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Background Objectives Materials and methods Results Conclusions Hypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.To report surgical strategies and outcomes for primary and redo hypospadias patients with LS.We conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.For primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).For primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively. [ABSTRACT FROM AUTHOR]

Lichen sclerosus is a chronic inflammatory condition of unknown etiology that affects the genital and extragenital skin, which can lead to sexual dysfunction and has been associated with vulvar cancer. The vaginal microbiome has a critical role in gynecologic health, but little is known about the microbiome in lichen sclerosus. This study investigated the vaginal and vulvar microbiomes of 27 post-menopausal women with lichen sclerosus. The most abundant genera detected in the vaginal microbiome were Lactobacillus, Gardnerella, and Anaerococcus, while Lactobacillus, Anaerococcus, and Staphylococcus were the most abundant in the vulvar microbiome. The vaginal samples clustered into two main groups, Lactobacillus dominant (n = 6, > 50% microbiome Lactobacillus) and polymicrobial (n = 21) with no dominant genus. The vulvar samples were mainly polymicrobial (n = 25). Actinomyces, Anaerococcus, and Ezakiella in the vaginal microbiome and Actinomyces and Ezakiella in the vulvar microbiome were significantly associated with lichen sclerosus symptoms (adjusted p < 0.05). In this population of post-menopausal women with lichen sclerosus the majority have diverse, non-Lactobacillus dominant microbiomes, which is considered less optimal for gynecologic health based on studies of pre-menopausal women. Actinomyces, Ezakiella, and Anaerococcus were associated with lichen sclerosus symptoms. Understanding the role of these bacteria in lichen sclerosus pathogenesis will be an essential future investigation. [ABSTRACT FROM AUTHOR]

Objectives: To explore the dermoscopic features of lichen sclerosus in different parts of the external genitalia in children. Methods: A retrospective analysis of the dermoscopic features of 42 female children with vulvar lichen sclerosus treated in the Department of Dermatology of Shanxi Children's Hospital from January 2020 to May 2023. Results: Among the 42 female children, aged 3–14 years (mean: 7.24 ± 2.43 years), the duration of vulvar lichen sclerosus ranged from 3 months to 2 years (mean: 9.83 ± 4.93 months). Clinical lesions occurred in the labia minora in 18 cases (42.9%), labia majora in 38 cases (90.5%), posterior fourchette in 36 cases (85.7%), perianal area in 13 cases (31.0%), anterior fourchette in 17 cases (40.5%), clitoris in seven cases (16.7%), and interlabial sulcus in 11 cases (26.2%). Dermoscopic findings common in the labia majora included follicular keratotic plugs, cloverleaf‐like structures, comedo‐like openings, and linear vessels (p <.05); however, purple–red globules and patches and white linear streaks were more common in the posterior fourchette (p <.05), whereas dotted vessels were more common in the labia minora (p <.05). Conclusions: Common dermoscopic findings in pediatric vulvar lichen sclerosus were yellow‐white structureless areas, white linear streaks, follicular keratotic plugs, and cloverleaf‐like structures; yellow‐white structureless areas and white linear streaks showed the highest specificity. The dermoscopic findings varied among different affected areas, which provides a basis for further understanding of the characteristics of different sites of vulvar lichen sclerosus in the pediatric population. [ABSTRACT FROM AUTHOR]

Calcinosis cutis (CC) is characterized by the deposition of calcium salts in the skin and subcutaneous tissues. CC involving the vulva or foreskin (prepuce) is uncommon. We present a 9‐year‐old female with vulvar CC and a 15‐year‐old male with preputial CC. Microscopic review of excisional specimens revealed calcification associated with follicular cysts in the vulvar case and lichen sclerosus in the preputial case, suggesting a dystrophic origin to a subset of cases of genital CC that might otherwise be classified as idiopathic. The clinical implication of these findings is the need for close histopathologic scrutiny and ongoing clinical surveillance of patients with genital CC initially deemed idiopathic. [ABSTRACT FROM AUTHOR]

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Vulvar cancer is rare with incidence of 45,240 new cases globally which account for 4% of all genitourinary tract neoplasma. It is considered as a postmenopausal disease, however incidence age has decreased over the years because of high prevalence of persistent high-risk human papillomavirus (hrHPV) infection. Vulvar cancer diagnosis in young women is challenging. Prompt and adequate diagnosis, and treatment can ensure the life quality. A 23 years old patient was admitted to Department of Operative Gynecology for treating malignant vulvar neoplasma. She was reffered to our clinic for electrocauterization after being diagnosed of condylomata accuminata. Physical examination revealed vulva atrophy with smooth discolored skin patches on both sides. A 2 cm exophytic lesion was noted ~10 mm from clitoris on right labia majora. Multifocal biopsy was performed for suspect finding which proved invasive vulvar squamous keratinizing cancer. Positron emission tomography-computed tomography (PET/CT) scan showed individual lymph nodes on right inguinofemoral region which were moderately metabolically active. Wide excision of cancer was performed with unilateral inguinofemoral lymphadenectomy. Macroscopic evaluation of entire specimen depicted 2.4 x 2.2 x 0.5 cm HPV associated invasive vulvar squamous keratinizing cancer, vulvar high grade squamous intraepithelial lesion (vHSIL) or usual type vulvar intraepithelial neoplasia (uVIN3) and lichen sclerosus. Healthcare professionals in primary care centers should be adequately trained, aware of and familiar with vulvar malignancies in younger women despite their rarity. Early diagnosis can improve outcomes in vulvar cancer via reducing morbidity and mortality. The individualized surgical treatment is the preferred strategy for patients at present. [ABSTRACT FROM AUTHOR]

