Management of Lichen Sclerosus and Related Comorbidities at a Tertiary Referral Center: Beyond Topical Steroids
Keywords:
lichen sclerosus, ADSCs, SVF, PRPAbstract
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.
References
Burshtein A, Burshtein J, Rekhtman S. Extragenital lichen sclerosus: a comprehensive review of clinical features and treatment. Arch Dermatol Res. Published online October 5, 2022. doi:10.1007/s00403-022-02397-1
Torres A, Zaborek-Łyczba M, Łyczba J, Mertowska P, Mertowski S, Grywalska E. The Importance of Immunological Disorders in the Pathogenesis of Lichen Sclerosus in Pediatric Patients: A Systematic Review. IJMS. 2022;23(22):14212. doi:10.3390/ijms232214212
Powell J, Wojnarowska F. Lichen sclerosus. The Lancet. 1999;353(9166):1777-1783. doi:10.1016/S0140-6736(98)08228-2
Celis S, Reed F, Murphy F, et al. Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series. J Pediatr Urol. 2014;10(1):34-39. doi:10.1016/j.jpurol.2013.09.027
Angotti R, Fusi G, Coradello E, et al. Lichen sclerosus in pediatric age: A new disease or unknown pathology? Experience of single centre and state of art in literature. Pediatr Med Chir. 2022;44(1). doi:10.4081/pmc.2022.275
O’Grady C, O’Connor C, Al Moosa A, Murphy M, Nic Dhonncha E. Burden of treatment in vulval lichen sclerosus. Skin Health Dis. 2022;2(3):e125. doi:10.1002/ski2.125
Virgili A, Borghi A, Cazzaniga S, et al. Gender differences in genital lichen sclerosus: data from a multicenter Italian study on 729 consecutive cases. G Ital Dermatol Venereol. 2020;155(2):155-160. doi:10.23736/S0392-0488.17.05819-9
Meffert JJ, Davis BM, Grimwood RE. Lichen sclerosus. J Am Acad Dermatol. 1995;32(3):393-416; quiz 417-418. doi:10.1016/0190-9622(95)90060-8
Arif T, Fatima R, Sami M. Extragenital lichen sclerosus: A comprehensive review. Aust J Dermatology. 2022;63(4):452-462. doi:10.1111/ajd.13890
Ju T, Hernandez L, Mohsin N, Labib A, Frech F, Nouri K. Evaluation of risk in chronic cutaneous inflammatory conditions for malignant transformation. J Eur Acad Dermatol Venereol. 2023;37(2):231-242. doi:10.1111/jdv.18663
Pope R, Lee MH, Myers A, et al. Lichen Sclerosus and Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2022;19(11):1616-1624. doi:10.1016/j.jsxm.2022.07.011
Steben M. Lichen Sclerosus: Why Do Most Women Struggle With Their Diagnosis? J Obstet Gynaecol Can. 2022;44(2):119-120.e1. doi:10.1016/j.jogc.2021.12.001
Tasker GL, Wojnarowska F. Lichen sclerosus. Clin Exp Dermatol. 2003;28(2):128-133. doi:10.1046/j.1365-2230.2003.01211.x
Felmingham C, Chan L, Doyle LW, Veysey E. The Vulval Disease Quality of Life Index in women with vulval lichen sclerosus correlates with clinician and symptom scores. Australas J Dermatol. 2020;61(2):110-118. doi:10.1111/ajd.13197
Ranum A, Pearson DR. The impact of genital lichen sclerosus and lichen planus on quality of life: A review. Int J Womens Dermatol. 2022;8(3):e042. doi:10.1097/JW9.0000000000000042
Vittrup G, Mørup L, Heilesen T, Jensen D, Westmark S, Melgaard D. Quality of life and sexuality in women with lichen sclerosus: a cross-sectional study. Clin Exp Dermatol. 2022;47(2):343-350. doi:10.1111/ced.14893
Casabona F, Gasparini G, Cozzani E, et al. Improvement in quality of life and sexual function in patients affected by vulvar lichen sclerosus treated with combined autologous platelet-rich plasma and fat grafting. Eur J Dermatol. 2023;33(3):249-254. doi:10.1684/ejd.2023.4480
Khan Mohammad Beigi P. The Immunogenetics of Morphea and Lichen Sclerosus. Adv Exp Med Biol. 2022;1367:155-172. doi:10.1007/978-3-030-92616-8_7
Veronesi G, Virdi A, Leuzzi M, et al. Vulvar vitiligo and lichen sclerosus in children: A clinical challenge. Pediatr Dermatol. 2021;38(5):1012-1019. doi:10.1111/pde.14771
Pérez-López FR, Vieira-Baptista P. Lichen sclerosus in women: a review. Climacteric. 2017;20(4):339-347. doi:10.1080/13697137.2017.1343295
Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14(1):27-47. doi:10.1007/s40257-012-0006-4
Kirtschig G, Becker K, Günthert A, et al. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol. 2015;29(10):e1-e43. doi:10.1111/jdv.13136
White C, Brahs A, Dorton D, Witfill K. Platelet-Rich Plasma: A Comprehensive Review of Emerging Applications in Medical and Aesthetic Dermatology. J Clin Aesthet Dermatol. 2021;14(11):44-57.
