Lichenoid vulvar dermatoses are a heterogeneous group of diseases characterized by a number of overlapping signs and/or morphological features. Clinical similarity is accounted for by the appearance of small discrete papules with closely adjacent superficial squamae. The prototype of lichenoid dermatoses is lichen ruber planus. Histologically, lichenoid pattern is characterized by basal epithelial cell damage and a band-like infiltrate in the upper dermis. The International Society on Vulvovaginal Diseases categorizes lichen ruber planus and early lichen sclerosus as dermatoses with this histological pattern. Some authors also classify plasma cell (Zoon) vulvitis as lichenoid vulvar dermatoses. The cause of diagnostic errors lies in the similarity of the clinical and histological presentations of lichenoid vulvar dermatoses. Dermatoscopy should be considered as an additional diagnostic test. Only few studies address the key dermatoscopic signs of vulvar dermatoses. Histological study is important for the differential diagnosis. However, at some stages of disease evolution, vulvar dermatoses can have an overlapping histological pattern. This paper summarizes the data on the clinical, histological, and dermatoscopic presentation of the most common lichenoid vulvar dermatoses, i.e., lichen planus, lichen sclerosus, lichen simplex chronicus, and plasma cell vulvitis. KEYWORDS: lichenoid dermatoses, vulvar dermatoses, lichen sclerosus, lichen planus, lichen simplex chronicus, plasma cell vulvitis, Zoon vulvitis, dermoscopy. FOR CITATION: Parygina O.V., Smirnova I.O., Oganesyan M.V. et al. Lichenoid vulvar dermatoses: clinical presentation, morphology, and dermatoscopic signs. Russian Medical Inquiry. 2020;4(10):617–624. DOI: 10.32364/2587-6821-2020-4-10-617-624.

The main manifestations of COVID-19 are primarily interstitial pneumonia and respiratory failure. No less than 20% of patients have variable skin rashes, which try to be interpreted as markers and predictors of the peculiarities of the course of coronavirus infection. In addition, hair loss is a characteristic manifestation of COVID-19, and the salivary follicles are regarded as a target for SARS-CoV-2. The most common variants of alopecia in patients with a new coronavirus infection or vaccine-induced alopecia are acute telogenic, nondescript, and androgenetic alopecia. This review provides information on the most common variants of hair loss in patients with SARS-CoV-2 infection, the features of their manifestations, and possible mechanisms of development. Acute telogenic hair loss is the most common variant of SARS-CoV-2-induced alopecia, is characteristic of patients with subacute course of COVID-19 and can be combined with trichodynia, anosmia and aguvia, which are markers of nervous syste damage. Given the variability in the time of onset after infection, a heterogeneous pathogenesis of alopecia can be assumed. Nested alopecia after COVID-19 is often a relapse of the disease, its severity and frequency do not correlate with the severity of the infectious disease, and its prevalence in women indicates the importance of hormonal factors in its development. Androgenetic alopecia may be a predictor of high risk of infection, severe course, and recurrence of COVID-19. The first two variants of alopecia may be associated with COVID-19 vaccination, and the latter is a predictor of inadequate immune response to vaccine administration. The mechanisms of the damaging effects of SARS-CoV-2 on hair follicles have not been fully deciphered and are most likely complex, with different leading links in different types of hair loss. Deciphering these mechanisms may provide prerequisites for understanding the mechanisms of COVID-19 damage to other tissues and organs.

BACKGROUND: In view of the lacking ineffectiveness of the currently established treatment methods of men with genital lichen sclerosus (GLS), as well as the lack of evidence-based ways of managing patients at the rehabilitation stage, there exists a want for new approaches to solve this problem. AIMS: The aim of the research was to study the possibility of applying electrophoresis of an enzyme preparation from hydrobiont collagenases at the stage of rehabilitation in men with GLS. MATERIAL AND METHODS: Open-label randomized controlled trial comparing clinical efficacy of hydrobiont enzyme preparation and standard supportive emollient therapy at the stage of rehabilitation in men with confirmed GLS was conducted. The follow-up period lasted for 16 weeks. Clinical efficacy was estimated using specifically developed scores LS-S (surface area), LS-A (disease activity) and validated dermatologic life quality index (DLQI) at 6th and 16th week of follow-up. The primary study outcome was the comparative efficacy at 16th week as based on the evaluated scores. RESULTS: All patients (n=27) were given topical glucocorticoids (TGCs) at the first stage of the study during the first 6 weeks. The patients were then randomly allocated into 2 groups for the rehabilitation stage that lasted from 6th to 16th week of the study. The first group (primary group, n=13) were managed with electrophoresis of an enzyme preparation from hydrobiont collagenases. The second group (control group, n=14) were managed with emollients at the rehab stage. The age of patients in the first group and in the second group was 36,6216,04 and 41,939,34 years, respectively. At baseline before initiating treatment patients in both groups as judged by LS-S (p=0,110), LS-A (p=0,757) и DLQI (p=0,149) comparable. At 6th week after course of TGCs no statistically significant differences were detected. At the primary study outcome at 16th week scores LS-S (p=0,002), LS-A (р 0,001) and DLQI (р 0,001) evidenced significantly in favour of enzyme electrophoresis. CONCLUSION: During staged treatment, a more pronounced and long-lasting effect was observed in the group of patients with electrophoresis of the enzyme complex during the rehabilitation stage compared to the group with emollients

The article provides an overview of the use of platelet-rich plasma (PRP) for the treatment of lichen sclerosis (LS). The definition, principle of operation and main characteristics of this method are given. Studies showing the effectiveness of PRP method were analyzed. Based on our research, we believe that PRP may be an alternative to treatment with topical corticosteroids. The method is a new treatment method for LS, which requires further randomized controlled trials.

Lichen planus is among the most common chronic anogenital noninfectious dermatoses both in male and female. The disease is characterized by clinical polymorphism, frequent involvement of skin and oral mucosa and protracted course. Typical, hypertrophic and erosive forms are distinguished. Erosive variant is commonly encountered in women and has a prominent tendency for scarring. The most common anogenital form in men is the typical lichen planus, which usually resolves completely. Vulvovagino-gingival and penogingival lichen planus are rare severe disease forms. Evolutional and biological heterogeny of clinical manifestations complicates the disease diagnosis. Lichen planus pathogenesis remains unclear. Pronounced scarring tendency in anogenital cases is believed to be the consequence of epithelial-mesenchimal transition. High-quality clinical trials of various therapeutic modalities in anogenital lichen planus are lacking. Management of such patients is mostly based on case series reports, practical experience and general principles of dermatologic treatment. This review focuses on contemporary views on clinical presentation, pathogenesis, diagnosis and approach to therapy of anogenital lichen planus.