Autoimmune and dermatologic conditions associated with lichen sclerosus

Abstract

To the Editor: Lichen sclerosus (LS) is a chronic, inflammatory disorder that may lead to anogenital malignancy and scarring. 1,2 The pathophysiology is poorly understood; although autoantibodies targeting extracellular matrix 1 protein and the basement membrane zone have been identified, experts favor a T-cellemediated pathogenesis. 1,2 Small studies show an association with thyroid disorders, vitiligo, and psoriasis. [1][2][3] Increased risk of vulvar squamous cell carcinoma is also reported, with a lifetime incidence of 0.4% to 6% in women with LS. 4 We sought to determine the prevalence of these commonly cited comorbidities in the largest cohort of women with LS to date.The study population included patients in the IBM MarketScan Databases from 2015 to 2017 with 2 or more independent diagnoses of LS (International Classification of Diseases, 10th RevisioneClinical Modification L90.0). This database comprises more than 21.7 million commercially insured women in the United States. The study population was compared to a control group of women without LS. Stata statistical analysis software version 15.0 (StataCorp, College Station, TX) was used to examine the prevalences of Hashimoto disease/chronic lymphocytic thyroiditis/autoimmune thyroiditis, Graves disease/thyrotoxicosis, vitiligo, psoriasis, and vulvar carcinoma. Odds ratios and 95% confidence intervals were calculated. A P value of \.05 was considered significant.We identified 10,004 women with LS and 21,672,016 female control individuals without LS from 2015 to 2017 in the United States. The mean age was 50.8 years; 79% were between 45 and 65 years old. The rates of comorbid conditions are shown in Table I. In the LS population, the prevalences were as follows: autoimmune thyroid diseases, 6.11%; vitiligo, 1.95%; psoriasis, 5.12%; and vulvar carcinoma, 1.9%. All comorbidities were more likely to occur in patients with LS compared to control individuals (Table II). The most commonly associated autoimmune disease was hypothyroidism, with a prevalence of 4.26%. Notably, vulvar carcinoma was 26 times more likely and vitiligo was 12 times more likely to occur in patients with LS.We identified only 4 studies that examined the rates of similar comorbidities in LS. [1][2][3]5 One comparing 50 patients with LS to 50 control individuals cited an autoimmune disease prevalence This project was accomplished through a generous gift from The Louis and Rachel Rudin Foundation, Inc, which supports the research education of residents at New York University Langone Health's Ronald O. Perelman Department of Dermatology.

Comorbidity of Dermal and Cardiovascular Disorders with Lichen Sclerosus: A Case-control Study

“…It has been hypothesized that LS and atopy might share a common immunological defect, or that LS might develop on top of atopically disturbed skin ( 5 ). The prevalence of psoriasis in the current study was 2.0% (RR 3.5), which is in line with previous studies showing a prevalence of 0.8–17% ( 3 , 6 – 8 , Table SI 1 ). In both LS and psoriasis, T-cells are activated and are believed to be involved in the pathogenesis of both conditions ( 9 ).…”

2021 European guideline for the management of vulval conditions

“…Maintenance treatment Proactive maintenance therapy with twice-weekly application of for example mometasone furoate 0.1% ointment or clobetasol propionate 0.05% ointment is effective and safe in maintaining remission, and may help to prevent malignant change. 61,66 Thirty grams of an ultra-potent steroid should last at least 3 months (GRADE 1, A).…”

The analysis of coexistence of celiac disease and vulvar lichen sclerosus in girls

“…This suggests there is a strong, positive association between LS and autoimmune disease in women and in contrast, a weak association in men [21]. Bieber et al [22] identified 10,004 women with VLS and 21,672,016 female control individuals without VLS from 2015 to 2017 in the United States. In the LS population, the prevalences were as follows: autoimmune thyroid diseases, 6.11%; vitiligo, 1.95%; psoriasis, 5.12%; and vulvar carcinoma, 1.9%.…”

“…The most associated autoimmune disease was hypothyroidism, with a prevalence of 4.26%. Notably, vulvar carcinoma was 26 times more likely, and vitiligo was 12 times more likely to occur in patients with LS [22]. According to Balakirski et al [23], the likelihood of developing related autoimmune diseases is less common in children than in adults, and they are observed mainly in girls: vitiligo, morphea, alopecia areata and autoimmune thyroiditis in progress on first place.…”