No abstract

Twenty patients with vulvar dystrophy (19 Lichen sclerosus, 1 Lichen ruber planus) were treated for 3 months with etretinate (Tigason) with an initial dose 0.54 mg/kg/day, maintenance dosage 0.26 mg/kg/day. All the patients had been unsuccessfully treated previously with topical oestrogen and corticosteroids. The therapeutic effect of etretinate on the subjective and objective symptoms of the disease was excellent. In most of the patients the pruritus and burning symptoms diminished within 2 weeks of treatment, and after 3 months the grade of symptoms was lower in 95% of cases. Clinically, a decrease in severity was achieved in 93% of cases among the group with severe vulvar dystrophy. The therapeutic effect of etretinate is strongly anti-inflammatory and it has a powerful effect on the epidermal tissues. According to the latest studies, etretinate also has a strong immuno-modifying effect on the epidermal cells. The secondary inflammatory changes, such as excoriatia, fissures and superinfections disappeared. In the histopathological follow-up hyperkeratosis in the stroma diminished and the inflamed cells and connective tissue normalised after 3 months of treatment. Side effects included cheilitis, dryness of mucous membranes and slight loss of hair. It must be taken into account that etretinate may cause liquid metabolism disturbances, particularly among risk factor patients (diabetes, obesity etc.). In our experience the best results to date in the treatment of vulvar dystrophy can be achieved with etretinate. Due to the teratogenic effect of etretinate, a reliable method of contraception must be used by fertile women of childbearing age.

We studied the quantity of Langerhans cells in 36 patients with cervical human papillomavirus (HPV) infection. Significantly fewer Langerhans cells (p<0.05) were found in patients with compared to those without DNA tetraploidy. Similarly, patients positive for HPV 16/18 DNA by in situ hybridization or antipeptide IgA antibodies to HPV 18 tended to have fewer Langerhans cells than those negative for HPV 16/18 DNA or IgA antibodies. Our results suggest that depletion of Langerhans cells is associated with productive HPV 16/18 infection in the cervical epithelium.

Fifteen women with lichen sclerosus (LS) of the vulva were treated for 3 months with 0.6 mg/kg of etretinate. The clinical response was good in 11/15 of the patients and, in agreement with this, light microscopy showed decreasing atrophy and hyperkeratosis together with subsiding inflammatory changes. However, orcein staining demonstrated that even after etretinate treatment, elastic fibers were still absent in the upper dermis with only few fibers being detectable in some specimens. Conventional electron microscopy and immunoelectron microscopy were used to examine these changes more in detail. Antiserum to the microfibrillar part of the elastic fibers confirmed that only remnants of microfibrillar coat persisted in the upper dermis and that deeper in the dermis, elastic fibers were porous and fragmented. These findings demonstrate that despite the normalization of clinical and certain histological parameters during etretinate treatment, the initial elastic fiber damage persists both at the light- and electronmicroscopic levels.

Forty-six patients with Lichen sclerosus (Ls) of the vulva were treated with peroral etretinate for 3 months. The pretreatment serum levels of vitamins A and E, and selenium were measured. Etretinate therapy proved to be effective in the treatment of Ls; however, it did not affect the vitamin A status of the Ls patients. Vitamin E and selenium levels did not differ from the control values, nor did they have any prognostic value.