Background: 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. Objective: 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. Methods: A retrospective analysis was conducted involving 70 patients diagnosed with lichen sclerosus who underwent treatment with hydroxychloroquine at our institution between 2018 and 2023. Results: 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. Limitation: This study is constrained by its retrospective nature and reliance on data from a single center, resulting in a limited sample size. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objectives: Vulval cancer accounts for around 4% of all gynaecological malignancies and most tumours (> 90%) are of a squamous cell histotype. Most lesions arise on a background of differentiated VIN (dVIN) or lichen sclerosus (LS). Surgical treatment has undergone a paradigm shift with less radical surgery being attempted to preserve vulval structure and function, without compromising oncological outcome. Material and methods: In this single site retrospective analysis, we consider the data from a tertiary oncology unit, to assess progression-free survival based on the presence of a precursor lesion at the margin of resection. 123 patients with FIGO stage 1 vulvar SCC (n = 33 1A, n = 90 1B) were included. Results: One hundred five patients (85%) had an associated precursor lesion (dVIN and/or LS). Within the follow-up period, 33 patients (26.8%) had invasive recurrence, of which 24 (72.7%) had surgical resection margins which were positive for a precursor lesion. In patients with an acceptable microscopically clear invasive resection margin of > 2 mm the presence of a precursor lesion at the margin conveyed a higher risk of malignant recurrence when compared to those with completely clear margins (HR = 2.42; 95% CI 1.14-5.16). Conclusions: This study adds to the available literature emphasising the clinical significance of dVIN or LS at the surgical margin of optimally resected disease. In those who have marginal involvement of a precancerous lesion, increased surveillance should be considered. Future work should explore the need for additional adjuvant therapy in this cohort. [ABSTRACT FROM AUTHOR]

We describe meatal outcomes for boys undergoing circumcision to treat Lichen Sclerosus (LS/BXO) with a focus on those who underwent meatotomy/meatoplasty at circumcision and factors associated with post-circumcision meatal intervention. Retrospective review of patients undergoing circumcision for histologically confirmed LS between 2011 and 2020. Statistical testing was by Chi2 and multivariate analysis. 382 patients underwent circumcision at a mean of 9.1 years (SD 2.9). At circumcision, LS on the glans was documented in 213/365 (58%). Meatal involvement was documented in 74/382 (19%); 25/382 (6.5%) had a meatotomy, 94/382 (25%) had meatal calibration/dilatation and 234/367 (64%) were prescribed post-operative topical steroids. Patients with LS glans or meatal involvement were more likely to have a meatotomy (p = 0.0013) and to receive post-operative steroids (OR 5, p = 0.0001). Post circumcision, 40/382 (10%) required a median of 1 subsequent procedure (range 1–5), 10 (2.6%) underwent dilatation, 30 (7.4%) had a meatotomy. Patients undergoing meatotomy at circumcision had an odds ratio (OR) of 1.2 for subsequent meatotomy (p = 0.027). Analysis based on requirement for any subsequent procedure identified an OR of 3.1 for having had a meatotomy at circumcision (p = 0.022) and an OR of 6.0 of receiving post-operative steroids (p=<0.001). Meatal stenosis following circumcision for LS requiring meatal intervention affected 10% of boys. Meatotomy at circumcision increased the likelihood of subsequent meatal intervention and is therefore not recommended. Level III. • What is currently known about this topic? Few studies advise on meatal management at the time of circumcision for LS; whilst long-term outcomes are rarely reported. • What new information is contained in this article? Meatotomy at circumcision and post-operative topical steroid use was significantly more likely in boys with glans or meatal LS. 10% developed meatal stenosis and meatotomy at circumcision does not appear protective. [ABSTRACT FROM AUTHOR]

Abstract Lichen sclerosus is a chronic inflammatory condition of unknown etiology that affects the genital and extragenital skin, which can lead to sexual dysfunction and has been associated with vulvar cancer. The vaginal microbiome has a critical role in gynecologic health, but little is known about the microbiome in lichen sclerosus. This study investigated the vaginal and vulvar microbiomes of 27 post-menopausal women with lichen sclerosus. The most abundant genera detected in the vaginal microbiome were Lactobacillus, Gardnerella, and Anaerococcus, while Lactobacillus, Anaerococcus, and Staphylococcus were the most abundant in the vulvar microbiome. The vaginal samples clustered into two main groups, Lactobacillus dominant (n = 6, > 50% microbiome Lactobacillus) and polymicrobial (n = 21) with no dominant genus. The vulvar samples were mainly polymicrobial (n = 25). Actinomyces, Anaerococcus, and Ezakiella in the vaginal microbiome and Actinomyces and Ezakiella in the vulvar microbiome were significantly associated with lichen sclerosus symptoms (adjusted p

Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin disorder affecting the vulvar region. VLS predominantly affects women, and most cases occur after menopause. Common symptoms include itching, skin-whitening, pain, discomfort, fissures, and scarring. Treatment options include topical steroids, emollients, lifestyle modifications, regular follow-up, and surgical interventions. Carbon dioxide (CO2) laser treatment is a therapeutic option for managing lichen sclerosus. We report a case of VLS successfully treated with a fractional microablative CO2 laser. A 72-year-old female presented with a dry vagina and vulvar itching for 6 months. She visited a local medical clinic, and oral anti-itching medication and topical anti-itching ointment were administered. However, the condition did not improve, and she felt itching. She visited our outpatient department, and a pelvic examination showed bilateral labia minor, revealing a white skin color change and a hardening sensation. The patient was diagnosed with VLS. Microablative fractional CO2 laser therapy was subsequently administered. The treatment course comprised three laser therapy sessions (treatment day, 1 month, and 2 months after the first therapy). The vulvovaginal symptoms questionnaire-21 scores were 14, 6, and 2 for the first, second, and third courses of treatment, respectively. Vulvar itching improved significantly after laser treatment – no more steroid treatment needed. After 10 months of follow-up, the condition of the vulva was maintained well. Although the treatment protocol requires further exploration, CO2 laser treatment could be considered for VLS if topical steroids are ineffective.

Even though intimate hygiene plays an essential role in the prevention of various genital diseases, there are currently few studies on this topic. There is a wide range of diseases that affect the male genital organs. There is a wide range of diseases that affect the male genital organs. Inflammation of the glans penis (balanitis) occurs in 3–11% of males during their lifetime; one of its leading causes is poor hygiene. However, many non-venereal dermatoses occur in this anatomical region. Most often, patients complain of itching, as well as pain, burning, and various rashes. The most common reason for seeking medical attention is irritant contact dermatitis. Various allergens cause more acute reactions in the anogenital region due to the structural features of the skin of the genitals. Components of detergents and hygiene products, accessories for sexual practices, medications, and contraceptives can become provoking factors of genital allergic dermatitis. Among the dermatoses affecting the male genitalia, lichen planus should be noted, which occurs in males twice as often as in females, and the oral mucosa is often involved in the inflammatory process. Lichen sclerosus can also occur on the skin of the penis, leading to phimosis, a decrease in quality of sexual life, and often requiring circumcision. Psoriasis also can affect the anogenital area. Rashes may be isolated, but other anatomical areas are also involved in most cases. Psoriatic lesions of the genitals are visually different from typical elements in other areas of the skin. Minimizing discomfort due to these diseases is possible by using specialized care products. The skin of the genitals in men has specific features that are important to consider when developing the composition of the products.

