scholarly journals Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 950
Author(s):  
Monica Corazza ◽  
Natale Schettini ◽  
Pierantonia Zedde ◽  
Alessandro Borghi
Keyword(s):  
Current Knowledge ◽  
Lichen Sclerosus ◽  
Therapeutic Approaches ◽  
National Library ◽  
Pubmed Database ◽  
Inflammatory State ◽  
Th 1 ◽  
Disease Pathways ◽  
Vulvar Lichen Sclerosus

Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.

scholarly journals The Influence of Inflammation on Anemia in CKD Patients

2020 ◽  
Vol 21 (3) ◽  
pp. 725 ◽  
Author(s):  
Anna Gluba-Brzózka ◽  
Beata Franczyk ◽  
Robert Olszewski ◽  
Jacek Rysz
Keyword(s):  
Treatment Strategies ◽  
Progression Rate ◽  
Therapeutic Approaches ◽  
Pharmacological Interventions ◽  
Anemia Of Chronic Disease ◽  
New Therapeutic Approaches ◽  
Persistent Inflammation ◽  
Inflammatory State ◽  
The Impact

Anemia is frequently observed in the course of chronic kidney disease (CKD) and it is associated with diminishing the quality of a patient’s life. It also enhances morbidity and mortality and hastens the CKD progression rate. Patients with CKD frequently suffer from a chronic inflammatory state which is related to a vast range of underlying factors. The results of studies have demonstrated that persistent inflammation may contribute to the variability in Hb levels and hyporesponsiveness to erythropoietin stimulating agents (ESA), which are frequently observed in CKD patients. The understanding of the impact of inflammatory cytokines on erythropoietin production and hepcidin synthesis will enable one to unravel the net of interactions of multiple factors involved in the pathogenesis of the anemia of chronic disease. It seems that anti-cytokine and anti-oxidative treatment strategies may be the future of pharmacological interventions aiming at the treatment of inflammation-associated hyporesponsiveness to ESA. The discovery of new therapeutic approaches towards the treatment of anemia in CKD patients has become highly awaited. The treatment of anemia with erythropoietin (EPO) was associated with great benefits for some patients but not all.

Experience of using a CO₂ laser in the stage treatment of vulvar lichen sclerosus

2020 ◽  
pp. 58-65
Author(s):  
A. V. Ignatovskiy ◽  
M. A. Nezabudkina
Keyword(s):  
Activity Index ◽  
Calcineurin Inhibitors ◽  
Lichen Sclerosus ◽  
Autologous Plasma ◽  
Area Index ◽  
Co Laser ◽  
Topical Calcineurin Inhibitors ◽  
Positive Therapeutic Effect ◽  
Vulvar Lichen Sclerosus

Vulvar lichen sclerosus is a chronic dermatosis in which first-line drugs are topical glucocorticosteroids, and alternative drugs are topical calcineurin inhibitors. To date, there is insufficient data on the effectiveness of using CO₂ lasers in the treatment of VLS, although the authors of the published works note a positive therapeutic effect. The results of step-by-step application of the Lutronic CO₂ fractional laser were studied. The efficiency of the treatment was evaluated using the skin activity index and the lesion area index developed by the author. The study included 8 women diagnosed with VLS. The obtained results demonstrated a positive effect of step-by-step treatment of VLS with sequential use of topical glucocorticosteroid and autologous plasma injections, followed by CO₂ laser fractional exposure. The positive dynamics of the treatment was confirmed by the dermatological index of quality of life, as well as the indices of assessment of the area and activity of the skin process of VLS.

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

2010 ◽  
Vol 6 (6) ◽  
pp. 515-525 ◽  
Author(s):  
Joseph H. Piatt
Keyword(s):  
Functional Outcomes ◽  
Neurological Status ◽  
Csf Shunt ◽  
Methodological Issues ◽  
National Library ◽  
Cross Sectional ◽  
Pubmed Database ◽  
Wide Range ◽  
Neurosurgical Techniques

Object Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. Methods A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. Results Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. Conclusions Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.

