Treatment for female external genital lichen sclerosus: from standards to innovations


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Resumo

Lichen sclerosus is one of the most common female external genital diseases. The limiting factor for the success of treatment for vulvar lichen sclerosus is a lack of consensus on the etiopathogenesis of the disease and accordingly targeted treatments. Topical glucocorticosteroids and calcineurin inhibitors are now the first-line therapy. Despite a variety of drugs for the treatment of vulvar lichen sclerosus, there are more and more cases of resistance and adverse reactions to traditional therapy, and considering the young age of patients, the search for new technologies in the treatment of vulvar lichen sclerosus is becoming urgent. The article reviews methods for treating the disease in accordance with international protocols and Russian recommendations. In addition, it describes minimally invasive techniques, such as high-frequency focused ultrasound (HIFU), photothermal vulvar tissue reconstruction using carbon dioxide, erbium, and neodymium lasers, platelet-rich plasma (PRP), and autologous stem-cell transplantation, which are currently actively used and have a great therapeutic potential to influence the foci of lichen sclerosus.

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Sobre autores

Anastasia Sokolova

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov

Email: stasia0590@mail.ru
MD, obstetrician&gynecologist, post-graduate student

Inna Apolikhina

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov

Email: apolikhina@inbox.ru
MD, obstetrician&gynecologist, professor

Bibliografia

  1. Jones R.W., Scurry J., Neill S., MacLean A.B. Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics. Am. J. Obstet. Gynecol. 2008; 198(5): 496. el-496. e3. https://dx.doi.org/10.1016/j.ajog.2007.05.031.
  2. Tran D.A., Tan X., Macri C.J., Goldstein A.T., Fu S.W. Lichen sclerosus: an autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int. J. Biol. Sci. 2019; 15(7): 1429-39. https://dx.doi. org/10.7150/ijbs.34613.
  3. Howard A., Dean D., Cooper S., Kirtshig G., Wojnarowska F. Circulating basement membrane zone antibodies are found in lichen sclerosus of the vulva. Australas. J. Dermatol. 2004; 45(1): 12-5. https://dx.doi.org/10.1111/j.1440-0960.2004.00026.x.
  4. Clifton M.M., Garner I.B., Kohler S., Smoller B.R. Immunohistochemical evaluation of androgen receptors in genital and extragenital lichen sclerosus: evidence for loss of androgen receptors in lesional epidermis. J. Am. Acad. Dermatol. 1999; 41(1): 43-6. https://dx.doi.org/10.1016/s0190-9622 (99) 70404-4.
  5. Higgins C.A., Cruickshank M.E. A population-based case-control study of aetiological factors associated with vulvar lichen sclerosus. J. Obstet. Gynaecol. 2012; 32(3): 271-5. https://dx.doi.org/10.3109/01443615.2011.649320.
  6. Nasca M.R., Lacarrubba F., Micali G. Human papillomavirus infection and lichen sclerosus: coincidence or link? Int. J. Dermatol. 2018; 57(5): 611-24. https://dx.doi.org/10.1111/ijd.13933.
  7. Aide S., Lattario F.R., Almeida G., do Val I.C., da Costa Carvalho M. Epstein-Barr virus and human papillomavirus infection in vulvar lichen sclerosus. J. Low. Genit. Tract. Dis. 2010; 14(4): 319-22. https://dx.doi.org/10.1097/ LGT.0b013e3181d734f1.
  8. Eisendle K., Grabner T., Kutzner H., Zelger B. Possible role of Borrelia burgdorferi sensu lato infection in lichen sclerosus. Arch. Dermatol. 2008; 144(5): 591-8. https://dx.doi.org/10.1001/archderm.144.5.591.
  9. Реуцкая М.А., Кулинич С.И. Новые подходы к диагностике и лечению заболеваний вульвы. Сибирский медицинский журнал. 2011; 6: 277-9.
  10. Kirtschig G., Cooper S., Aberer W., Gunthert A., Becker K., Jasaitiene D. et al. Evidence-based (S3) guideline on (anogenital) lichen sclerosus. J. Eur. Acad. Dermatol. Venereol. 2017;31(2): e81-3. https://dx.doi.org/10.1111/jdv.13740.