Eshtiaghi P, Sadownik LA. Fact or Fiction? Adipose-Derived Stem Cells and Platelet-Rich Plasma for the Treatment of Vulvar Lichen Sclerosus. J Low Genit Tract Dis. 2019;23(1):65-70. doi:10.1097/LGT.0000000000000440
Sharma P, Khullar G, Nagia S, Sharma S. Clinical, histopathological and dermatoscopic overlap of lichen sclerosus and morphea in the same lesion. Australas J Dermatol. 2023;64(3):e292-e294. doi:10.1111/ajd.14088
Bieber AK, Steuer AB, Melnick LE, Wong PW, Pomeranz MK. Autoimmune and dermatologic conditions associated with lichen sclerosus. Journal of the American Academy of Dermatology. 2021;85(1):228-229. doi:10.1016/j.jaad.2020.08.011
Gulin SJ, Lundin F, Seifert O. Comorbidity in patients with Lichen sclerosus: a retrospective cohort study. Eur J Med Res. 2023;28(1):338. doi:10.1186/s40001-023-01335-9
Terlou A, Santegoets LAM, van der Meijden WI, et al. An autoimmune phenotype in vulvar lichen sclerosus and lichen planus: a Th1 response and high levels of microRNA-155. J Invest Dermatol. 2012;132(3 Pt 1):658-666. doi:10.1038/jid.2011.369
Tran DA, Tan X, Macri CJ, Goldstein AT, Fu SW. Lichen Sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci. 2019;15(7):1429-1439. doi:10.7150/ijbs.34613
De Luca DA, Papara C, Vorobyev A, et al. Lichen sclerosus: The 2023 update. Front Med (Lausanne). 2023;10:1106318. doi:10.3389/fmed.2023.1106318
Belotto RA, Chavantes MC, Tardivo JP, et al. Therapeutic comparison between treatments for Vulvar Lichen Sclerosus: study protocol of a randomized prospective and controlled trial. BMC Womens Health. 2017;17(1):61. doi:10.1186/s12905-017-0414-y
Carli P, Moretti S, Spallanzani A, Berti E, Cattaneo A. Fibrogenic cytokines in vulvar lichen sclerosus. An immunohistochemical study. J Reprod Med. 1997;42(3):161-165.
Farrell AM, Dean D, Millard PR, Charnock FM, Wojnarowska F. Cytokine alterations in lichen sclerosus: an immunohistochemical study. Br J Dermatol. 2006;155(5):931-940. doi:10.1111/j.1365-2133.2006.07414.x
Bobeica C, Niculet E, Craescu M, et al. Immunologic and nonimmunologic sclerodermal skin conditions - review. Front Immunol. 2023;14:1180221. doi:10.3389/fimmu.2023.1180221
Paganelli A, Contu L, Condorelli A, et al. Platelet-Rich Plasma (PRP) and Adipose-Derived Stem Cell (ADSC) Therapy in the Treatment of Genital Lichen Sclerosus: A Comprehensive Review. Int J Mol Sci. 2023;24(22):16107. doi:10.3390/ijms242216107
Tedesco M, Pranteda G, Chichierchia G, et al. The use of PRP (platelet‐rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results. Acad Dermatol Venereol. 2019;33(2). doi:10.1111/jdv.15190
Paganelli A, Fabbri PV, Ghidini F, Bigi L, Lasagni C, Ceccarelli PL. Treatment and follow-up of genital lichen sclerosus in male children: multidisciplinary management at a tertiary care center. Dermatol Reports. Published online August 9, 2023. doi:10.4081/dr.2023.9774
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Alessia Paganelli, Luca Contu, Elena Ficarelli, Federico Garbarino, Alberico Motolese
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
