Koebnerization of Lichen Sclerosus Et Atrophicus at Insulin Injection Sites – A Rare Case with Dermoscopic Features

Vishwanath, Tejas; Ghate, Sunil; Shinde, Geeta; Lahoria, Vikram; Binny, Binny; Sonwane, Ankita

doi:10.4103/ijd.ijd_634_18

Cited by 4 publications

(1 citation statement)

References 12 publications

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“…There are also reports about koebnerization of eLS after insulin injections, influenza vaccination and intramuscular drug administration ( 63 – 65 ). Periostomal LS around urostomies are described as uncommon complications, possibly due to local trauma, occlusion and urine irritation ( 66 ).…”

Section: Risk Factorsmentioning

confidence: 99%

Lichen sclerosus: The 2023 update

et al. 2023

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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.

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Section: Risk Factorsmentioning

confidence: 99%

Lichen sclerosus: The 2023 update

et al. 2023

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Side effects of insulin and oral antihyperglycemic drugs

D’Souza

Alnaif

Ray

2022

Side Effects of Drugs Annual

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Complex anti-relapse therapy of various variants of the course of the vulvar lichen sclerosus: A randomized prospective study

Kolesnikova,

Zharov,

Mingaleva

et al. 2024

Gynecology

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Aim. To develop and evaluate the effectiveness of complex therapy of vulvar lichen sclerosus (VLS), considering the clinical and immunological variant (CIV) of the disease. Materials and methods. A randomized prospective study included 292 patients 20-70 years old with different CIVs of the VLS course: atrophic (n=101), sclerosing (n=154), scleroatrophic (n=37), as well as 35 females with VLS in the comparison group of the same age category. Based on the clinical, immunological, and morphological features of the VLS course, a complex anti-relapse therapy was developed, the effectiveness of which was evaluated after a year of follow-up in comparison with the standard of care (SoC) of patients (from the comparison group) based on the number of disease relapses and the results of the Vulvar Quality of Life Index Questionnaire (VQLI) survey of women with vulvar diseases. Results. In patients with the sclerosing variant of VLS, short courses of topical glucocorticoids during exacerbations are justified; in patients with the scleroatrophic variant – topical calcineurin inhibitors, in the atrophic variant – a protein-peptide complex from porcine blood leukocytes (vaginal suppositories and cream-balsam with lanolin) containing interleukin-1, 6, tumor necrosis factor α, transforming growth factor, macrophage migration inhibitory factor. Patients with any variant of VLS are instructed to follow household and hygienic recommendations, use emollients daily, take prophylactic doses of vitamins A, E, and D to correct its deficiency or insufficiency, as well as use local enzyme therapy, as indicated, aimed at preventing or treatment of cicatricial changes. Local estrogens were prescribed only to women with genitourinary menopausal syndrome in the peri- and postmenopausal period. The developed complex anti-relapse therapy of VLS showed greater clinical efficacy compared to SoC: 3.7-fold decrease in episodes of disease exacerbation, as well as a significant (p=0.001) 1.3-fold decrease in the negative effect of VLS on the QoL of patients in the main clinical group (15.4 points according to the VQLI assessment – a mild effect on QoL) compared to SoC with the average score of 27.6, which corresponded to a strong negative effect of the disease on QoL. Conclusion. The results of the study support the distinction of VLS CIVs and the need to consider their features when choosing an effective therapy for the disease. Properly selected complex, supportive therapy of VLS can significantly increase the QoL of patients, minimize the number of relapses, and prevent the development of complications, including, probably, the risk of malignant transformation.

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Koebnerization of Lichen Sclerosus Et Atrophicus at Insulin Injection Sites – A Rare Case with Dermoscopic Features

Cited by 4 publications

References 12 publications

Lichen sclerosus: The 2023 update

Lichen sclerosus: The 2023 update

Side effects of insulin and oral antihyperglycemic drugs

Complex anti-relapse therapy of various variants of the course of the vulvar lichen sclerosus: A randomized prospective study

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