  11. Kravvas G., Shim T.N., Doiron P.R., Freeman A., Jameson C., Minhas S. et al. The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients. J. Eur. Acad. Dermatol. Venereol. 2018; 32(1): 91-5. https://dx.doi.org/10.1111/jdv.14488.
  12. Marfatia Y., Surani A., Baxi R. Genital lichen sclerosus et atrophicus in females: An update. Indian. J. Sex. Transm. Dis. AIDS. 2019; 40(1): 6-12. https://dx.doi. org/10.4103/ijstd.IJSTD_23_19.
  13. Sherman V., McPherson T., Baldo M., Salim A., Gao X.H., Wojnarowska F. The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study. J. Eur. Acad. Dermatol. Venereol. 2010; 24(9): 10314. https://dx.doi.org/10.1111/j.1468-3083.2010.03572.x.
  14. Virgili A., Borghi A., Cazzaniga S., Di Landro A., Naldi L., Minghetti S. et al.; GLS Italian Study Group. New insights into potential risk factors and associations in genital lichen sclerosus: Data from a multicentre Italian study on 729 consecutive cases. J. Eur. Acad. Dermatol. Venereol. 2017; 31(4): 699-704. https://dx.doi.org/10.1111/jdv.13867.
  15. Powell J.J., Wojnarowska F. Lichen sclerosus. Lancet. 1999; 353(9166): 1777-83. https://dx.doi.org/10.1016/S0140-6736(98)08228-2
  16. Burns P.B., Rohrich R.J., Chung K.C. The levels of evidence and their role in evidence-based medicine. Plast. Reconstr. Surg. 2011; 128(1): 305-10. https:// dx.doi.org/10.1097/PRS.0b013e318219c171.
  17. Федеральные клинические рекомендации. Дерматовенерология 2015: Болезни кожи. Инфекции, передаваемые половым путем. 5-е изд. М.: Деловой экспресс; 2016. 768 с.
  18. Lewis F.M., Tatnall F.M., Velangi S.S., Bunker C.B., Kumar A., Brackenbury F. et al. British Association of Dermatologists guidelines for the management of lichen sclerosus. Br. J. Dermatol. 2018; 178(4): 839-53. https://dx.doi. org/10.1111/bjd.16241
  19. Virgili A., Gorghi A., Toni G., Minghetti S., Corazza M. First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability. Br. J. Dermatol. 2014; 171(2): 38896. https://dx.doi.org/10.1111/bjd.12910.
  20. Ventolini C., Swenson K.M., Galloway M.L. Lichen sclerosus: a 5-year follow-up after topical, subdermal, or combined therapy. J. Low. Genit. Tract. Dis. 2012; 16(3): 271-4.
  21. Baggish M.S., Ventolini C. Lichen sclerosus: Subdermal steroid injection therapy. A large, long-term follow-up study. J. Gynecol. Surg. 2006; 22(4):, 137-41. https://dx.doi.org/10.1089/gyn.2006.22.137.
  22. Von Krogh G., Dahlman-Ghozlan K., Syrjanen S. Potential human papillomavirus reactivation following topical corticosteroid therapy of genital lichen sclerosus and erosive lichen planus. J. Eur. Acad. Dermatol. Venereol. 2002; 16(2): 130-3. https://dx.doi.org/10.1046/j.1468-3083.2002.00420.x
  23. Strittmatter H.J., Hengge U.R., Blecken S.R. Calcineurin antagonists in vulvar lichen sclerosus. Arch. Gynecol. Obstet. 2006; 274(5): 266-70. https://dx.doi. org/10.1007/s00404-006-0151-1.
  24. Funaro D., Lovett A., Leroux N., Powell J. A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. J. Am. Acad. Dermatol. 2014; 71(1): 84-91. https://dx.doi.org/10.1016/j.jaad.2014.02.019.
  25. Hodgins M.B., Mackie R.M., Spike R.C., Maclean A. An immunohistochemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina. Br. J. Obstet. Gynaecol. 1998; 105(2): 216-22. https://dx.doi. org/10.1111/j.1471-0528.1998.tb10056.x.
  26. Bracco G.L., Carli P., Sonni L., Maestrini G., De Marco A., Taddei G.L., Cattaneo A. Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. J. Reprod. Med. 1993; 38(1): 37-40.
  27. Preti M., Vieira-Baptista P., Digesu G.A., Bretschneider C.E., Damaser M., Demirkesen O. et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. Neurourol. Urodyn. 2019; 38(3): 1009-23. https://dx.doi.org/10.1097/LGT.0000000000000462.
  28. Bizjak Ogrinc U., Senear S., Luzar B., Lukanovic A. Efficacy of non-ablative laser therapy for lichen sclerosus: a randomized controlled trial. J. Obstet. Gynaecol. Can. 2019; 41(12): 1717-25. https://dx.doi.org/10.1016/j.jogc.2019.01.023
