Hirsutism _ excesive terminal hair growth in the women on a male pattern distribution-face, body(sexual hear,androgendependent)-common in PCOS
Hypertricosis_ can involve of vellus, lanugo, nonpigmanted hair and terminal hear occupying the entire body surface including the face ( androgen independent disorder)- congenital, caused by drugs, hypothyroidism, anorexia nervosa
Virilization _ production of androgens in women is extremely high (presence of clitoromegaly,alopecia- balding, deepening of the voice- bariphonia, male body habitus)-usually caused by androgen producing tumors, CAH
Acne _ du to hyperceratosis and occlusion of duct of sebaceum gland plus inflammation( multifactoral, androgendependent)
Acanthosis nigricans _ skin grey- brown ,velvety appearance mainly in the neck, axillae,vulva and groin (local hyperpigmentation of skin on specific area-marker of hyperinsulinemia/insulinresistance)
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
Hirsutism _ excesive terminal hair growth in the women on a male pattern distribution-face, body(sexual hear,androgendependent)-common in PCOS
Hypertricosis_ can involve of vellus, lanugo, nonpigmanted hair and terminal hear occupying the entire body surface including the face ( androgen independent disorder)- congenital, caused by drugs, hypothyroidism, anorexia nervosa
Virilization _ production of androgens in women is extremely high (presence of clitoromegaly,alopecia- balding, deepening of the voice- bariphonia, male body habitus)-usually caused by androgen producing tumors, CAH
Acne _ du to hyperceratosis and occlusion of duct of sebaceum gland plus inflammation( multifactoral, androgendependent)
Acanthosis nigricans _ skin grey- brown ,velvety appearance mainly in the neck, axillae,vulva and groin (local hyperpigmentation of skin on specific area-marker of hyperinsulinemia/insulinresistance)
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
Rosacea is a chronic (long-term) disease
that affects the skin and sometimes the eyes. The disorder is characterized by
redness, pimples, and, in advanced stages, thickened skin. Rosacea usually
affects the face. Skin on other parts of the upper body is only rarely
involved.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV).
> than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Rosacea is a chronic (long-term) disease
that affects the skin and sometimes the eyes. The disorder is characterized by
redness, pimples, and, in advanced stages, thickened skin. Rosacea usually
affects the face. Skin on other parts of the upper body is only rarely
involved.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV).
> than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Massive Splenomegaly By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir Associa...Prof Dr Bashir Ahmed Dar
Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India,Associate Prof of medicine presently working in malaysia is a keen teacher, educator and takes pride in his clinical and research accomplishments. His interests include publishing articles related to health issues.Email drbashir123@gmail.com
Causes of Splenomegaly By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir Assoc...Prof Dr Bashir Ahmed Dar
Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India,Associate Prof of medicine presently working in malaysia is a keen teacher, educator and takes pride in his clinical and research accomplishments. His interests include publishing articles related to health issues.Email drbashir123@gmail.com
Lymphogranuloma venerum is a sexually transmitted disease caused by Chlamydia, primarily involving the lymphatics.
LGV is caused by Chlamydia trachomatis biovars L1, L2, and L3
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Lichen sclerosus
(LS) is a chronic
inflammatory
dermatosis that
results in white
plaques with
epidermal atrophy
and scarring.
Lichen sclerosus
3. Lichen sclerosus has both
genital and extragenital
presentations and also
goes by the names lichen
sclerosus et
atrophicus, balanitis
xerotica obliterans (glans
penis presentation), and
kraurosis vulvae.
5. Etiology and Pathogenesis
The etiology and pathogenesis of lichen sclerosus
is unknown but may include:
● Autoimmune factors.
● Genetic factors.
● Hormonal factors.
● Infections.
● Trauma.
6. Autoimmune Factors
Arguments supporting the hypothesis that LS is an
autoimmune disease include, on the one hand, the
greater prevalence of autoimmune diseases reported in
patients with LS and, on the other hand, the presence of
autoantibodies and a family history of immune disease.
Recently, low-titer autoantibodies against the
extracellular matrix protein-1 (ECM-1) and collagen XVII
have been identified in 67 % of LS.