Genital ulcers may be located on the genital region and may be due to infectious or noninfectious etiology. Although sexually transmitted infections are a common cause of genital lesions, it is essential to consider nonvenereal disorders in the differential diagnosis. Squamous cell carcinoma appearing in lesions of chronic vulval lichen sclerosus et atrophicus is a rare occurrence of clinical significance. We present a case report of a 62-year-old postmenopausal woman who presented with a long-standing history of vulval pruritus, and mild pain.

Background: Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcin- oma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC). Methods: An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed. Results: Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p < 0.001). If treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups. The most reported reason for treating patients in both groups with TCS was symptoms, followed by clinical aspects of the lesion and prevention of progression to dVIN and VSCC. Conclusion: The majority of GOs who participated in our study endorse the utilisation of long-term ultra-potent TCS therapy in both patients with LSnoVSCC and LSVSCC. Nevertheless, Dutch GOs are currently prescribing TCS more frequently to patients with LSnoVSCC than to patients with LSVSCC. [ABSTRACT FROM AUTHOR]

Lichen sclerosus (LS) is a chronic inflammatory disease of the skin, and the gold standard for treatment is the use of the very potent topical steroids, but they can have side effects. Previously, we demonstrated that OZOILE (stable ozonides) were effective in children affected by LS, reducing the inflammatory process and stimulating tissue regeneration of the foreskin, showing a similar efficacy to steroid treatment. In this study, the modulation of inflammatory and oxidative stress pathways was evaluated by qRT-PCR and Western blotting in foreskins affected by LS removed from patients untreated or treated with OZOILE or corticosteroid cream formulations for 7 days before circumcision. OZOILE induced a significant increase in NRF2 and SOD2 levels, while it did not produce change in MIF, NF-kB subunits, and MMPs in comparison to untreated foreskins. Conversely, steroid topical treatment produced a significant reduction in the expression of p65, MIF, and MMP9, but it did not cause variation in NRF2 and SOD2 levels. These results demonstrate that the use of OZOILE as cream formulation exhibits effects on NRF2 signaling, and it does not induce NF-κB activation, unlike corticosteroids. On the basis of our biochemical data, further studies evaluating the role of NRF2 signaling cascade are necessary.

Wei Zhang,1,&ast; Jiayu Zhang,2,&ast; Dian Jiao,1,&ast; Qisheng Tang,1 Xiaoping Gao,1 Zhenyu Li,1 Fa Yang,3 Zhiguang Zhao,1 Longfei Yang4 1Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, 710038, People’s Republic of China; 2Department of Urology, Air Force Hospital of Southern Theater Command, Guangzhou, Guangdong, 510062, People’s Republic of China; 3Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China; 4Department of Transfusion Medicine, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, 710038, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Longfei Yang; Zhiguang Zhao, Email y68lf@163.com; zzg13991809889@163.comPurpose: Lichen sclerosus urethral stricture disease (LS USD) is a refractory and progressive disease primarily affecting the anterior urethra in males. Various potential etiological factors, such as genetics, autoimmunity, infection, and exposure to infectious urine, have been suggested. However, the accurate etiology of LS in the male urethra remains unclear.Patients and Methods: In this study, we conducted single-cell RNA sequencing to identify the transcriptional profiles of three patients with LS USD and three patients with non-LS USD. Immunofluorescence was used to confirm the single-cell sequence results.Results: Our study revealed distinct subsets of vein endothelial cells (ECs), smooth muscle cells (SMCs), and fibroblasts (FBs) with high proportions in LS USD, contributing to the tissue microenvironment primarily involved in proinflammatory and immune responses. In particular, FBs displayed a unique subset, Fib7, which is exclusively present in LS USD, and exhibited high expression levels of SAA1 and SAA2. The accumulation of macrophages, along with the dysregulated ratios of M1/M2-like phenotype macrophages, may be engaged in the pathogenesis of LS USD. Through cell–cell communication analysis, we identified significant interactions involving CXCL8/ACKR1 and CCR7/CCL19 in LS USD. Remarkably, Fib7 exhibited exclusive communication with IL-1B macrophages through the SAA1/FPR2 receptor–ligand pair.Conclusion: Our study provides a profound understanding of the tissue microenvironment in LS USD, which may be valuable for understanding the pathogenesis of LS USD. Keywords: lichen sclerosus, urethral stricture disease, single-cell RNA sequencing, heterogeneity, fibroblasts, macrophages

Khalid M Al-Husain,1 Abdulaziz Madani,2 Ahmed Alhumidi,3 Turky Alsehli,2 Khalid Nabil Nagshabandi2 1Department of Dermatology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Khalid Nabil Nagshabandi, Email khalidnagshabandi@gmail.comIntroduction: Lichen sclerosus is a chronic inflammatory dermatological condition of unknown etiology, primarily impacting the genital epidermis in individuals of all genders, with a higher prevalence observed among postmenopausal women and prepubescent girls. Additionally, extragenital manifestations occur in approximately 20% of the patients diagnosed with genital lichen sclerosus. Notably, folliculocentric extragenital lichen sclerosus is rare and unusual, with only limited instances documented in existing literature.Case Description: We report a 33 years old lady presented with multiple asymptomatic lesions on the dorsal feet for 1 year and similar lesions on the left hand for 4 months. On examination: folliculocentric, shiny, atrophic papules coalescing into reticulated plaques over the dorsum of both feet and few shiny, flat-topped, pink papules over the dorsum of the left hand. A skin biopsy was performed and confirmed the diagnosis of extragenital lichen sclerosus.Conclusion: Acral folliculocentric extragenital lichen sclerosus is an unusual and rare clinical variant. Clinicopathologic correlation is necessary to establish the correct diagnosis.Contribution to the Literature: Herein, we present an unusual presentation of extragenital lichen sclerosus, and we highlight the importance of considering it in the differential diagnosis of guttate acral skin lesions. We also review and summarize relevant cases from the literature in hope to aid physicians, especially dermatologists, to consider and swiftly reach the diagnosis and offer appropriate management. We also hope to bring about new insights and broaden future research efforts regarding lichen sclerosus especially and atrophic skin disease in general.Keywords: lichen sclerosus et atrophicus, lichen sclerosus, morphea, anetoderma

