Diagnostic des lésions pigmentées de la vulve

Lisner, Tomo; Plantier, F.

doi:10.1016/j.annpat.2021.01.002

Cited by 1 publication

(3 citation statements)

References 13 publications

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“…Compared to the general female population, we detected an over 5-fold increased frequency of hyperpigmented lesions in the anogenital region of patients with VLS. 3–7 In agreement with the data of De Giorgi et al, 10 we did observe malignant transformation of hyperpigmented lesions on long-term follow-up. In all cases requiring histopathological confirmation, we observed benign melanosis.…”

Section: Discussionsupporting

confidence: 92%

“…In the general female population, different pigmented lesions of the vulva can be observed systematically in about 10% of cases and are most frequently ignored. [3][4][5][6][7] Our clinical long-term observations, however, suggest that pigmented skin changes are much more common in VLS patients than previously reported. Hence, we aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients.…”

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confidence: 65%

“…Therefore, hyperpigmented anogenital skin lesions require careful inspection with each full-skin or gynecologic examination, followed by dermoscopy and/or biopsy of any suspicious lesion. [3][4][5][6][7] With respect to vulvar melanosis, De Giorgi et al 10 recently have shown in an over 20-year follow-up study that this condition has a benign nature and changes in lesions over time do not show malignant transformation. However, this study did not systematically evaluate which comorbidities (eg, VLS) were associated with vulvar melanosis.…”

Section: Discussionmentioning

confidence: 99%

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Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus

Gambichler,

Erdogan,

Weyer-Fahlbusch

et al. 2024

International Journal of Women’s Dermatology

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Background: Pigmented lesions such as melanosis have rarely been reported in patients with vulvar lichen sclerosus (VLS) that is typically characterized by hypopigmented lesions. Objective: We aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients. Methods: We analyzed the clinical data of 198 female patients with VLS. The anogenital lesions of all patients were professionally photographed in a standardized position and illumination. Severity classification of architectural findings followed an easy-to-use clinical score. A modified Melasma Area and Severity Index and an image analysis software were used to evaluate the area and intensity of pigmentation. Results: According to the clinical score, 79 (198/39.9%) patients showed grade 1 disease, 78 (198/39.4%) grade 2, 37 (198/18.7%) grade 3, and 4 (198/2%) grade 4 disease. About 111 (56.1%) of the 198 patients had anogenital melanosis with a median modified Melasma Area and Severity Index of 3.6 (0.4–14). Univariate analysis revealed that anogenital melanosis was positively correlated with the use of topical estrogens (P = .0018) and negatively correlated with the use of pulsed high-dose corticosteroids plus low-dose methotrexate (PHDC-LDM, P = .021). On multivariable analysis, the use of topical hormone therapy turned out to be a strong independent predictor for the presence of anogenital melanosis (odds ratio: 4.57, 95% confidence interval: 1.66–12.57, P = .0033), whereas PHDC-LDM use was an independent predictor for the absence of anogenital melanosis (odds ratio: 0.35, 95% confidence interval: 0.15–0.84, P = .018). Limitations: The study includes the retrospective monocentric design. Conclusion: Anogenital melanosis is a very frequent and so far, under-reported clinical finding in VLS patients. It is likely caused by the use of topical estrogens employed for VLS treatment. In contrast, patients with more severe disease and PHDC-LDM treatment appear to develop less likely anogenital melanosis.

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Section: Discussionsupporting

confidence: 92%

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confidence: 65%