Lichen sclerosus

Lichen sclerosus

Paolo Inghirami1 – Orcid, Roberto Senatori– Orcid

1 – Medical Director, Obstetrics and Gynecology, S. Eugenio Hospital, Rome

2 – Freelance Professional, Villa Margherita Nursing Home, Rome

Corresponding author: Paolo Inghirami

inghiramip@tiscali.it


DOI: 10.53146/lriog120218

Abstract

Lichen Sclerosus (LS) is a chronic inflammatory disease of genital and extra-genital muco-cutaneous districts, presenting a double pick of incidence in pre-puberty and peri-post menopausal women. The pathognomonic symptomatology is represented by itch, but also pain, dysuria, restriction of micturition and entry dyspareunia. If not treated, it might cause a significant and permanent subversion of vulvar anatomy with scarring of the clitoral hood, stenosis, and disappearance of skin reliefs. Uncertainty exists around its pathogenesis, however, there are important hypotheses involving an autoimmune target for its formation and progression. The gold standard in treatment is topical steroids. Second line treatment includes calcineurin inhibitors, phototherapy, plated-rich plasma therapy, fractional Co2 laser. Surgery is reserved only for the treatment of obliterative complications such as introital stenosis. Patient education and long follow up have primary importance.

Keywords: lichen sclerosus; itching; topical steroids; differentiated VIN.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar condilomatosis

Vulvar condilomatosis

Roberto Senatori 1 – Orcid, Barbara Dionisi 2 – Orcid

1 – Board member of SICPCV (Italian Society of Colposcopy and Cervical Vaginal Pathology)

Board member of AGEO (Association of Extra-Hospital Gynecologists)

Coordinator of the Multi-specialty HPV Center, Villa Margherita Nursing Home, Rome

2 – Freelance Professional, Rome

Corresponding author: Roberto Senatori

robertosenatori@gmail.com


DOI: 10.53146/lriog120213

Abstract

Vulvar condylomatosis is a major health problem. It is a benign epithelial proliferative viral lesion that can affect any area of the vulvo-perineal district supported by human papilloma virus (HPV).
The clinical manifestation, the lesion recognizable through direct observation, is defined condyloma.
Often the patient realizes on her own the presence of condylomas in the vulval area or because she feels itchy during the growth phase of the formations, resulting in a strong emotional and psychosexual impact. Conventional diagnosis is based on clinical examination, also called vulvologic examination, which is the objective examination of the area as a whole. Only in very rare cases is a biopsy necessary. The most common diagnostic errors are related to genital, physiological or pathological manifestations, which can mimic the HPV-pathology and which require a different diagnostic and therapeutic approach. The aim of the therapy is to eliminate lesions, promote the remission of symptoms where present, prevent sequelae and restore the physiological morphology and function of tissues. The therapies, indicated by international guidelines, can be subdivided, according to the mode of action, into surgical, cytotoxic and immuno-modulating and are often used in combination with each other. The most important problem in the treatment of genital warts lesions is the high frequency of recurrence, estimated at 20-30%, which is a function of the host’s immunocompetence.
The only method to prevent HPV infection is vaccination.

Keywords: hpv; genital warts; therapy; recurrence; counselling.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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