Aim. To develop and evaluate the effectiveness of complex therapy of vulvar lichen sclerosus (VLS), considering the clinical and immunological variant (CIV) of the disease. Materials and methods. A randomized prospective study included 292 patients 20-70 years old with different CIVs of the VLS course: atrophic (n=101), sclerosing (n=154), scleroatrophic (n=37), as well as 35 females with VLS in the comparison group of the same age category. Based on the clinical, immunological, and morphological features of the VLS course, a complex anti-relapse therapy was developed, the effectiveness of which was evaluated after a year of follow-up in comparison with the standard of care (SoC) of patients (from the comparison group) based on the number of disease relapses and the results of the Vulvar Quality of Life Index Questionnaire (VQLI) survey of women with vulvar diseases. Results. In patients with the sclerosing variant of VLS, short courses of topical glucocorticoids during exacerbations are justified; in patients with the scleroatrophic variant – topical calcineurin inhibitors, in the atrophic variant – a protein-peptide complex from porcine blood leukocytes (vaginal suppositories and cream-balsam with lanolin) containing interleukin-1, 6, tumor necrosis factor α, transforming growth factor, macrophage migration inhibitory factor. Patients with any variant of VLS are instructed to follow household and hygienic recommendations, use emollients daily, take prophylactic doses of vitamins A, E, and D to correct its deficiency or insufficiency, as well as use local enzyme therapy, as indicated, aimed at preventing or treatment of cicatricial changes. Local estrogens were prescribed only to women with genitourinary menopausal syndrome in the peri- and postmenopausal period. The developed complex anti-relapse therapy of VLS showed greater clinical efficacy compared to SoC: 3.7-fold decrease in episodes of disease exacerbation, as well as a significant (p=0.001) 1.3-fold decrease in the negative effect of VLS on the QoL of patients in the main clinical group (15.4 points according to the VQLI assessment – a mild effect on QoL) compared to SoC with the average score of 27.6, which corresponded to a strong negative effect of the disease on QoL. Conclusion. The results of the study support the distinction of VLS CIVs and the need to consider their features when choosing an effective therapy for the disease. Properly selected complex, supportive therapy of VLS can significantly increase the QoL of patients, minimize the number of relapses, and prevent the development of complications, including, probably, the risk of malignant transformation.

Cutaneous squamous cell carcinoma (cSCC) is the second-most-prevalent malignancy in humans. A delayed diagnosis of cSCC leads to heightened invasiveness and positive surgical margins. Bowen's disease (BD) represents an early form of cSCC and presents as a small erythematous, photo-distributed, psoriasiform plaque. Although certain dermoscopy features in BD are quite characteristic, histopathology remains the gold standard for diagnosis and provides a severity-scoring system that assists in guiding appropriate treatment strategies. The classification of precancerous lesions of the vulva and penis has undergone multifarious transformations due to variations in clinical and histopathological characteristics. Presently, erythroplasia of Queyrat is categorized as a clinical variant of penile intraepithelial neoplasia (PeIN). The diagnoses of vulvar intraepithelial neoplasia (VIN) and PeIN present significant challenges and typically necessitate one or more biopsies, potentially guided by dermoscopy. Aceto-white testing demonstrates a notably high negative predictive value for genital precancerous lesions. Histopathological examination represents the gold-standard diagnosis in VIN and PeIN, while p16 and p53 immunostainings alongside HPV testing provide crucial diagnostic clues. The histopathologic features, degree of differentiation, and associations with lichen planus, lichen sclerosus, and HPV guide the selection of conservative treatments or surgical excision. [ABSTRACT FROM AUTHOR]

To evaluate the impact of high-potency topical steroid use on risk of recurrence of lichen sclerosus-associated vulvar cancer. This is a retrospective cohort study evaluating patients with lichen sclerosus (LS)- associated vulvar squamous cell cancer (VSCC). Demographic and clinical outcome data were compared between two comparison groups: patients who received steroids, mainly clobetasol, and patients who did not receive steroids following treatment of LS-related vulvar cancer. Categorical variables were compared using Fisher's exact test or chi-square test. Continuous variables were compared using a two-sided student's t-test. Time to recurrence (TTR) and overall survival (OS) were analyzed using Kaplan-Meier survival plot and compared using Mantel-Cox log rank test. Cox proportional hazard regression models were conducted to generate hazard ratios for both TTR and OS. A p value of <0.05 was considered statistically significant. A total of 49 patients were included, with 36 patients receiving steroid treatment and 13 patients in the expectant management group. The median age of diagnosis was 68. The average BMI was 31.7 +/− 7.0. The median length of follow up was 41 months. The majority of patients were diagnosed with stage I VSCC. There was no difference in demographics or oncologic management of vulvar cancer between the two cohorts. Overall recurrence was decreased among patients who received steroid treatment when compared to patients who did not, 12 patients (33.3%) versus 9 patients (69.2%) respectively (p = 0.048). High-potency topical steroid use following treatment of lichen sclerosus-associated vulvar squamous cell carcinoma is associated with decreased risk of recurrence and prolonged median time to recurrence. • Lichen sclerosus - associated vulvar cancer carries a worse prognosis when compared with HPV- associated vulvar cancer. • Topical steroids represent standard of care therapy for lichen sclerosus but its impact on vulvar cancer risk is unknown. • High-potency topical steroids may reduce risk of recurrence and prolong recurrence free survival in LS-associated VSCC. [ABSTRACT FROM AUTHOR]

Population‐based data on the epidemiology of vulvar lichen sclerosus (LS) are sparse and only few prospective studies have investigated the malignant potential of the disease. We used the nationwide Danish Pathology Registry to first assess the incidence of biopsy‐verified vulvar LS in the period 1997–2022 and second to examine the incidence of vulvar high‐grade squamous precancer and squamous cell carcinoma (SCC) in women with biopsy‐verified vulvar LS (1978–2019) compared with that expected in the general female population. For the latter aim, we computed standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). During our study period, the age‐standardized incidence rate of vulvar LS increased from 5.0 (1997–1998) to 35.7 (2021–2022) per 100,000 person‐years. Compared with the general female population, women with biopsy‐verified vulvar LS had significantly increased rates of vulvar high‐grade squamous precancer (SIR = 8.5; 95% CI: 7.2–10.0) and SCC (SIR = 16.2; 95% CI: 14.2–18.4). The SIRs of vulvar high‐grade squamous precancer and SCC did not vary substantially according to length of follow‐up. This nationwide and population‐based study shows a 7‐fold increase in the incidence of biopsy‐verified vulvar LS since 1997. Data also show that women with biopsy‐verified vulvar LS have 8.5 and 16 times higher than expected incidence of vulvar high‐grade squamous precancer and SCC, respectively. The substantially increased incidence of vulvar high‐grade squamous precancer and SCC following LS is important in relation to the clinical management and follow‐up of LS patients. [ABSTRACT FROM AUTHOR]

