The patient reported a case of genital candidiasis for more than 10 years without success, with no other diseases reported. She was referred to the gynecology department of the CAISM-Unicamp, São Paulo/Brazil, where a biopsy from the genital mucosa was performed and confirmed genital lichen planus. The oral biopsy had the same result, and lichen planus was confirmed again. With the result of vulvovaginal gingival syndrome, this case is being managed with the use of topical and systemic corticosteroids. Vulvovaginal gingival syndrome is defined as a type of lichen planus involving the oral cavity causing desquamative gingivitis with the presence of erythema, pain, halitosis, and bleeding and provoking intensive erythema, pain, loss of the labia minora, vaginal stenosis, and sexual activity impairment due to inflammation and atrophy. A 45-year-old Caucasian woman visited the oral medicine clinic complaining gingival bleeding, lip sores, and severe pain. The patient reported a case of genital candidiasis for more than 10 years without success, with no other diseases reported. She was referred to the gynecology department of the CAISM-Unicamp, São Paulo/Brazil, where a biopsy from the genital mucosa was performed and confirmed genital lichen planus. The oral biopsy had the same result, and lichen planus was confirmed again. With the result of vulvovaginal gingival syndrome, this case is being managed with the use of topical and systemic corticosteroids.

Frontal Fibrosing Alopecia: A Retrospective Study of 75 Patients

Background and objectiveFrontal fibrosing alopecia is an increasingly common form of scarring alopecia. The aim of this study was to describe the demographic and clinical characteristics of patients with FFA seen at the trichology unit of a medium-sized regional hospital and to report on treatments used. Material and methodsWe reviewed the medical records of all patients with FFA seen at the trichology unit of Hospital Universitario Infanta Sofía in Madrid, Spain between May 2016 and May 2018. We analyzed associations between disease severity, clinical patterns, need for oral medications, and other characteristics. ResultsSeventy-five patients (73 women and 2 men) were studied. Diagnosis was clinical in most cases and 13 cases (17.3%) were confirmed histologically. Median (interquartile range) age at reported onset of symptoms was 61 (12) years. Involvement of the eyebrows was recorded in 70 patients (93.3%) and signs of oral and genital lichen planus in 7 (9.6%). Eleven patients (14.7%) had hypothyroidism and 15 (20.0%) had signs of rosacea. Only 5 of the patients who presented a linear pattern (21.7%) had severe hairline recession. Patients with unstable and/or symptomatic disease (n=24) were treated with oral medications (5-alpha reductase inhibitors, hydroxychloroquine, corticosteroids, and isotretinoin) or intralesional corticosteroids. Eighteen patients (75.0%) achieved disease stability. Ten of the 15 patients with signs of rosacea and 10 of those with facial papules required systemic treatment. ConclusionsMost of the patients in this series of FFA were postmenopausal women. The prevalence of oral and genital lichen planus was higher than that observed in the general population. Patients with a linear pattern had less severe disease. Facial papules were more common in younger patients and both facial papules and rosacea were associated with a greater need for oral treatment.

Alopecia frontal fibrosante: estudio retrospectivo de 75 pacientes

Background and objectiveFrontal fibrosing alopecia is an increasingly common form of scarring alopecia. The aim of this study was to describe the demographic and clinical characteristics of patients with FFA seen at the trichology unit of a medium-sized regional hospital and to report on treatments used. Material and methodWe reviewed the medical records of all patients with FFA seen at the trichology unit of Hospital Universitario Infanta Sofía in Madrid, Spain between May 2016 and May 2018. We analyzed associations between disease severity, clinical patterns, need for oral medications, and other characteristics. ResultsSeventy-five patients (73 women and 2 men) were studied. Diagnosis was clinical in most cases and 13 cases (17.3%) were confirmed histologically. Median (interquartile range) age at reported onset of symptoms was 61 (12) years. Involvement of the eyebrows was recorded in 70 patients (93.3%) and signs of oral and genital lichen planus in 7 (9.6%). Eleven patients (14.7%) had hypothyroidism and 15 (20.0%) had signs of rosacea. Only 5 of the patients who presented a linear pattern (21.7%) had severe hairline recession. Patients with unstable and/or symptomatic disease (n=24) were treated with oral medications (5-alpha reductase inhibitors, hydroxychloroquine, corticosteroids, and isotretinoin) or intralesional corticosteroids. Eighteen patients (75.0%) achieved disease stability. Ten of the 15 patients with signs of rosacea and 10 of those with facial papules required systemic treatment. ConclusionMost of the patients in this series of FFA were postmenopausal women. The prevalence of oral and genital lichen planus was higher than that observed in the general population. Patients with a linear pattern had less severe disease. Facial papules were more common in younger patients and both facial papules and rosacea were associated with a greater need for oral treatment.

An unusual presentation of an oral human papillomavirus (HPV) lesion.

Image in medicine A 45-year-old male patient went to our observation for a white lesion in the left lower gum. At the anamnesis, he reported previous diagnosis of oral erosive and genital lichen planus (discovered 2 and 12 years before respectively) and the excision of 2 small oral squamous papillomas 2 year ago. A PCR-real time test using a saliva sample was carried out a year ago, but it did not confirm the presence of the HPV DNA. During the clinical examination, we observed a white not scrapable lesion of 2.2cm in the vestibular gum around the teeth 3.6-3.7. The lesion is not linked with a traumatic event and we decided to make an incisional biopsy to verify if it was another injury linked to the spread of oral erosive lichen planus or a new entity. The histological examination confirmed a diagnosis of oral HPV lesion, precisely squamous papilloma, but in-situ hybridation did not find HPV DNA. The presence of a mild dysplasia with unaffected margins was also confirmed. At our first knowledge, this is the first documented case in literature of an oral squamous papilloma with a keratin-like appearance, rather than exophytic and/or cauliflower form. The differential diagnosis could be with oral lichen planus, leukoplakia or verruca vulgaris. The patient was advised of the risk of malignancy connected with the simultaneous presence of oral erosive lichen planus and HPV lesions. Figure 1 particular presentation of a relapse of squamous papilloma