Antibodies to basement membrane protein bp180 has
been detected in children with vulval LS lesions in 4 OF 9
lesions analyzed. All antibodies of IgG type.
7. Genetic Factors
Genetic factors have been proposed as underlying
the development of LS based on the presence of the
disease in several family members.
In identical twins and in nonidentical twins, various
studies have demonstrated that patients with HLA-
DQ715 are at higher risk of presenting LS.
Interleukin 1 receptor antagonist gene
polymorphism has also been associated with the
severity of LS.
8. Hormonal Factors
Sex hormones are considered to be an influential factor
in the development of LS.
On the one hand, peak incidence coincides with
decreased estrogen levels, such as during premenarche
and menopause, and thus a relevant role has been
attributed to estrogens in the development of LS.
Decreased levels of testosterone, androstenedione, and
dihydrotestosterone in patients with LS have also been
observed.
Despite this, treatment with estrogens and testosterone
has not demonstrated clear benefit in these patients.
9. Infection
Several microorganisms have been
associated with the appearance LS lesions:
● Borrelia burgdorferi
● Hepatitis C virus.
● Human papillomavirus.
10. Koebner Phenomenon
In LS, as in other skin diseases, lesions are
more often found in areas that have
undergone trauma.
Cases of LS have been reported following
sunburn and radiation therapy, and after
surgery, as occurs around vulvectomy scars.
11. Epidemiology
Frequency
International
The population rate is unknown. Male genital lichen sclerosus
is seen almost exclusively in uncircumcised or incompletely
circumcised men and boys.
Mortality/Morbidity
Lichen sclerosus has no associated increased mortality unless
the patient develops a malignancy in the area.
Extragenital cases and many genital cases are asymptomatic
except for the cosmetic aspect or pruritus.
Recalcitrant cases, especially those associated with erosion or
progressive scarring, may result in severe sexual dysfunction.
12. The male-to-female ratio is 1:6, with female genital
cases making up the bulk of reports.
Up to 15% of cases are in children with the majority
being vulvar presentations.
13. History
History
Extragenital lichen sclerosus may be asymptomatic
or it may itch, although itching is not usual.
Vulvar lichen sclerosus usually presents with
progressive pruritus, dyspareunia, dysuria, or genital
bleeding.
Penile lichen sclerosus usually is preceded by
pruritus but may present with sudden phimosis of
previously retractable foreskin, and urinary
obstruction can result.
14. Skin primary
lesion
Lichen sclerosus
usually begins as
white, polygonal
papules that
coalesce into
plaques.
Skin primary lesion
15. Evenly spaced dells or
comedolike plugs
correspond to obliterated
appendiceal ostia.
These may be easily
identified with
dermoscopy, keeping in
mind that other
conditions such as
chronic cutaneous lupus
may also show follicular
plugs.
16. With time, the plugs and
dells will disappear and
leave a smooth, porcelain-
white plaque.
Skin color is white, often
with a shiny porcelain
appearance.
Telangiectases and
follicular plugs may be
seen.
The size of the plaque or
plaques may vary widely
from a few millimeters
resembling lichen nitidus
to the entire upper trunk.
17. Vulvar lichen sclerosus may progress to gradual
obliteration of the labia minora and stenosis of the
introitus.
The most common variation occurs when the
inflammation is intense enough to cause separation
of a large area of epidermis, creating blisters or large,
occasionally hemorrhagic, bullae.
Because this occurs more often in genital cases, it
may be confused with the trauma of sexual abuse or
other genital ulcerative disease.
18. Given the high frequency
of genital mucosal
disease, it is surprising
that more oral cases have
not been reported.
Those rare cases
reported are usually seen
in patients with
widespread, generalized
lichen sclerosus.
19. Clinical Features
Genital “female lesions”.
Genital “male lesions”.
Perianal pyramidal protrusion.
Extragenital including mucosal lesions.
20. Female genital LS
The presentation of LS is usually similar in both sexes, with
the appearance of erythematous papules that coalesce
initially into erythematous plaques and then become white
and hard.
In women, the most frequent location is usually the
anoperineal region, forming a typical figure-8 pattern
around the labia minora and anus, without affecting the
vagina or hymen.
