Liken Sklerozus

Abstract

Öğrenme HedefleriLiken sklerozusun etyopatogenezinde suçlanan faktörlerin belirlenmesi, klinik ve histopatolojik özelliklerinin tanınması, ayırıcı tanısına giren diğer dermatozların dışlanması, dermatozun ve tedavi sırasında ortaya çıkabilecek komplikasyonlarının ayırd edilebilmesi ve algoritmik tedavi programının oluşturulmasıdır. TanımLiken sklerozus (LS); porselen beyazı maküller ile karakterize, progresif, sklerozan inflamatuvar bir dermatozdur (1). Tarihçeİlk kez 1887 yılında, Hallopeau tarafından, liken planusun atrofik formu (lichen plan atrophique) şeklinde rapor edilen hastalığı, AbstractLichen sclerosus is a progressive, inflammatory dermatosis characterized with porcelain white sclerotic plaques most commonly in the anogenital area of postmenopausal women. Children and men can also be affected. Extragenital involvement may occur. Even though the etiology is unknown; autoimmune, genetic, hormonal and infectious factors are suggested. Lichen sclerosus is associated with autoimmune diseases such as thyroid disease, alopecia areata, vitiligo, diabetes and pernicious anemia. An increased incidence of autoantibodies to the extracellular matrix protein 1 is shown in sera of patients with lichen sclerosus. Familial occurence and an association with HLA DQ7 supports the presence of genetic factors in its etiology. However, the role of estrogen and androgens could not be demonstrated as etiologic factors. Clinical similarity with acrodermatitis chronica atrophicans led researches to be held for the detection of Borrelia burgdorferi antibodies ended with conflicting results. Disease may be triggered with trauma in the presence of genetic predisposition. Pruritus is the main symptom. Pain, burning and dysesthesia may occur. Lichen sclerosus may be confused with sexual abuse in girls. Furthermore, it is more severe in the presence of sexual abuse. If not treated it leads to permanent anatomical disorders in the anogenital region. It is one of the most common cause of acquired phimosis in boys. Meatal stenosis and urinary obstruction may develop. Erectile dysfunction and dyspareunia due to introital stenosis may cause psychosexual problems in men and women. Perianal involvement causes constipation in women and girls. Long-standing anogenital lesions have the risk of developing squamous cell carcinoma. Verrucous carcinoma rarely occurs. Extragenital symptoms do not have similar risks. Ultra-potent topical corticosteroids are used as the first line therapy. In the case of unresponsiveness to corticosteroids the alternative approaches are topical immunmodulators, UVA1, calcipotriol, retinoids, and photodynamic therapy. In the presence of neoplasia and other complications surgical interventions are considered. Due to mainly preputial involvement, circumcision is an alternative procedure to topical corticosteroids in men. Often it may be curative. Lichen sclerosus is a disease with serious complications that needs life-long follow-up. Patients should be trained and encouraged for effective participation to the treatment...

Vaginal Atrophy and Lichen Sclerosus: Case Report

“…Treatment of LS is performed to relieve the complaints of itching, pain, dysesthesia, and so on, and to prevent formation of anatomic defects and complications. Besides, it is also suggested that malignant transformation may be prevented by suppression of the inflammatory process [7] . Patients with vulvar LS are at increased risk of developing SCC [8] .…”

“…The total dose of potent topical corticosteroids should not exceed 30 g within 12 weeks. Topical corticosteroids should be discontinued if no response is obtained despite regular follow-up and treatment for 6 months [7] .…”

An uncommon cause of vulval pruritus in childhood: Lichen sclerosus

“…Çocukluk döneminde ergen kızlarda 1/900, erkek çocuklarda 1/200 oranında bildirilmiştir. Anogenital bölge tutulumu %85-98 arasında değişir (3,4). Klinik olarak, genital bölgede eritemli makül ve papüler olarak başlar.…”