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.

Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders

2019 ◽  
Vol 23 (4_suppl) ◽  
pp. 27S-34S ◽  
Author(s):  
Lyn Guenther ◽  
Charles Lynde ◽  
Yves Poulin
Keyword(s):  
Lupus Erythematosus ◽  
Therapeutic Option ◽  
Seborrheic Dermatitis ◽  
Cutaneous Lupus Erythematosus ◽  
Calcineurin Inhibitors ◽  
Lichen Sclerosus ◽  
Hand Dermatitis ◽  
Off Label ◽  
Topical Calcineurin Inhibitors ◽  
Quality Evidence

Off-label prescribing is a common practice in dermatology, particularly when uncommon dermatologic diseases have limited or no approved treatment options. Topical calcineurin inhibitors are approved for the treatment of eczema, and their anti-inflammatory, immunomodulatory, and steroid-sparing effects make them an attractive therapeutic option for a wide variety of other dermatologic diseases. This review summarizes and qualifies the available evidence supporting the clinical effectiveness of tacrolimus ointment and pimecrolimus cream in non-eczema indications. There is high-quality evidence supporting the effectiveness of topical calcineurin inhibitors in multiple dermatological disorders including vitiligo; psoriasis of the face, folds, and genitals; seborrheic dermatitis; chronic hand dermatitis; contact dermatitis; oral lichen planus; lichen sclerosus; morphea; and cutaneous lupus erythematosus. Lower-quality evidence suggests they may be considered as an option in many other cutaneous disorders.

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 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 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

Lichen sclerosus in men: improving diagnostic and treatment methods

2020 ◽  
pp. 64-69
Author(s):  
A. V. Ignatovskiy
Keyword(s):  
Topical Corticosteroid ◽  
Interferon Alpha ◽  
Comparison Group ◽  
Activity Index ◽  
Lichen Sclerosus ◽  
Main Group ◽  
Complex Treatment ◽  
External Application ◽  
Area Index ◽  
Interferon Alpha 2B

Objective of the study. To evaluate the effectiveness of systemic interferon alpha‑2b in the complex therapy of lichen scleroatrophic of the penis.Material and methods. The study involved 26 male patients with a verified diagnosis: lichen scleroatrophic of the penis. The main group was 19 people, the comparison group was 7 men. The duration of the disease in men was from 9 to 12 months. To estimate the area of lesion as well as to estimate their dynamic changes were developed: Scleroatrophic Lichen Area Index (LS-S in men) and Scleroatrophic Lichen Activity Index (LS-A). Treatment in the main group: topical corticosteroid momentasone cream two times a day for 21 days, as well as interferon alpha‑2b suppositories in a dose of 3 million ME two times a day, daily for 10 days, then three times a week for 2 months with subsequent external application of 1–2 times a day for 2 months of ointment with interferon alpha‑2b. In patients with balanopostitis the cream was used in combination with momentazone, economazole, gentamycin and dexpanthenol. Patients from the comparison group received momentazone cream for 21 days, and in case of recurrence of symptoms – the prescription of topical calcineurin inhibitors. Patients of both groups received vitamin E of 200 mg per day for 2 months. The end point of observation for patients of both groups was 3 months after the end of therapy.Results. Against the background of treatment, improvement was achieved in all patients in the main group within 21 days. Subsequent cancellation of topical corticosteroid and continuation of therapy with suppositories and ointment of the interferon alpha‑2b allowed to maintain positive dynamics of the skin process during the whole period of observation. The control group also achieved a positive effect from therapy with topical corticosteroids (cream with momentazone), but after its cancellation, in the period from 4 to 6 weeks, symptoms were recurrent, which required the continuation of therapy with topical calcinerin inhibitors – tacrolimus ointment 0.1% 1–2 times a day for 4 weeks. The use of the LS-A Index showed that the indices of skin manifestations were the fastest to regress than those of the LS-S index assessing the area of lesion.Conclusions. 1. The use of system therapy with interferon alpha‑2b, along with topical GCSs, in the complex treatment can reduce the severity of clinical manifestations of GSAL without resorting to prolonged use of topical GCSs. 2. The use of interferon alpha‑2b in the complex treatment of the genital lichen sclerosus has demonstrated its effectiveness in a small group of patients. 3. Application of the developed Lesion Area Index and Lichen Sclerosus Activity Index in men allow to objectively assess the effectiveness of treatment. 4. Lichen sclerosus assessment indices allow to develop an individual plan of rehabilitation measures. 5. It is expedient to continue studies on pathogenetic mechanisms of influence of alpha‑2b interferon in genital lichen sclerosus. 

Dermatology prescribing update: eczema

2020 ◽  
Vol 2 (11) ◽  
pp. 590-597
Author(s):  
Julie Van Onselen
Keyword(s):  
Calcineurin Inhibitors ◽  
Management Plan ◽  
Skin Condition ◽  
Care Nurse ◽  
Care Plans ◽  
Topical Calcineurin Inhibitors ◽  
Common Skin ◽  
Huge Impact ◽  
Evidence Based Guidelines

Eczema is a common skin condition, which for the majority is managed in primary care. Nurse prescribers should be aware of evidence–based guidelines in eczema treatment, on which they need to base prescribing decisions and work with the patient on individual skin care plans. Education and support in managing eczema is essential for patients of all ages (and carers of children and older people). Eczema has a huge impact on quality of life but a good management plan can make a big difference to controlling eczema, which is a chronic condition. This article explains the principles of eczema treatments, in acute, sub-acute and chronic stages of eczema with emollients, topical corticosteroids, antibiotics, antimicrobials and antivirals, topical calcineurin inhibitors and antihistamines.

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