Lichen sclerosus

Lichen sclerosus

Paolo Inghirami1 – Orcid, Roberto Senatori– Orcid

1 – Dirigente medico UOC, Ostetricia e Ginecologia, Ospedale S. Eugenio, Roma

2 – Libero Professionista, Casa di Cura Villa Margherita, Roma

Autore di riferimento: 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.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Il clitoride: organo bersaglio di molte patologie vulvari

Il clitoride: organo bersaglio di molte patologie vulvari 

Pietro Lippa1 – Orcid, Federica Frascani2 – Orcid

1 – AIED, Viale Gorizia 14, Roma

2 – BIOS Via Archimede 12, Roma

Autore di riferimento: Pietro Lippa

dermatologopietrolippa@gmail.com


DOI: 10.53146/lriog120216

Abstract

This article aims to bring attention to how frequently the clitoris, despite being a small anatomical niche within the vulvar region, deserves careful diagnostic observation.
In fact, various inflammatory diseases often originate in the clitoral area and have specific clinical, symptomatic and perceptive characteristics. Lichen planus and scleroatrophic lichen are among the most frequent inflammatory vulvitis to originate in this anatomical region.
We describe in the morphological details all the diagnostic phases of these two pathologies. Often the pathologies affecting the clitoral area are subject to diagnostic delays for subjective reasons of the patients (delays in medical checks, long periods of tolerance of the disorders) or due to lack of attention from clinicians. We want to underline how an early intervention can determine a partial regression of an initial damage, its stabilization and, therefore, an improvement in the patient’s subjective perception with considerable advantages also for the relationship life. The clitoral area, being placed above the vulvar introitus, can very often be subject to in-depth observations. An adequate diagnostic observation, also with the help of the colposcope, a targeted biopsy and a consequent therapeutic behavior suitable for the clinical evolutionary phase in which the pathology itself is located, would also allow to intercept the possible proliferative changes that initially occur indeed in this anatomical site. On the basis of an algorithm based on these observations, it is possible to opt for drug therapy or non-invasive surgical therapy aimed at preventing and removing initially and potentially aggressive lesions.

Keywords: lichen sclerosus; lichen planus; vulva; clitoris; diagnosis; initial forms.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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