The effect of vulvar lichen sclerosus on quality of life and sexual functioning

2010 ◽  
Vol 31 (4) ◽  
pp. 279-284 ◽  
Author(s):  
Hedwig P Van De Nieuwenhof ◽  
Kim A. P. Meeuwis ◽  
Theodoor E. Nieboer ◽  
Marianne C. M. Vergeer ◽  
Leon F. A. G. Massuger ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sexual Functioning ◽  
Lichen Sclerosus ◽  
Vulvar Lichen Sclerosus

scholarly journals Efficiency of Liposomal Gelcoat with Dihydroquercetin Flamena in Therapy of Vulvar Lichen Sclerosus

Doctor Ru ◽  
2021 ◽  
Vol 20 (6) ◽  
pp. 102-106
Author(s):  
N.I. Chernova ◽  
◽  
I.S. Zadorozhnaya ◽  
Keyword(s):  
Quality Of Life ◽  
Combination Therapy ◽  
Lichen Sclerosus ◽  
Study Objective ◽  
White Spots ◽  
Study Results ◽  
Group 2 ◽  
Vulvar Lichen Sclerosus ◽  
Group 1

Study Objective: To assess the therapeutic efficiency of liposomal gelcoat with dihydroquercetin Flamena in combination therapy of vulvar lichen sclerosus (VLS). Study Design: open comparative perspective study. Materials and Methods. The study included 52 patients with VLS aged 22 to 65 years. Patients were randomised into two therapeutic groups: 27 patients in group 1 had a standard course of therapy with ultrapotent topic glucocorticosteroids (tGCS) for 3 months; 25 patients in group 2 had a standard intermittent 3-month therapy with Flamena gel for 1.5 month. Therapy efficiency was evaluated using the Dermatological Symptom Scale, visual analogue scale, and Dermatological Quality of Life Index (DQoLI). Therapeutic manipulations were assessed during 6 visits. Study Results. Flamena gel facilitated clinical remission maintenance and prolongation. Starting from visit 4, there were differences between group 1 and group 2 values. By visit 5, group 2 patients demonstrated stable regression or reduction in white spots and papules/plaques (not more than 0.8 ± 0.35 and 0.5 ± 0.26 points, respectively). At the same time, group 1 had clinical symptoms intensity rising to 1.6 ± 0.87 points (white spots) and 1.2 ± 0.9 points (papules/plaques), correlating with subjective symptoms aggravation. Effects of therapy on DQoLI were demonstrated with reduction in mean values to 4.2 ± 2.6 points (group 1) and 3.2 ± 1.4 points (group 2) by visit 2. In group 2, the values remained at 3.3 ± 0.6 points by day 60 (visit 6) of follow-up, whereas in group 1 the VLS impact over quality of life increased from mild (4.2 ± 2.6 points — visit 2) to moderate (7.1 ± 2.3 points — visit 6) in a majority of study subjects. Conclusion. A comparative study demonstrated a marked therapeutic effect and high safety profile of Flamena gel in a combination therapy of VLS patients. It improves disease prognosis due to antiinflammatory, antiseptic and regenerative action, thus allowing reducing the frequency and amount of tGCS use. Keywords: vulvar lichen sclerosus, Flamena gel, vulvar itching

scholarly journals Psycho-emotional profile of patients with vulvar lichen sclerosus

2020 ◽  
Vol 14 (2) ◽  
pp. 203-210
Author(s):  
A. G. Solopova ◽  
E. E. Achkasov ◽  
A. D. Makatsariya ◽  
V. S. Moskvichyova ◽  
A. E. Ivanov
Keyword(s):  
Quality Of Life ◽  
Depressive Disorders ◽  
Life Quality ◽  
Depression Scale ◽  
Lichen Sclerosus ◽  
Well Being ◽  
Control Group ◽  
Significant Deterioration ◽  
Vulvar Lichen Sclerosus

