Incidence Of Lichen Sclerosus Research Articles

Lichen Sclerosus-Incidence and Comorbidity: A Nationwide Swedish Register Study.

Background: Data on the incidence and comorbidity of Lichen sclerosus (LS), based on validated nationwide population-based registries, remains scarce. Objective: To explore the incidence and association of comorbidities with LS in Sweden, emphasizing its potential links to malignancies and autoimmune disorders. Methods: A population-based retrospective open cohort study was conducted using the National Patient Register to identify all individuals diagnosed with LS (ICD-10 code L90.0) from 1 January 2001 to 1 January 2021. The study included 154,424 LS patients and a sex and age matched control group of 463,273 individuals to assess the incidence and odds ratios for various cancers and premalignant conditions. Results: The incidence of LS in Sweden was 80.9 per 100,000 person per year, with higher incidence in females (114.4) than in males (47.2). LS patients showed an increased odds ratio for vulvar cancer (OR = 8.3; 95% CI = 7.5-9.0), penile cancer (OR = 8.9; 95% CI = 7.3-11.0), prostate cancer (OR = 1.2; 95% CI = 1.1-1.2), testicular cancer (OR = 1.4; 95% CI = 1.1-1.7), bladder cancer (OR = 1.1; 95% CI = 1.1-1.2), breast cancer (OR = 1.4; 95% CI = 1.3-1.4), leukoplakia of the vulva (OR = 253.5; 95% CI = 221.9-289.6), and leukoplakia of the penis (OR = 5.1; 95% CI = 4.9-5.4). Conclusions: This study underscores the significantly increased association of various cancers and premalignant conditions in LS patients, highlighting the critical need for efficacious treatment and diligent follow-up. The association between LS and autoimmune diseases further necessitates comprehensive investigation to understand the underlying mechanisms and clinical management implications. Future research is essential to confirm these findings and elucidate the role of LS in cancer development.

Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma.

The association between lichen sclerosus and vulvar squamous cell carcinoma (VSCC) has long been recognized, but large epidemiologic studies are lacking. Data of women diagnosed with vulvar pathology in the Netherlands were retrieved from the Dutch Pathology Registry. All vulvar pathology reports of this historical cohort were reviewed to construct a research database, including 3,038 women with lichen sclerosus diagnosed between 1991 and 2011. The incidence rate of lichen sclerosus and the cumulative incidence of VSCC among women with lichen sclerosus were estimated. Between 1991 and 2011, the incidence rate of lichen sclerosus increased from 7.4 to 14.6 per 100,000 woman-years. The median age at time of lichen sclerosus diagnosis was 59.8 years and the cumulative VSCC incidence was 6.7%. The 10-year VSCC incidence in women with lichen sclerosus was associated with concurrent vulvar intraepithelial neoplasia (VIN; 18.8% in women with VIN and 2.8% in women without VIN) and age at time of lichen sclerosus diagnosis (5.9% in women of ≥70 years, 3% in women between 50 and 70 years, and 1.8% in women <50 years). The effects of presence of VIN and age remained significant in adjusted Cox regression analysis. This historical cohort showed a nearly 100% increase in incidence of lichen sclerosus between 1991 and 2011. Concurrent VIN and age ≥70 years at time of lichen sclerosus diagnosis are important risk factors for vulvar cancer development. The incidence of lichen sclerosus is rising and special attention is needed in particular in women with concurrent VIN because of their high risk of cancer. Cancer Epidemiol Biomarkers Prev; 25(8); 1224-30. ©2016 AACR.

