Genital piercing: A warning for the risk of vulvar lichen sclerosus

Giorgi, Vincenzo De; Scarfì, Federica; Silvestri, Flavia; Maida, Pierandrea; Venturi, Federico; Trane, Luciana; Gori, Alessia

doi:10.1111/dth.14703

Cited by 9 publications

(8 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Periostomal LS around urostomies are described as uncommon complications, possibly due to local trauma, occlusion and urine irritation ( 66 ). There are reports of LS after intimate body piercing ( 67 , 68 ). Postirradiation eLS was described in patients treated for breast neoplasm, and VLS after vaginal cancer radiotherapy ( 69 – 71 ).…”

Section: Risk Factorsmentioning

confidence: 99%

Lichen sclerosus: The 2023 update

et al. 2023

View full text Add to dashboard Cite

Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.

show abstract

Section: Risk Factorsmentioning

confidence: 99%

Lichen sclerosus: The 2023 update

et al. 2023

View full text Add to dashboard Cite

show abstract

Section: Case Reportmentioning

confidence: 99%

“…Di Giorgi et al reported one case of vulval LSc associated with genital piercing, although no urinary association was identified in this case and the authors attributed the case to repetitive trauma and irritation from the piercing. 3 The aetiology of LSc is uncertain with several potential aetiological factors (genetic, autoimmunity, infectious agents, trauma, and environmental) proposed in its pathogenesis. 1,2 There is growing evidence that chronic exposure of susceptible genital epithelium to urine under occlusion plays an important role in the development of the condition.…”

Section: Case Reportmentioning

confidence: 99%

“…1,2 There is growing evidence that chronic exposure of susceptible genital epithelium to urine under occlusion plays an important role in the development of the condition. [1][2][3][4][5][6][7] This hypothesis is supported by several clinical observations including (i) the variation in anatomical distribution between men and women that follow sites of urinary occlusion, (ii) the observation that LSc is vanishingly rare in men circumcised at birth but observed in circumcised patients with hypospadias, 2 (iii) cases of MGLSc that have been described in circumcised men with perineal urethrostomies (that predispose to chronic urinary leakage onto otherwise normally uninvolved genital skin) (Table 1) 2,8-10 and (iv) the high prevalence of post-micturition incontinence 'dribbling' among those with MGLSc compared with health controls 6 due to an abnormal naviculomeatal meatal fossaan embryogenic forme fruste of hypospadias. 11 In these men, urine becomes trapped between the glans and the inner aspect of the prepuce.…”

Section: Case Reportmentioning

confidence: 99%

See 1 more Smart Citation

Lichen sclerosus following genital piercing

et al. 2022

View full text Add to dashboard Cite

Male genital lichen sclerosus (MGLSc) is a chronic inflammatory dermatosis that predominantly affects uncircumcised males. Several aetiological factors have been described, with growing evidence supporting chronic urine exposure of susceptible epithelium being crucial to its pathogenesis. We describe a 45-year-old man with a 2-year history of MGLSc at the site of a urethrocutaneous fistula secondary to a penile piercing. To our knowledge, this is the first documented case of MGLSc occurring at the site of a genital piercing.

show abstract

“…The Koebner phenomenon, also termed isomorphic response, which describes the occurrence of clinically and histologically disease specific lesions on normal appearing skin after trauma, is described in LS [2]. Mechanical factors like friction due to tight clothing, occlusion, sexual intercourse, tissue damage during childbirth, genital jewellery and piercing, surgery, radiotherapy and scars, in general, are thought to trigger and maintain genital LS [31,[95][96][97][98][99][100][101].…”

Section: Triggering Factorsmentioning

confidence: 99%

Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects

et al. 2021

View full text Add to dashboard Cite

Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.

show abstract

Genital piercing: A warning for the risk of vulvar lichen sclerosus

Cited by 9 publications

References 9 publications

Lichen sclerosus: The 2023 update

Lichen sclerosus: The 2023 update

Lichen sclerosus following genital piercing

Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects

Contact Info

Product

Resources

About