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Acrofacial Vitiligo
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Studies have shown an association of acrofacial vitiligo with autoimmune comorbidities such as thyroid disease and diabetes, though many studies have shown it to be less frequent than in generalized vitiligo [4]. Clinical and histological association with lichen sclerosus is reported [10].
Clinical specialties
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 57-year-old lady comes into your GP practice complaining of a skin lesion around her anogenital region. It appears as a white atrophic area and is itchy. You are confident this is a case of lichen sclerosus. Give three differential diagnoses other than lichen sclerosus. (3)Name two other symptoms or signs she may complain of. (2)Name one investigation you would order. (1)How would you treat this patient? Name two points. (2)Name two complications of lichen sclerosus. (2)
Problems with the foreskin
Published in Manu Shah, Ariyaratne de Silva, The Male Genitalia, 2018
Manu Shah, Ariyaratne de Silva
There are a large number of symptoms that may be associated with lichen sclerosus. Men often present with symptoms of phimosis. Retracting the foreskin may be difficult due to scarring or adhesions. Discomfort such as pain, soreness, bleeding, splitting of the foreskin and itching may occur, especially during or after sexual intercourse. Where scarring is a prominent feature (particularly around the urethral meatus) the symptoms may be related to micturition problems such as urinary retention, poor stream and dysuria.
The efficacy and safety of secondary focused ultrasound therapy for recurrence of non-neoplastic epithelial disorders of the vulva
Published in International Journal of Hyperthermia, 2022
The pathogenesis of NNEDV is still unclear, and treatment methods are diverse. Local drugs, such as corticosteroids, have been widely accepted and provide prompt symptomatic relief [5]. Corticosteroids have been a mainstay in the treatment of inflammatory skin conditions for decades, and there is ample evidence to support their long-term efficacy and safety. The British Association of Dermatologists guidelines for the management of lichen sclerosus advocate for an individualized treatment regimen of topical steroids to maintain disease control and prevent scarring [6]. However, advice given to patients with NNEDV by other healthcare professionals regarding corticosteroid-related risks—including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis—may represent a barrier to compliance with long-term corticosteroid usage among female patients [7,8].
An evaluation of the pharmacotherapeutic options for the treatment of adult phimosis. A systematic review of the evidence
Published in Expert Opinion on Pharmacotherapy, 2022
Anna Lygas, Hrishikesh Bhaskar Joshi
Phimosis is essentially a clinical diagnosis. Although, in adult population it is expected to correlate with the histological diagnosis of lichen sclerosus, this is not always possible to establish in everyday practice. This is important as topical treatment is usually started based on the patient’s history and the findings of the clinical examination only. There is no standard system of quantifying and grading the severity of the phimosis and LS in the adults. The pathological process has a significant impact on the patient’s physical, psycho-social and sexual domains of HRQoL. Currently, there are no valid and reliable clinical and patient reported outcome measures (PROM) to uniformly assess the impact of the disease and the different treatments available. The reported assessments are often subjective. It is well recognized that the subjective QoL can be measured objectively using reliable and valid PROMs.
Skin diseases of the vulva: inflammatory, erosive-ulcerating and apocrine gland diseases, zinc and vitamin deficiency, vulvodynia and vestibulodynia
Published in Journal of Obstetrics and Gynaecology, 2018
Freja Lærke Sand, Simon Francis Thomsen
Lichen sclerosus is a chronic, inflammatory mucocutaneous disorder of unknown aetiology, but evidence points to autoimmune mechanisms in the pathogenesis as the disease has been associated with other autoimmune conditions, such as pernicious anaemia, thyroid disease, vitiligo and alopecia areata (Fistarol and Itin 2013). The exact prevalence of lichen sclerosus is uncertain as the disease may be asymptomatic, and probably also underreported (Neill et al. 2010). There is a bimodal age of onset; in prepubertal girls and postmenopausal women, but the disease may present at any age (Powell and Wojnarowska 2001; Goldstein et al. 2005b). Symptoms include itching, vulvar irritation, pain and dyspareunia and significant sexual dysfunction (Fistarol and Itin 2013). On physical examination porcelain-white hypopigmented and atrophic cigarette paper-like plaques are distributed symmetrically at the labia minora, labia majora, perineum, and perianal area, giving rise in women with extensive disease to the characteristic figure of eight configuration (Figure 4). Minor trauma to the vulnerable skin often results in painful fissures and purpura (Figure 5). Over time the sclerotic component may result in resorption of the labia minora and narrowing of the introitus as well as producing clitoral phimosis (Figure 6). The vagina and cervix are unaffected.