Clinical and morphological stages vulvar lichen sclerosus

Sokolova, Anastasiia V.; Владимировна, Соколова Анастасия; Apolikhina, I.A.; Анатольевна, Аполихина Инна; Zaitsev, Nikon V.; Владимирович, Зайцев Никон; Chernukha, Lyudmila V.; Владимировна, Чернуха Людмила

doi:10.26442/20795696.2020.4.200278

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…В поверхностных слоях дермы отмечался фиброз с отложением масс гиалина, а также редукция кровеносных сосудов мелкого калибра, окруженных клеточным воспалительным инфильтратом из лимфоцитов и макрофагов (рис. [14][15][16][17]. При наличии у пациенток клинически участков экскориаций, при морфологическом исследовании в поверхностных слоях дермы кровеносные сосуды были неравномерно эктазированы, а в их стенках отмечалось развитие рыхлой и плотной соединительной ткани (рис.…”

Section: результаты и обсуждениеunclassified

Morphological features of various variants of the course of scleroatrophic lichen of the vulva

Колесникова

Жаров

Todorov

et al. 2023

Vestn. Ross. univ. družby nar., Ser. Med.

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Relevance. Most of the scientific papers presented in the literature indicate morphological features of the stages of development of sclerotic lichen of the vulva, or in comparison with other vulvar skin lesions. At the same time, data on the features of morphological examination of vulvar biopsies, depending on the clinical variants of the course of sclerotic lichen of the vulva, is currently insufficient. The aim of the study - to determine the presence or absence of distinctive morphological features of the sclerotic lichen of the vulva, depending on the clinical variants of its course. Materials and Methods. The study included 292 patients with sclerotic lichen of the vulva (20-70 years old). Based on the scale of assessment of objective and subjective clinical signs of sclerotic lichen of the vulva developed by us, 3 clinical groups: 101 patients with an atrophic variant of the course, 154 with a sclerosing variant and 37 patients with a scleroatrophic variant of the course of sclerotic lichen of the vulva. In addition to clinical laboratory, instrumental and immunological studies, all patients underwent incisional biopsy of the vulva followed by morphological examination of biopsies. Results and Discussion. The features of the results of morphological examination of various clinical variants of the course of sclerotic lichen of the vulva are described and presented in the form of images. The characteristic morphological signs for each clinical group, as well as common signs characteristic of all variants of the course of this pathology, were revealed. Morphological examination of vulvar tissues is informative only to confirm the diagnosis of «Sclerotic lichen of the vulva», to determine the stage of the disease, as well as to exclude the malignant process, while for a clear differentiation of variants of the clinical course of sclerotic lichen of the vulva, conventional morphological examination is not enough, which requires further studies using immunohistochemical and molecular genetic methods. Conclusion. The revealed differences in morphological parameters of various variants of the course of sclerotic lichen of the vulva are insufficiently specific, which excludes the possibility of accurate morphological verification of the variants of the course of sclerotic lichen of the vulva and confirms the expediency of using clinical classification of variants of the course of sclerotic lichen of the vulva based on objective and subjective clinical signs.

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Section: результаты и обсуждениеunclassified

Morphological features of various variants of the course of scleroatrophic lichen of the vulva

Колесникова

Жаров

Todorov

et al. 2023

Vestn. Ross. univ. družby nar., Ser. Med.

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Immune pathogenesis and immune therapy of a sclerosing variant of vulvar lichen sclerosus: a prospective cohort study

Kolesnikova,

Zharov,

Penzhoyan

et al. 2023

Kuban. nauсh. med. vestnik

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Background. Today, no unified clinical classification of vulvar lichen sclerosus is registered (is yet to be registered?). Isolation of pathogenetically and clinically different variants of its course enable new approaches to the treatment to be developed. Objective. To develop a pathogenetic therapy for the sclerosing variant of vulvar lichen sclerosus, taking into account its clinical and immunological characteristics. Methods. A prospective cohort study was conducted from 2018 to 2022 on the basis of Regional Clinical Hospital No. 2, Krasonodar, Russia. 292 patients aged 20 to 70 years were histologically diagnosed with vulvar lichen sclerosus. After a clinical examination using the scale for assessing subjective and objective clinical signs of vulvar lichen sclerosus, 154 patients with a sclerosing variant of the disease course were selected for the study. The control cohort consisted of 30 women of the same age category without vulvar lichen sclerosus, taking into account the exclusion criteria. The study involved a clinical assessment (in points) of objective and subjective criteria characteristic of this variant of vulvar lichen sclerosus, as well as an assessment of the level of cytokines (interleukin-20; interleukin-23; interleukin-10; tumor necrosis factor α, interferon γ) in peripheral blood of the patients from the main and control groups. One month after the immunotherapy with sodium deoxyribonucleate, the authors evaluated its clinical efficacy (using Numerical rating scale for pain (vulvodynia) and Vulvar pruritus severity scale) and immunological efficacy (repeated assessment of the level of the studied cytokines). Analysis and statistical processing of the obtained data were performed using Graph Pad Prism version 6.0 (GraphPad Software, Inc., San Diego, CA). Results. Depigmentation of the vulvar skin against the background of vulvar sclerosis and thickening features a sclerosing variant of vulvar lichen sclerosus compared to vulvar atrophy. Stenosis of the vaginal vestibule is either absent (51.3%) or predominantly corresponds to grade I, and is less specific than depigmentation and even skin atrophy. The subjective signs include a severe vulvar pruritus without or with moderately expressed (in 68.1%) vulvodynia. An immunological study showed a statistically significant increase in the level of interleukin-20 (p < 0.0001), interleukin-23 (p < 0.0001), interferon-γ (p < 0.03), tumor necrosis factor α (p < 0.009) in patients with maximal tissue sclerosis with respect to the control group, along with a statistically significant decrease in the level of anti-inflammatory interleukin-10 (p < 0.01). The immunological efficacy of sodium deoxyribonucleate was confirmed by a statistically significant (compared to baseline) decrease in interleukin-20 (p < 0.0001), interferon-γ and tumor necrosis factor α (p < 0.002), interleukin-23 (p < 0.012) without statistical differences with the control group (except for interleukin-23, the level of which decreased after therapy but remained statistically higher (p < 0.01) than in the control group). Clinical efficacy of immunotherapy was confirmed by a statistically significant (p < 0.001) reduction in vulvodynia and vulvar pruritus after the treatment. Conclusion. The obtained data demonstrate characteristic clinical features and immunological differences in relation to the norm in women with the sclerosing variant of vulvar lichen sclerosus, thereby justifying the use of sodium deoxyribonucleate in this variant with confirmed clinical and immunological efficacy.

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Experience of using laser shock-wave destruction in the treatment of focal squamous cell hyperplasia of the vulva (а case report)

Polukhova,

Umakhanova,

Yezhov

et al. 2024

Lazernaâ medicina

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The article demonstrates a clinical example of the effective application of laser shock-wave destruction for the treatment of a patient with focal squamous cell hyperplasia of the vulva. The example is illustrated in dynamics and shows the selective impact at biological tissues without damaging the neighboring areas. The effectiveness of the discussed technique has been confirmed and a stable long-term remission was observed

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Clinical and morphological stages vulvar lichen sclerosus

Cited by 3 publications

References 6 publications

Morphological features of various variants of the course of scleroatrophic lichen of the vulva

Morphological features of various variants of the course of scleroatrophic lichen of the vulva

Immune pathogenesis and immune therapy of a sclerosing variant of vulvar lichen sclerosus: a prospective cohort study

Experience of using laser shock-wave destruction in the treatment of focal squamous cell hyperplasia of the vulva (а case report)

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