Atopic dermatitis, psoriasis and lichen sclerosus are among the most challenging conditions treated by dermatologists worldwide, with potentially significant physical, social and psychological impacts. Emerging evidence suggests that autologous-platelet-rich plasma could be used to manage skin inflammation. However, the presence of soluble autoimmune components could hinder their therapeutic potential. The aim of this study was to analyze the proteomic profile of plasma rich in growth factors (PRGFs) obtained from donors with inflammatory skin conditions to evaluate the impact of skin health status on the composition and bioactivity of PRGF-based treatments. Venous blood from healthy volunteers and patients with psoriasis, lichen sclerosus and atopic dermatitis was processed to produce PRGF supernatant. Half of the samples were subjected to an additional thermal treatment (56 °C) to inactivate inflammatory and immune molecules. Proteomic analysis was performed to assess the protein profile of PRGFs from healthy and non-healthy patients and the effect of Immunosafe treatment. Differential abundance patterns of several proteins related to key biological processes have been identified, including complement activation, blood coagulation, and glycolysis- and gluconeogenesis-related genes. These results also demonstrate that the thermal treatment (Immunosafe) contributes to the inactivation of the complement system and, as a consequence, reduction in the immunogenic potential of PRGF products. [ABSTRACT FROM AUTHOR]

Child sexual abuse is a severe and widespread problem across the globe. The sexual exploitation of children is incomparable whose dynamics are very unusual to that of adult sexual abuse and hence should be handled and investigated differently. Failure to misdiagnose sexual abuse can expose the children to the risk of further abuse and may lead to serious consequences. This case report describes the forensic examination of a 17-year-old girl who primarily presented to the obstetrics and gynecology department with complaints of episodic acute urinary retention and difficulty in passing urine. While evaluating her, the primary physicians observed complete adhesion and fusion of labia majora. This unusual presentation made the examining physicians suspicious of genital mutilation and child sexual abuse. The examination revealed that the labia majora was less appreciable and was fused like parchment-like skin with no visualization of labia minora, clitoris, hymen and vaginal opening. There were no fresh signs of injuries to the anogenital region and no evidence of any surgical procedure done in the recent past suspected to be of genital mutilation. The local examination findings and absence of signs of trauma or surgical scar marks disproved the suspicion of genital mutilation and sexual abuse. The patient's condition was diagnosed with lichen sclerosus et atrophicus, causing genital labial sclerosus. The attending physicians often mistake such conditions as signs of suspected sexual abuse and if not correctly identified, may invite unwarranted child abuse inquiry by law enforcement authorities. [ABSTRACT FROM AUTHOR]

Background: Vulvar stenosis is a debilitating condition that compromises sexual function, urination, and the ability to undergo gynecological examinations. The purpose of this study is to describe the technique of capillary perforator perineal flaps (CPPF) for the correction of vulvar stenosis. Methods: We retrospectively examined patients with vulvar stenosis treated through surgical separation and reconstruction with CPPF. The procedure involved vulvar separation with the creation of a subsequent defect, repaired using a flap, harvested laterally to the labia majora including a capillary perforator and transferred through a subcutaneous tunnel to repair the vulvar defect. The functional outcome was evaluated with the Bradford scale, comparing the preoperative and postoperative scores using the Student's t-test. Results: thirteen patients were included, three with stenosis following treatment for vulvar cancer and ten due to lichen sclerosus. In total, we analyzed 29 flaps, with an average size of 15.6 cm2. We always included just one perforator in the flap and no postoperative complications. Stenosis was resolved in all patients, with no recurrences one year after the surgery. The preoperative average severity of the stenosis was 2.3 + 0.6, reducing to 0.3 + 0.4 post-intervention, indicating a significant improvement (p < 0.01). Conclusions: CPPF has proven to be a quick and safe method for the reconstruction of vulvar stenosis. [ABSTRACT FROM AUTHOR]

It is estimated that approximately one out of 200 boys has the diagnosis of lichen sclerosus (LS), previously referred to as BXO (balanitis xerotica obliterans). Severe progressive disease is rare however, mismanagement of urethral tissues may contribute to progression of LS. The current literature regarding the management of severe lichen sclerosus was reviewed alongside our management of seven patients with ages ranging from six to ten years of age with severe lichen sclerosus who required surgical intervention. These patients were identified out of a busy pediatric practice that saw 5507 patients during the four-year span. Based on the pathophysiology of lichen sclerosus, urethral anatomy, and our management an algorithm was developed for medical and surgical management. All patients received initial medical treatment with topical steroids. Three patients underwent urethral mobilization and serial biopsy. One of these patients with severe disease required a second distal urethral mobilization. Three patients were treated with circumcision, and one is responding well to topical steroids after complex reconstruction. None developed postoperative urethral disease. Lichen sclerosus affects squamous epithelium but can extend to unaffected tissue if traumatized via the Koebner phenomenon. There are no randomized control trials for the management of the disease. Thus, appropriate early management with avoidance of urethral dilation or incision may prevent extension down the urethra that can lead to severe stricture disease. Several authors identified this as one of the worst forms of stricture diseases to manage. Based on the pathophysiology of the disease and our 4-year experience treating patients, we propose an algorithm for management of severe lichen sclerosus in boys. The diagnosis of lichen sclerosus in boys requires a high level of suspicion, and early biopsies should be obtained if suspected. If identified before circumcision or meatotomy, initial treatment should be medical. If the patient fails topical steroid therapy, circumcision and biopsy are the initial recommended surgical approach. Optimally, a biopsy with the first meatotomy establishes the diagnosis. If the disease persists, urethral mobilization may represent a curative treatment as it advances healthy urethra and allows complete removal of distal squamous epithelium instead of traumatic repeated dilations or incisions. This paper summarizes the available literature on the management of severe LS and provides a flow diagram based on the pathophysiology of the disease and our experience sever cases. [ABSTRACT FROM AUTHOR]