MP13-07 UNDERDIAGNOSIS OF LICHEN SCLEROSIS IN ISOLATED BULBAR URETHRAL STRICTURES

INTRODUCTION AND OBJECTIVES: Lichen Sclerosus (LS) is a chronic inflammatory genital skin condition that can cause destructive urethral scarring in men. No prior studies have reported LS in isolated bulbar urethral stricture segments without the presence of progressive disease originating from the penile urethra and/or preputial skin. The aim of this study was to determine the incidence of LS in isolated bulbar urethral stricture segments. METHODS: We retrospectively reviewed 70 patients undergoing urethroplasty for isolated bulbar stricture disease between 20072013. Demographic information, etiology, comorbidities, prior procedures, surgical intervention, outcomes and pathology were reviewed. Stricture specimens at the time of urethroplasty were retrospectively reviewed by a single uropathologist, blinded to patient history and prior histopathologic diagnosis. Cases were evaluated using common histologic features in LS including hyperkeratosis or epithelial atrophy, vacuolar degeneration of basal cells, lichenoid lymphocytic infiltrate and presence of superepithelial sclerosis. RESULTS: The average age of patients was 46.5 (19-77) years and stricture length was 3.5 (1-7) cm. 10 patients (14.2%) had a smoking history, 43 (61.4%) had undergone prior intervention for stricture, of which 3 (4.3%) had prior urethroplasty and 5 (7.1%), prior hypospadias. 51 patients (73.0%) underwent excision and primary anastomosis, and 18 (25.7%) and 1 (1.4%) underwent dorsal or ventral onlay of buccal mucosal graft, respectively. 6 patients (8.6%) developed recurrent stricture requiring intervention over a median follow-up of 22 (IQR 14, 44) months, of which 3 had LS. Initial surgical pathology showed LS in 5 patients, or 7.1% (CI 1.0-13.3). On re-review of specimens using LS pathologic criteria, 31 patients, or 44.3% (32.4-56.2), showed pathology highly suggestive (13) or diagnostic (18) for LS (p<0.05). No significant difference existed between patient characteristics with and without LS on re-review. On univariate analysis, diabetes and pathologic diagnosis of LS are associated with recurrence after bulbar urethroplasty (p1⁄40.03). On multivariate analysis controlling for age, prior procedures and diabetes, no significant association was found. CONCLUSIONS: We report a significant incidence of LS in isolated bulbar strictures in men undergoing urethroplasty on re-review of surgical specimens. The incidence of LS may be higher than reported in isolated segments of the bulbar urethra without evidence of progressive disease.

1218 LICHEN SCLEROSUS: EPIDEMIOLOGIC DISTRIBUTION IN AN EQUAL ACCESS HEALTH CARE SYSTEM

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101218 LICHEN SCLEROSUS: EPIDEMIOLOGIC DISTRIBUTION IN AN EQUAL ACCESS HEALTH CARE SYSTEM Dayne Nelson and Andrew Peterson Dayne NelsonDayne Nelson More articles by this author and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lichen sclerosus (LS) has been identified in patients of all ages. The exact prevalence and incidence of LS are difficult to estimate because patients with this disease process may present to various specialists. Prior reports estimate the rate of LS to be 0.1% to 0.3%. We analyzed the frequency of diagnosis of LS per clinical encounter in a very large worldwide cohort of male military health care beneficiaries. METHODS We conducted a retrospective review of all encounters from 2003 to 2009 in the Department of Defense electronic medical record system, the Armed Forces Health Longitudinal Technology Application (AHLTA). We recorded data from all unique male patient encounters that identified a diagnosis of LS during one or more visits, and calculated the overall proportion of clinical encounters resulting in the diagnosis of LS, further stratifying these frequencies by age, race, and geographic region. RESULTS Between 2003 and 2009, 42,648,923 males were evaluated at least once in a DoD clinic. Of these, 604 individuals had a diagnosis of LS (0.0014%) or 1.4 cases of LS per 100,000 male patients evaluated. The proportions of LS diagnosis more than doubled over the fourth through sixth decade of life and was highest in the 61+ age group. LS was diagnosed most commonly in Caucasians. The distribution was also broken down by region, as defined by Department of Health and Human Services, and ranged from 0.3/100,000 (Region 2, New York) to 2.2/10,000 (Seattle) (Pearson Chi-Square <.0001). CONCLUSIONS In the Department of Defense's equal-access health care system, 1.4/100,000 males evaluated had LS. Cases of LS appear to be more frequent among white males, especially after the third decade of life. There may also be a difference in the likelihood of diagnosis by geographic region with more cases of LS occurring in the Western United States. Additional analyses are needed to explore these highly provocative findings more thoroughly. Tacoma, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e471-e472 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dayne Nelson More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High Prevalence of Concomitant Anogenital Lichen Sclerosus and Extragenital Psoriasis in Adult Women