  29. Lee A., Lim A., Fischer G. Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus. Australas. J. Dermatol. 2016; 57: 39-43. https://dx.doi. org/10.1111/ ajd.12305.
  30. Карабут М.М., Гладкова Н.Д., Фельдштейн Ф.И. Фракционный лазерный фототермолиз в лечении кожных дефектов: возможности и эффективность (обзор). Современные технологии в медицине. 2016; 8(2): 98-108.
  31. Arroyo C., Perez A., Munoz L. Treatment of lichen sclerosus with Erbium:YAG Laser - an option to consider. J. Laser Health Academy. 2018; 1: S14. Available at: https://www.laserandhealthacademy.com/en/library/4725/cesar-arroyo-er-yag-treatment-of-lichen-sclerosus
  32. Gomez-Frieiro M., Laynez-Herrero E. Use of Er:YAG Laser in the treatment of vulvar lichen sclerosus. Int. J. Women's Dermatol. 2019; 5(5): 340-4. https:// dx.doi.org/10.1016/j.ijwd.2019.05.007.
  33. Windahl T. Is carbon dioxide laser treatment of lichen sclerosus effective in the long run?, Scandinavian J. Urol. Nephrol. 2006; 40(3): 208-11. https://dx.doi. org/10.1080/00365590600589666.
  34. Pagano T., Conforti A., Buonfantino C., Schettini F., Vallone R., Gallo A. et al. Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study. Menopause. 2020; 27(4): 418-22. https://dx.doi.org/10.1097/GME.0000000000001482.
  35. Хашукоева А.З., Отдельнова О.Б., Купеева Е.С. Фотодинамическая терапия дистрофических заболеваний вульвы в сочетании с папилломавирусной инфекцией. Лечение и профилактика. 2012; 1: 78-80.
  36. Новикова Е.Г., Соколов В.В., Сидорова И.С., Чулкова Е.А. Флюоресцентная диагностика и фотодинамическая терапия фоновых и предраковых заболеваний вульвы с применением 20% мази «Аласенс». Российский онкологический журнал. 2009; 2: 12-9.
  37. Shi L., Miao F., Zhang L.L., Zhang G.L.,Wang P.R., Ji J. et al. Comparison of 5-aminolevulinic acid photodynamic therapy and clobetasol propionate in treatment of vulvar lichen sclerosus. Acta Derm. Venereol. 2016; 96(5): 684-8. https://dx.doi.org/10.2340/00015555-2341.
  38. Krapf J.M., Mitchell L., Holton M.A., Goldstein A.T. Vulvar Lichen Sclerosus: Current Perspectives. Int. J. Womens Health. 2020; 12: 11-20. https://dx.doi. org/10.2147/IJWH.S191200.
  39. Marx R. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant. Dent. 2001; 10(4): 225-8. https://dx.doi.org/10.1097/00008505-200110000-00002.
  40. Аполихина И.А., Соколова А.В., Педанов А.М., Иванова Е.В. Применение богатой тромбоцитами плазмы в эстетической гинекологии. Учебное пособие. М.: Меркурий; 2019. 100 с.
  41. Tedesco M., Pranteda G., Chichierchia G., Paolino G., Latini A., Orsini D. et al. The use of PRP (platelet-rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results. J. Eur. Acad. Dermatol. Venereol. 2019; 33(2): e58-9. https://dx.doi.org/10.1111/jdv.15190.
  42. Turzi Antoine & Regen Lab team. PRP standardisation & cells therapies. (PRP - Platelet Rich Plasma). Biobridge Foundation Editions; 3 Jan. 2018. 96p.
  43. Casabona F., Priano V., Vallerino V., Cogliandro A., Lavagnino G. New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration. Plast. Reconstr. Surg. 2010; 126(4): 210e-211e. https://dx.doi.org/10.1097/PRS.0b013e3181ea9386.
  44. Boero V., Brambilla M., Sipio E., Liverani C.A., Di Martino M., Agnoli B. et al. Vulvar lichen sclerosus: a new regenerative approach through fat grafting. Gynecol. Oncol. 2015; 139(3): 471-5. https://dx.doi.org/10.1016/j. ygyno.2015.10.014.
  45. Monreal J. Safety and efficacy of stromal vascular fraction enriched Fft grafting therapy for vulvar lichen sclerosus. Cureus. 2020; 12(2): e7096. https://dx.doi. org/10.7759/cureus.7096.
  46. Pinheiro N.M., Crema V.O., Millan B.M., Carvalho F.A., Mendonga A.C. Comparison of the effects of carboxytherapy and radiofrequency on skin rejuvenation. J. Cosmet. Laser Ther. 2015; 17(3): 156-61. https://dx.doi.org/10.3109/14764172.2014.1003238.

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