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital area, with potential systemic implications. Objective: Our aim is to elucidate its clinical characteristics and management strategies. Methods: We conducted a retrospective observational study on adult patients with LS referred to our center between January 2022 and December 2023. Results: Forty-six adult subjects affected by LS were enrolled in the present study. The majority of patients presented with genital involvement, but a significant subset exhibited extragenital LS and concomitant immune-mediated disorders. Common symptoms included itching, soreness, and dyspareunia, with characteristic skin findings of erythema and atrophy. Topical corticosteroids were the mainstay of therapy, complemented by alternative treatments in refractory cases. Alternative therapeutic approaches, such as platelet rich plasma or adipose-tissue derived stromal/stem cell-based strategies, were effectively employed in refractory cases, in the absence of major adverse events. Conclusions: Our findings underscore the importance of alternative approaches in the management of LS and highlight the need for further research to elucidate its pathogenesis and optimize therapeutic interventions.

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Objective: The study aimed to investigate the feasibility of a newly available topical gel in improving the symptoms of various vulvovaginal skin conditions (NCT05396261). Methods: Fifty-two women with diagnosed lichen sclerosus, lichen simplex chronicus, or genitourinary syndrome of menopause participated in this prospective single-arm feasibility study. Consented patients applied the product daily internally and externally to the genital area for approximately 6 months (short-term) and optionally up to 2 years (long-term). Outcome measures included patient-rated symptoms, investigator-assessed clinical signs, and visual severity of pathology of these vulvovaginal conditions. Clinical outcomes, patient adherence to the treatment, and adverse events were assessed, and the statistical analysis was split according to short-term and long-term treatment. Results: The majority of patients enrolled in the study suffered from an uncontrolled disease (90.4%). All patients showed significant improvement in all patient-rated symptoms (p < 0.001), overall clinical signs (p < 0.001), and visual severity of pathology (p < 0.001) short-term. These favorable results were maintained from month 6 up to 2 years. Patient compliance was high, and no adverse events were reported with use of the investigational product. Conclusions: This topical medical device could be an effective symptomatic management option for women suffering from various vulvovaginal conditions.

Lin Liu,1,2 Qiuli Zhang,1 Jianmin Chang,1,2 Kun Yang1 1Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Peking Union Medical College, Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Kun Yang; Jianmin Chang, Email yangkun12.ky@icloud.com; changjianmin@medmail.com.cnBackground: Previous observational studies have found that lichen sclerosus (LS) is associated with metabolic statuses, such as diabetes mellitus (DM) and body mass index (BMI). However, there are also some studies showing that LS is not related to DM and BMI. The mechanism behind observational results is still unclear. Therefore, the causality of this relationship remains unknown. In this study, a bidirectional two-sample Mendelian randomization (MR) was conducted to investigate the correlation between DM, BMI, and LS.Methods: The instrumental variables related to DM (including type 1 and type 2 diabetes), and BMI were identified from genome-wide association studies (GWAS) and a GWAS meta-analysis. The GWAS data for LS was from obtained the eighth edition of the FinnGen biological database released in 2022. Inverse variance weighted (IVW), weighted median, and MR-Egger methods were used to conduct a bidirectional two-sample MR analysis. Thereafter, the heterogeneity and horizontal pleiotropy were examined to determine whether the results were affected by a single-nucleotide polymorphism (SNP).Results: We found a lack of evidence for the causal association of DM, and BMI on LS in inverse variance weighted (type 1 diabetes, OR=0.97, 95% CI=0.91– 1.04, p=0.429; type 2 diabetes, OR=0.91, 95% CI=0.82– 1.00, p=0.0511; BMI, OR=0.92, 95% CI=0.73– 1.15, p=0.4554). In the other direction, the results also showed that LS had no significant causal effect on DM and BMI.Conclusion: This MR analysis demonstrated no significant causal relationship between DM and BMI with LS in both directions, which contradicts previous observational studies reporting a positive association. Potential confounding factors may contribute to previously observed associations, and further research is necessary.Keywords: lichen sclerosus, diabetes mellitus, body mass index, Mendelian randomization

Relevance. Until now, disputes among scientists about its etiology, pathogenesis, nomenclature and risk factors for the development of vulvar lichen sclerosis have not subsided, which actualizes the need for scientific research aimed at solving these problems. The aim of the study - to establish statistically significant clinical and anamnestic risk factors for vulvar lichen sclerosis. Materials and Methods. An electronic database was formed with data from 344 patients with lichen sclerosus of the vulva and 60 women without vulvar diseases aged 20-70 years on hereditary, obstetric-­gynecological, somatic and infectious history. Astatistical comparative correlation analysis of the obtained data was carried out using the Spearman correlation coefficient (R0.15), nonparametric Mann - Whitney U test and Student t test (p0.05), Chi-square tests, Phi and Cramer statistics. Results and Discussion. Statistically significant (p0.05) risk factors for the development of vulvar lichen sclerosus (R, in descending order) were established: the presence of fibrocystic mastopathy (-0.29); late menarche (15 years and older) (-0.28); onset of menopause (-0.25); recurrent vulvo-­vaginal infections (-0.18); recurrent bacterial vaginosis (-0.18); autoimmune thyroiditis(-0.16) and stage II obesity (-0.16). Also, the average number of abortions and births (1.23 and 1.49, respectively) in the group of patients with lichen sclerosis of the vulva is statistically significantly greater (p0.05) than the average value (0.27 and 1.13, respectively) in control group. Conclusion. The data obtained on the impact of obesity and autoimmune thyroiditis on the risk of developing vulvar sclerotic lichen are consistent with the results of global studies and confirm the association of the disease with autoimmune and metabolic disorders. Recurrent vulvo-­vaginal infections and dysbiotic processes in the vagina can be both acause and aconsequence of vulvar lichen. The relationship between fibrocystic mastopathy and vulvar lichen sclerosus remains debatable and requires further research. Late menarche, the onset of menopause, alarge number of abortions and childbirth can also be considered triggers for vulvar lichen sclerosus in patients with agenetic predisposition to the disease.