It usually presents with pruritus, dysuria, dyspareunia, or
pain on defecation, the most frequent symptom in girls and
a cause of constipation.
If the inflammatory process is intense and long-lasting,
atrophy, retraction of the vulva, and synechiae of the labia
minora that alter the structure of the external genitalia may
occur.
21. Female genital LS
Lichen sclerosus in a 6-year-old girl. Typical figure-8
pattern with perineal fissure.
Lichen sclerosus in a 50-year-old woman. Atrophic
white plaques in a figure-8 pattern.
22. Male genital LS
In men, anal involvement is rare, and the disease is
usually limited to the glans penis and prepuce. This
may lead to difficulties in retraction and pain
during erection.
A retrospective study of 522 patients reported that
the glans penis and prepuce were affected in 57%,
the meatus in 4% and the urethra in 20%.
Symptoms usually begin as in women, with
erythematous papules that turn white and then
progress to an atrophic band that can lead to
phimosis, paraphimosis, and urethral stenosis.
23. Often, an hourglass,
butterfly, or figure-8
pattern involves the
perivaginal and perianal
areas, with minimal
involvement of the
perineum in between.
24. advanced vulvar lichen
sclerosus; eroded areas
need to be carefully
examined and a biopsy
sample should be taken
to exclude coexistent
squamous cell
carcinoma.
Advanced vulvar lichen sclerosus
25. Male genital lesions
Male genital lesions
usually are confined to
the glans penis and the
prepuce or foreskin
remnants.
Penile shaft involvement
is much less common,
and scrotal involvement
is rare. The initial
manifestation may be a
sclerotic ring at the
prepuce edge.
26. Male genital LS
Lichen sclerosus in a 40-year-old
man. Shiny erythematous
plaques without infiltrates on the
glans penis
.
27. Perianal pyramidal protrusion
The term infantile
perineal pyramidal
protrusion -IPPP-
defines a benign
condition clinically
characterized by a
solitary pyramidal
protrusion, pink or skin
colored, localized on the
median perineal region
in front of the anus,
mainly affecting females.
28. Perianal pyramidal protrusion
The first reports of
perianal protrusions in
prepubertal girls date
back to 1989. Since then
about 90 cases of IPPP
have been reported.
This exophytic lesion
that develops in the
perianal region presents
histological signs
compatible with LS.
29. Extragenital LS
Extragenital involvement
occurs in 15% to 20% of
the patients, with
plaques that resemble
plaque morphea that are
usually asymptomatic.
They may be located on
any part of the body
(most often on the upper
back, neck and
abdomen).
30. Mucosal LS
The oral mucosa is rarely affected, with few cases
reported in the medical literature. It usually presents
as asymptomatic white plaques that affect the oral
mucosa and labial mucosa.
31. Complications
Synechiae: these particularly affect the labia minora,
forming adhesions that may surround the clitoris and lead
to phimosis.
In men, these adhesions cause phimosis and paraphimosis
of the prepuce, and may also lead to urethral stenosis.
Infections: these result from scratching and manipulation of
the affected region.
Epidermoid carcinoma: in women, the risk of malignancy is
4% to 6%,whereas recent studies have shown this to be
around 8% in men.
Malignancies have not been reported in extragenital
regions.
Sexual problems: dyspareunia, vulvodynia, and decreased
libido.
Constipation: this is usually a complication found in
untreated children arising from discomfort on defecation.
33. Laboratory Studies
Laboratory Studies
Skin biopsy (punch preferred) is the primary study
to perform for diagnosis of lichen sclerosus.
Despite the presence of autoantibodies described
in several studies, an autoimmune workup is still
not generally recommended.
34. Histologic Findings
Histologic
Findings
Classic lichen sclerosus
demonstrates a lichenoid
infiltrate in the dermal-
epidermal junction,
compact hyperkeratosis
with stratum corneum,
which often is thicker
than the greatly effaced
epidermis.
35. Remarkable edema in
the papillary (upper)
dermis is replaced by a
dense, homogenous
fibrosis as the lesion
matures.