Aim: to assess the psycho-emotional profile in patients with vulvar lichen sclerosus.Materials and methods. We examined 57 patients with a diagnosis of vulvar lichen sclerosus, the average age of 35.0 ± 0.6 (from 18 to 45) years. The control group included 45 healthy women without dystrophic changes in the external genital organs, who applied for a routine examination. The following methods were used to analyze the psycho-emotional profile: WAM questionnaire (well-being, activity, mood), Hospital Anxiety and Depression Scale (HADS), the Dermatology Life Quality Index (DLQI).Results. In patients with vulvar lichen sclerosus a decrease in indicators “well-being” (24.3 ± 1.7 versus 52.4 ± 5.6 scores) and “mood” (28.7 ± 3.6 versus 58.1 ± 6.1 scores) was revealed; “activity” was changed slightly (41.2 ± 3.2 against 47.4 ± 4.9 scores). Depressive (75.4 % versus 15.6 %) and anxiety (68.4 % versus 20 %) disorders were also more common in this group. Significant deterioration in the quality of life in patients was confirmed by a DIQL (18.79 ± 4.98 scores).Conclusion. Psycho-emotional profile of patients with vulvar lichen sclerosus is characterized by a change in most of the analyzed parameters. The presence of anxiety-depressive disorders can aggravate both the general somatic state and the course of the underlying disease. So activities aimed at improving the quality of life should be included in the rehabilitation of these patients.

scholarly journals The effect of vulvar lichen sclerosus on quality of life and sexual functioning

2021 ◽  
Vol 5 (7) ◽  
pp. 691-694
Author(s):  
Özlem HELVACİOGLU ◽  
Zeynep TOPKARCI ◽  
Çağlar HELVACIOĞLU ◽  
Ayşe KAVAK
Keyword(s):  
Quality Of Life ◽  
Sexual Functioning ◽  
Lichen Sclerosus ◽  
Vulvar Lichen Sclerosus

Novel Therapeutic Approaches and Targets for Treatment of Vulvar Lichen Sclerosus

2020 ◽  
Vol 22 (1) ◽  
pp. 99-114
Author(s):  
Alessandro Borghi ◽  
Monica Corazza
Keyword(s):  
Maintenance Treatment ◽  
English Literature ◽  
Lichen Sclerosus ◽  
Treatment Phase ◽  
Current Evidence ◽  
Systemic Treatments ◽  
Pubmed Database ◽  
Term Maintenance ◽  
Vulvar Lichen Sclerosus

Background: Vulvar Lichen Sclerosus (VLS) is a chronic inflammatory disease with a huge impact on a person’s quality of life. A correct therapy is required for relieving symptoms, reversing signs and preventing further anatomical changes. Objective: The main objective of the present paper is to provide suggestions for the best treatment approach, based on the available evidence. Treatment strategies are divided on the basis of the treatment phase, distinguishing options for initial, acute or attack treatment and those for long-term, maintenance treatment. Methods: An electronic search was performed using the National Library of Medicine PubMed database. All the studies evaluating treatment of vulvar lichen sclerosus published in the English literature were analyzed, including controlled studies, case series, guidelines and reviews. Results: Current evidence identifies ultra-potent and potent corticosteroids, administered for 12 weeks, as the first-line recommended treatment for active VLS. Topical calcineurin inhibitors, tacrolimus and pimecrolimus, are effective and safe alternatives. Long-term maintenance strategies aimed at preventing recurrences are required, after the initial treatment phase. Maintenance treatment mostly consists in topical corticosteroids, administered i) on an “as needed” basis (“reactive” scheme), ii) on a continuative regimen, iii) on a low-dose, intermittent regimen (“proactive” scheme). Further investigations are needed for better defining the placement of other options within the VLS therapeutic algorithm, including retinoids, physical and systemic treatments. Conclusion: The available evidence provides useful indications for the management of VLS. Both the identification of new therapeutic targets and the optimization of the available options represent the main objectives of future research.

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