Introduction and Objective: : In the past decade, there have been significant advancements in understanding the etiology, molecular mechanisms, and best treatment options for lichen sclerosus (LS). However, to date, there is a lack of published data on the costs of care, associated comorbidities, and quality of life related to the condition. Therefore, this study aims to investigate the global costs associated with the treatment of LS using a contained insurance dataset. Methods: : Deidentified 12-month data from 2022 to 2023 for a northeastern private insurer of teachers and municipal workers was queried to analyze costs associated with a diagnosis of LS (ICD-10 code L90.0). Comorbidities were also queried. Descriptive statistics were utilized to describe the population’s expenditures. Johns Hopkins Adjusted Clinical Groups (ACG) risk assessment was utilized to determine future costs. Z-tests were utilized to determine the differences in rates of comorbidities, and T-tests for differences in cost. Results: : The database included all 4,306 members. Average annual cost per member was $9,280, average age was 35.5 years, behavioral health prevalence was 26%, and 53% were female. Cost for members with a behavioral health condition was $18,125 (2.0-fold) and $6,219 average cost for members without (0.7-fold). LS was present in 161 (3.7%) members, with average age of 42.0, prevalence of behavioral health 37%, and 62% were female. The presence of lichen sclerosus was associated with a 3.5-fold increase in average cost per member ($32,437 annually). For those with LS and a behavioral health condition, cost was $53,539 (5.8-fold average per member) compared to $19,901 (2.1-fold average plan cost) for those with LS and no BH condition. Median cost for those with LS was $8,755 compared to $2,056 for the entire cohort which was a significant difference (P < 0.0001). Incidence of behavioral health conditions, low back pain, obesity, chronic obstructive pulmonary disease, hyperlipidemia and hypertension were increased in the LS group versus the plan population (P < 0.01). Pharmaceutical expenditure for those with LS was a median of $267.58 compared to $94.80 average for the entire cohort (P < 0.0001). Conclusions: : The presence of LS in this privately insured population significantly raises costs, exacerbated by elevated rates of mental health and other comorbidities, highlighting the need for comprehensive care addressing these complexities to improve health outcomes and reduce overall expenses.

AbstractBackground: Vulvar lichen sclerosus treatment consists of topical corticosteroids followed by maintenance therapy. Self-reported adherence to topical corticosteroids in vulvar lichen sclerosus is approximately 66-70.4% and adherence to chronic topical medications is poor.Objective: To measure treatment adherence for vulvar lichen sclerosus.Methods: Adults with vulvar lichen sclerosus who were receiving or who were candidates to receive treatment with topical clobetasol propionate 0.05% ointment twice daily received medication tubes equipped with adherence monitors capturing the time and amount of dose dispensed. After 2 months, monitors were returned, and patients were surveyed regarding their adherence.Results: Ten patients participated for a median (range) of 8.5 (7–11) weeks. Eight (80%) and 7 (70%) caps captured medication timing and dosing events, respectively. Median (interquartile range) adherence was 65% (42–77) and median (interquartile range) medication dispensed per use was 0.15 (0.14 − 0.5) grams. Of the 8 patients using active adherence monitors, 2 did not clinically improve; adherence rates and mean quantity dispensed for these two patients were 31% and 0.13 grams, and 9% and 0.74 grams, respectively.Conclusion: Poor adherence to both twice daily application and prescribed medication quantity occurred frequently. Factors related to self-reported non-adherence included perceived greater efficacy, inconvenience, and time-constraints. Patient adherence to recommended treatment and clinical outcomes are areas for improvement in patients with vulvar lichen sclerosus.

Background Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcinoma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC).Methods An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed.Results Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p

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. [ABSTRACT FROM AUTHOR]

We undertook a retrospective observational review of patients referred to a tertiary dermatology department with vulval complaints over 12 months. The most common provisional diagnoses made by the referrer and final dermatology diagnoses were lichen sclerosus (54% and 38%), dermatitis (12.7% and 16.5%) and psoriasis (5.1% and 6.3%). Referrers may benefit from further education about skin diseases of the vulva, topical steroids for vulval complaints and the importance of clinical photography. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of a novel non‐ablative Nd:YAG/Er:YAG dual laser treatment for vulvar lichen sclerosus (LS) in comparison with the recommended first‐line therapy with topical steroid. Design: A randomised investigator‐initiated active‐controlled trial. Setting: Single tertiary referral centre. Population: Women with vulvar LS. Methods: Randomisation (2:1) to Nd:YAG/Er:YAG laser therapy or topical clobetasol proprionate therapy. Four laser treatments at 0, 1, 2 and 4 months or decreasing doses of steroid for 6 months. Main Outcome Measures: The primary outcome was the change in objective validated clinical LS score in the laser arm between baseline and 6 months. Secondary outcomes were laser tolerability/safety, symptom scores and patient satisfaction. Results: Sixty‐six women were included, 44 in the laser group and 22 in the steroid group. The total LS score decreased by −2.34 ± 1.20 (95% CI −2.71 to −1.98) in women treated with laser compared with a decrease of −0.95 ± 0.90 (95% CI −1.35 to −0.56) in those receiving steroid applications (p < 0.001). Laser treatment was safe and well tolerated. Subjective severity scores (on visual analogue scale) and vulvovaginal symptoms questionnaire scores improved similarly for the laser and steroid arms without significant differences between the two treatments. Patient satisfaction was higher in the laser arm than in the steroid arm (p = 0.035). Conclusions: Non‐ablative dual Nd:YAG/Er:YAG laser therapy was safe and significantly improved clinical outcome and subjective symptoms at the 6‐month follow up. This suggests that laser may be a promising alternative to corticosteroid therapy. However, the authors caution regular follow ups because of the premalignant nature of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Vulvar lichen sclerosus (VLS) is a chronic progressive, lymphocyte-mediated inflammatory disease whose pathogenesis is complex and not fully elucidated. Aim: In the current study we have investigated for the first time the expression of interleukin-17 (IL-17) and S100A7 in lesional skin obtained from female individuals with histologically confirmed VLS. Material and methods: In our study we used skin biopsies obtained from female patients with histologically confirmed VLS (n = 20) and skin samples from healthy age- and gender-matched individuals (plastic surgery procedures) (n = 10) serving as controls. The tissue expressions of IL-17 and S100A7 were assessed with an immunohistochemical method. Results: The number of cells showing IL-17 expression was significantly higher in VLS lesional skin as compared to normal skin of healthy controls (p < 0.0001). In VLS lesional skin, IL-17 was expressed in the epidermis and by cells within the inflammatory infiltrate in the upper dermis. The number of cells showing S100A7 expression was significantly higher in VLS lesional skin as compared to normal skin of healthy controls (p < 0.0001). In VLS lesional skin, S100A7 was expressed by suprabasal keratinocytes in epidermis. S100A7 was also expressed by cells within the inflammatory infiltrate in the dermis. Conclusions: The results of our study may suggest the involvement of IL-17 and S100A7 in the pathogenesis of VLS. The better understanding of this disease may lead to the development of novel, effective therapeutic strategies e.g. using well-known biologics IL-17 inhibitors class. [ABSTRACT FROM AUTHOR]