To analyze the prevalence of lichen sclerosus and psoriasis in gynecologic patients. The prevalence of lichen sclerosus and psoriasis individually, as well as the prevalence of both diseases in the same patient, was evaluated among 2,800 women attending a primary care gynecology practice for annual routine gynecologic examinations. The incidence of lichen sclerosus (new diagnosis of lichen sclerosus per year/population at risk) was calculated for the last 5 years. Two hundred (7.1%) women had a biopsy-proven anogenital lichen sclerosus, and 57 women (2%) had an extragenital psoriasis vulgaris. Fifteen women had both diseases (0.5%). The prevalence of psoriasis in lichen sclerosus patients was 7.5% (15 of 200; 95% confidence interval 4.3-12.1%) compared with 1.6% (42 of 2,600) in the non-lichen sclerosus patient group. Lichen sclerosus was diagnosed in 13 of 15 psoriasis patients at an average of 19.5 years after the diagnosis of psoriasis at the age of 48 years (range 30-70 years). The incidence rates of lichen sclerosus for the last 5 years were 0.5% in 2002, 0.7% in 2003 and 2004, 1.9% in 2005, and 1.8% in 2006. The prevalence of psoriasis in lichen sclerosus patients (7.5%) is higher than in the general population and among the non-lichen sclerosus patients in this practice (1.6%). This association may result from a similar immune dysregulation in these women. II.

Análise clínica e estudo anatomopatológico do prepúcio de pacientes submetidos à postectomia

FUNDAMENTOS E OBJETIVO: Este trabalho tem como objetivo analisar as características histológicas do prepúcio na presença de fimose e a incidência de líquen escleroso (LE) como causa de fimose. MÉTODOS: O Estudo prospectivo incluiu 40 pacientes do sexo masculino com idade entre cinco e 14 anos, com diagnóstico de fimose e indicação cirúrgica como tratamento. Os pacientes - distribuídos em dois grupos em relação ao tempo de doença: fimose primária e secundária - foram submetidos à postectomia no Hospital Infantil Joana de Gusmão, e as peças excisadas, examinadas separadamente por três patologistas. De acordo com as características histopatológicas, os pacientes foram distribuídos em três grupos: achado histológico normal de pele, infiltrado liquenóide e LE. RESULTADOS: As intercorrências clínicas mais freqüentes relatadas pelos pacientes com fimose foram a balanopostite e a infecção do trato urinário (ITU). A maioria deles, 65%, não apresentou alteração histológica da pele; em 22,5% encontrou-se infiltrado liquenóide; e 12,5% dos casos apresentaram alterações próprias de LE. Predominaram os casos de fimose adquirida, representando 57,5% do total. Todos os casos de LE ocorreram nos pacientes com fimose adquirida. A principal indicação cirúrgica desta casuística foi a falência do tratamento clínico (45%), seguida por balanopostite de repetição (25%), estenose grave do prepúcio (17,5%), ITU de repetição (10%) e doença urinária associada (2,5%). CONCLUSÃO: Neste estudo, os autores concluíram que o LE, como causa de fimose, mostrou a incidência de 12,5%.

Lichen Sclerosus et Atrophicus Causing Phimosis in Boys: A Prospective Study with 5-Year Followup After Complete Circumcision

We prospectively investigated 100 pediatric patients suffering from phimosis and found a 10% incidence of lichen sclerosus et atrophicus. This condition usually can be diagnosed preoperatively because of its classic manifestation of severe phimosis due to a sclerotic, whitish ring at the tip of the prepuce, which in our cases was accompanied by sclerogenous glanular lesions. To our knowledge our study represents the first evidence that the development of secondary phimosis with no apparent reason in school-age boys is highly suggestive for lichen sclerosus et atrophicus. Complete circumcision is the therapy of choice because it completely removes all affected tissue and it allows spontaneous regression or resolution of glanular lesions. There has been no recurrence after 5 years of followup.

Adenoid squamous cell carcinoma of the vulva.

Fifty cases of histologically proven invasive squamous cell carcinoma of the vulva were reviewed. It was found that 2 of the patients had extensive areas of adenoid squamous cell carcinoma, and 15 had focal changes. The adenoid variety of squamous cell carcinoma consists of rounded spaces, lined by squamous cells primarily of one cell thickness, and conatining in the lumen single or grouped dyskeratotic acantholytic cells. The incidence of lichen sclerosus et atrophicus in the 50 patients with squamous carcinoma of the vulva was found to be 18%. There was no statistical significance in the observed difference in mortality between patients with adenoid squamous and the usual variety of squamous cell carcinoma. Adenoid squamous carcinoma, which is often attributed to solar damage, has previously been described only in sun-exposed areas of the skin. Our report is the first describing this entity in the vulva.