Extensive and deeper
biopsies may show areas
more consistent with
scleroderma than classic
lichen sclerosus.
36.
37.
38.
39. Differential Diagnosis
In children, the differential diagnosis should take
into account lesions resulting from sexual abuse,
since these can present as erosions, fissures,
hematomas, bleeding, and secondary scars in the
anogenital area.
Several articles report that in certain cases there
is an association between LS and previous sexual
abuse (Koebner phenomenon).
41. Treatment
If a patient has suspected LS, a complete medical
history should be taken and any personal and
family background of immune disease thoroughly
explored (vitiligo, symptoms of diabetes, thyroid
disease symptoms, alopecia areata, or digestive
symptoms).
Physical examination should rule out extragenital
involvement, including involvement of the oral
mucosa.
Signs of active disease should be noted: erosions,
petekias, hemorrhages, and surface hyperkeratosis.
42. Asymptomatic extragenital lichen sclerosus usually requires
no treatment as control of pruritus rather than resolution of
the lesion, which is a more realistic goal of therapy.
The treatment goals are to reduce irritation, burning
sensations and pain, minimize scarring, and prevent
malignant transformation.
Before beginning pharmacological treatment, basic hygiene
measures should be recommended: neutral soap should be
used, irritants avoided, and cotton underwear used although
this should be worn as little possible, especially at night.
Emollients and lubricants should be used if needed and any
infections should be detected and treated.
43. The pharmacological treatment of choice in LS is highly
potent topical corticosteroids, such as 0.05% clobetasol
propionate, in children and in adults.
Treatment should begin with 1 or 2 applications per day
for 4 weeks, continue with 1 application every 48 hours
for another 4 weeks and, subsequently, 2 or 3
applications per week for 1 month more.
A checkup is recommended after 3 months of treatment,
and if symptoms of activity persist, topical
corticosteroids should be maintained (2 or 3 applications
per week) or be replaced by topical 0.1% tacrolimus or
topical 1% pimecrolimus 3 times per week.
44. Therapy with tazarotene (Tazorac) is off label for this medication
in this location and for this indication.
Especially in genital and other occluded areas, short-contact
therapy is used, in which the gel (or cream) is initially applied for
15 min and washed off. Every 2-3 wk, the time applied may be
increased by about 15 min until either therapeutic effect or
limiting adverse effects are noted.
If a patient is applying the medication for 3 h or more, they may
consider leaving the medication in place.
For extragenital lichen sclerosus, this may be applied and left in
place. This may be done in conjunction with topical steroid use.
Tazarotene has not been well studied for lichen sclerosus in
children, but application should be similar to adult usage.
A pregnancy test is recommended before starting therapy, and the
drug is category X (contraindicated).
Tazarotene may be irritating and is not likely to be tolerated on
open and denuded areas.
45. Other treatments for LS have been used, but none has
proven to be more effective than topical corticosteroids
in clinical trials. Topical 2% testosterone, despite being
more effective than placebo, is not superior to
corticosteroids in the treatment of LS.
The use of topical 0.005% calcipotriol applied daily for
1 week increasing to 2 daily applications for several
months will alleviate the pruritus.
Other treatments, such as carbon dioxide laser therapy,
cryosurgery, photodynamic therapy and phototherapy
(ultraviolet A161 and psoralen with ultraviolet lead to
improvements in symptomatology, although the
lesions persist, and require many treatment sessions
without achieving good cosmetic results.
In patients resistant to topical treatment, oral retinoids
can be used with good long-term results.
46. Surgery is reserved for the majority of the complications.
Adhesions and vulval synechiae should be treated by genital
reconstruction, despite the risk of recurrence.
In men, circumcision is the treatment of choice for lesions
that cause phimosis, and urethral dilatation in cases of
urethral stenosis.
In all cases complicated by carcinoma, surgery is the
treatment of choice.
All patients with LS symptoms should be treated due to the
risk of malignancy and to improve the quality of life.
The situation is less clear in asymptomatic patients and in
children. Each case should be considered on its own merits
and the advantages and disadvantages assessed, since
corticosteroid treatment involves several risks, but these
should be balanced against the risk of developing
carcinoma.