Background In Western countries, lichen sclerosus is a common disease that affects commonly middle-aged females that present most commonly as a disease of genital and anal regions in both sexes while extra-genital involvement is less frequent. Objective To record all cases of lichen sclerosus in Iraqi population as one of Middle East country and to do a full clinical evaluation and to be compared with published literature as seen in Western countries. Methods This is a cross-sectional descriptive study where all patients with lichen sclerosus were recorded during the period from 2013-2022. All demographic features were estimated and full history and examination were carried out. A histopathological assessment was performed as a confirmatory test. Results All data related to 28 patients with lichen sclerosus were registered and evaluated. The age of patients has a bimodal peak in incidence from prepubertal to a postmenopausal age group and ranged from 8-63 years with a median of 40 years with 24 (85.7%) females and 4 (14.2%) males with a ratio of 6:1. The clinical features of the disease were found to be genital involvement in three (10.7%) patients, one male with follicular lesions of penis and two females with vulval involvement: one with extensive atrophy of vulva while the other with very early lesions). While 25 (89.2%) cases with extragenital sites where the trunk and limbs were the main locations but lips were affected in one female patient another one the ears were involved. The primary lesions in almost half of the cases were follicular whitish sclerosed macules, some with follicular plugs. These lesions over time coalesced together into larger whitish ivory leukoderma in the form of patches and plaques. The rash was localized in 22 (78.6%) cases while extensive in 5 (17.9%) patients. The lesion was asymptomatic apart from slight discomfort and itching but was severe intractable itching in the female genitalia. The HE-stained sections showed complete atrophy of the epidermis with complete sclerosis of the dermis leaving sub-epidermal cleft. Conclusion Lichen sclerosus is a disease of females that commonly presents with extragenital whitish sclerosed leukoderma in the form of follicular macules, patches and plaques while female genital involvement is a rare presentation. The likelihood of extragenital lichen sclerosus following the Blaschko lines was pronounced. [ABSTRACT FROM AUTHOR]

This article discusses the use of reflectance confocal microscopy (RCM) as a diagnostic tool for vulvar lichen sclerosus (VLS) and vulvar vitiligo (VV) in juvenile Chinese girls. VLS and VV have similar clinical appearances, but RCM can reveal distinct features that aid in diagnosis. The study examined 28 patients, with 17 having VLS and 11 having VV. The results showed that VLS is characterized by structural disorder, fibrous material deposits, and larger cellular structures, while VV is characterized by weakened dermal papillary rings. The authors suggest that RCM can be used to support clinical diagnosis of VLS and VV. [Extracted from the article]

Lichen sclerosus (LS) et atrophicus et atrophicus, commonly referred to as LS, is a relatively uncommon chronic inflammatory condition that typically affects the skin of the vulvar and perianal regions but can involve extragenital areas. This review will focus primarily on vulvar LS. Although LS can affect men and prepubescent patients, LS has a much higher incidence in women over the age of 30 years. When correctly diagnosed and treated in its earlier stages, LS, although still chronic, is manageable with the appropriate protocol. When left untreated or poorly managed, LS can progress to its later "atrophic" stages and cause severe lichenification, atrophy, and destructive scarring, resulting in the loss of normal anatomic landmarks and function of the genitals. In addition, both men and women with genital LS have an increased risk of developing squamous cell carcinoma in the affected skin. In women, 65% of genital squamous cell carcinomas arise from a preexisting lesion from LS. This can negatively affect a patient's sleep and physical, mental, and social/emotional health. Increased awareness of the presentation and symptoms, in both providers and patients, of LS et atrophicus encourages earlier treatment and management while preventing long-term, irreversible physical, mental, and emotional damage. [ABSTRACT FROM AUTHOR]

Vulvar lichen sclerosus is a chronic inflammatory condition characterized by the thinning and atrophy of the skin and mucosa surrounding the vulva and anus. This study evaluates the efficacy of a treatment protocol utilizing blue-diode laser photobiomodulation in managing vulval lichen sclerosus symptoms in a cohort of 12 female patients. The treatment protocol consisted of laser sessions for 3 times a week for 2 weeks, and follow-up sessions over a 16-week period. Objective and subjective parameters were assessed before treatment, at the end of treatment, and at 4-month follow-up visits. Results demonstrated significant reductions in subjective symptoms such as itching and pain, as well as improvements in objective signs including erythema and fissures. No side effects were observed, indicating the safety and tolerability of laser treatment. These findings suggest that photobiomodulation can be an effective therapeutic option for patients with vulval lichen sclerosus, with future research aimed at refining treatment protocols and evaluating its long-term benefits.

Oral lichen sclerosus (OLS) represents a diagnostic challenge even for expert dermatologists due to its rarity and subtle clinical manifestations. Only few cases have been reported in literature to date. OLS typically presents with whitish macules in the oral cavity. Histopathological examination remains crucial for definitive diagnosis, with characteristic features including epithelial atrophy, subepithelial hyalinization, loss of elastic fibers, and lymphocytic infiltration. Management strategies vary depending on lesion size and symptomatic presentation, with topical or intralesional corticosteroids being the most commonly used treatment modalities. Long-term monitoring is recommended due to the potential for malignant transformation, although no cases have been reported to date. Greater awareness and understanding of OLS are essential for accurate diagnosis and effective management. Based on these findings, we recommend performing an accurate evaluation of the oral mucosa, especially when dealing with patients affected by genital or extragenital lichen sclerosus (LS). Moreover, we emphasize the importance of multidisciplinary collaboration between dermatologists and other specialists of oral disorders, such as dentists. This short review briefly summarizes available data on OLS, highlighting its diverse clinical presentations and diagnostic challenges. Despite its infrequent occurrence, OLS should be considered in the differential diagnosis of white macules in the oral cavity.