Photodynamic Therapy in the Treatment of Vulvar Lichen Sclerosus: A Systematic Review of the Literature

Gerkowicz, Agnieszka; Szczepanik-Kułak, Paulina; Krasowska, Dorota

doi:10.3390/jcm10235491

Cited by 14 publications

(8 citation statements)

References 49 publications

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“…From a histological point of view, complete tissue recovery was characterized by the absence of a zone of homogenization of the dermis and the absence of inflammatory signs of VLS. Previously published histological findings after topical PDT with 5-aminolevulinic acid (5-ALA-PDT) are inconsistent [ 48 ]. For this reason, some researchers did not record histological improvements after topical 5-ALA-PDT, and other authors stated only a decrease in the density of inflammatory cell infiltration.…”

Section: Discussionmentioning

confidence: 99%

Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study

Potapov,

Matveev,

Moiseev

et al. 2023

IJMS

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Photodynamic therapy (PDT) is a modern treatment for severe or treatment-resistant vulvar lichen sclerosus (VLS). The chronic and recurrent nature of VLS requires control of recurrences at an early stage. In this paper, a non-invasive multimodal optical coherence tomography (OCT) method was used to control for early histological signs of VLS recurrence after systemic PDT using Photodithazine®. To interpret the OCT data, a histological examination was performed before PDT and 3 months after PDT. Two groups of patients were identified: with early histological signs of VLS recurrence (Group I, n = 5) and without histological signs of VLS recurrence (Group II, n = 6). We use structural OCT, OCT angiography, and OCT lymphangiography throughout 6 months after PDT to visually assess the skin components and to quantitatively assess the dermis by calculating the depth-resolved attenuation coefficient and the density of blood and lymphatic vessels. The OCT data assessment showed a statistically significant difference between the patient groups 3 months after PDT. In Group II, all the studied OCT parameters reached maximum values by the 3rd month after PDT, which indicated recovery of the skin structure. At the same time, in Group I, the values of OCT parameters did not approach the values those in Group II even after 6 months. The obtained results of multimodal OCT can be used for non-invasive control of early histological recurrence of VLS after systemic PDT and for adjusting treatment tactics in advance, without waiting for new clinical manifestations of the disease.

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Section: Discussionmentioning

confidence: 99%

Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study

Potapov,

Matveev,

Moiseev

et al. 2023

IJMS

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“…Unfortunately, the great heterogeneity of light sources, formulations, and photosensitizer types reported in literature makes comparison and analysis difficult. Moreover, PDT has been used with satisfying results in adults for other dermatologic conditions which may be explored also in pediatric patients, including connective tissue disorders, such as chronic lupus erythematosus or morphea/scleroderma, genital and oral lichen planus, lichen sclerosus, and several types of scars ( Kvaal et al, 2013 ; Gordon Spratt et al, 2015 ; Wennberg, 2015 ; Borgia et al, 2016b ; Gerkowicz et al, 2021 ). Specific protocols for pediatric patients as well as the length of follow-up intervals must be better standardized in larger RCT studies in order to draw up shared guidelines taking full advantage from such versatile treatment.…”

Section: Discussionmentioning

confidence: 99%

Photodynamic therapy in pediatric age: Current applications and future trends

et al. 2022

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Photodynamic therapy (PDT) is a photochemotherapy based on local application of a photosensitive compound and subsequent exposure to a light source of adequate wavelength. It is a non-invasive therapeutic procedure widely used in oncodermatology for treatment of numerous skin cancers, but in the last years its use has been gradually extended to an increasing list of skin diseases of both infectious and inflammatory nature. Although PDT is proven as a safe and effective therapeutic option in adults, its use is not well standardized in the pediatric population. In this review, we will focus on clinical applications, mechanisms of action, protocols, and adverse events in children and adolescents. Most of pediatric experiences concerned treatment of skin cancers in Gorlin syndrome and xeroderma pigmentosum, acne vulgaris, and viral warts, but other applications emerged, such as cutaneous lymphoma and pseudo-lymphomas, necrobiosis lipoidica, hidradenitis suppurativa, dissecting cellulitis, leishmaniasis, angiofibromas, verrucous epidermal nevus, and linear porokeratosis. In these pediatric diseases, PDT appeared as an effective therapeutic alternative. The results on vitiligo were limited and not fully encouraging. Although highly versatile, PDT is not a therapy for all skin diseases, and a deeper knowledge of its mechanisms of action is required to better define its spectrum of action and safety in pediatric patients.

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“…Photodynamic therapy (PDT) with topical 5-aminolevulinic acid is a valid option to treat incoercible pruritus in VLS, when other therapies have failed ( 9 ). However, clinical and histological improvements are controversial ( 160 ). Objectively, some cases reported healing of superficial erosions and improvement of the clinical signs, whereas others demonstrated no clinical changes after PDT ( 161 – 164 ).…”

Section: Managementmentioning

confidence: 99%

Lichen sclerosus: The 2023 update

et al. 2023

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Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.

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Photodynamic Therapy in the Treatment of Vulvar Lichen Sclerosus: A Systematic Review of the Literature

Cited by 14 publications

References 49 publications

Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study

Multimodal OCT Control for Early Histological Signs of Vulvar Lichen Sclerosus Recurrence after Systemic PDT: Pilot Study

Photodynamic therapy in pediatric age: Current applications and future trends

Lichen sclerosus: The 2023 update

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