1/7. Surgicel in the management of labial and clitoral hood adhesions in adolescents with lichen sclerosus. STUDY OBJECTIVE: Lichen sclerosus (LS) is an inflammatory dermatosis of the vulva with potentially destructive consequences to the young woman's perineum. Long-term sequelae include atrophy of the labia minora, scarring of the clitoral hood, and labial and/or clitoral hood adhesions. This study aims to find techniques for preventing these devastating effects. PARTICIPANTS: Three young women, ages 14 and 15 years, with a long history of lichen sclerosus and labial adhesions, presented with recurrent labial and periclitoral adhesions. Increasing pain prior to presentation, exquisite enough to inhibit even walking, necessitated urgent operative intervention. Scarring of the clitoral hood with an area of firmness beneath the scarring was present. Sharp dissection of the clitoral hood was performed with the entrapped keratinaceous debris and hair expressed. The adherent labia were separated. Surgicel, oxidized regenerated cellulose gauze (Johnson & Johnson, Arlington, TX), was sutured to the exposed clitoral hood and labial surfaces with vicryl suture. Complete dissolution of the Surgicel occurred between postoperative day 4-6 without recurrence of adhesions. One-year follow-up did not reveal any evidence of recurrence in any of the three patients. CONCLUSION: The recurrence of labial and clitoral hood adhesions in young women with a history of LS was prevented for at least 1 year by surgical lysis and application of Surgicel to the affected area. This technique has prevented the recurrence during the interval when these surfaces are at highest risk of re-agglutination. ( info) |
| Large numbers of milia were seen in areas of skin affected with bullae in a 68-year-old woman who had extensive lichen sclerosus et atrophicus. Although milia are frequently seen in other sub-epidermal bullous disorders, they have not previously been reported in lichen sclerosus et atrophicus. ( info) |
3/7. Mucinous metaplasia of the vulva in a case of lichen sclerosus. A case report. Mucinous metaplasia of the genital area is a rare condition characterised by the emergence of mucin containing cells in stratified squamous epithelium. This report describes a unique case of benign mucinous metaplasia of the vulva associated with lichen sclerosus in a 60 year old woman. Histopathology revealed cervical type metaplasia with otherwise typical lichen sclerosus. This report discusses the pathogenesis and differential diagnosis of mucinous epithelium. ( info) |
4/7. Lichen sclerosus involving the vagina. BACKGROUND: A review of the English literature since 1940 did not reveal a reported case of lichen sclerosus involving the vaginal mucosa. diagnosis of lichen sclerosus involving the vagina must thus be a rare occurrence. CASE: This report presents the findings on a 54-year-old white woman with a history of lichen sclerosus involving the vulva. She was found to have lichen sclerosus involving the vaginal mucosa extending to the posterior vaginal fornix. The patient was started on the use of topical clobetasol ointment 0.05% to the vulva to be used twice daily for 1 month, at bedtime for 2 months, and every other day for 3 months. At follow-up, the vulvar and vaginal lichen sclerosus was unchanged, but the patient was asymptomatic. She was using the clobetasol 1 to 2 times per week. CONCLUSION: Lichen sclerosus involving the vagina is a rare occurrence. Each case must be assessed separately and therapy initiated accordingly in each circumstance. biopsy must be performed in all cases to identify the disease process and rule out malignancy. ( info) |
5/7. Childhood lichen sclerosus. Presented is a case of a 6-year-old girl with biopsy-proved lichen sclerosus et atrophicus (LSA) localized to the anogenital region. She was seen approximately 3 months after the development of vulvar pruritus and burning on micturition. Following vulvar biopsies the patient was treated with hydrocortisone cream. Four months postbiopsy the patient is asymptomatic but with the coalesced white plaques remaining. Although cases benefiting from such various regimens as estrogen creams have been reported in the literature, the major benefit of therapy is relief of symptoms. This may be more safely accomplished with treatment of any vaginal discharge and the use of topical hydrocortisone cream. In children with regression of lichen sclerosus, complete resolution is common. No definite relationship to the menarche is documented. ( info) |
6/7. Familial vulvar dystrophy of lichen sclerosus type. lichen sclerosus et atrophicus (LS&A) of the vulva and perianal skin is an atrophic condition that con occur alone or in association with additional lesions situated elsewhere on the skin surface. The cases of three sisters with LS&A of the vulva are reported herein; in one a squamous cell carcinoma developed in a hyperplastic area of mixed dystrophy (LS&A with foci of hyperplasia). Familial occurrences of LS&A are rare. Malignant neoplasms arising in areas of LS&A have been reported previously. Squamous cell carcinoma arises in hyperplastic areas of mixed dystrophy where there is evidence of both LS&A and epithelial hyperplasia. ( info) |
7/7. Chronic white plaque of the vulva in postmenopausal women. We report 13 cases of white lesions in the vulva in postmenopausal women. Nine cases had clinical and histological features typical of lichen sclerosus et atrophicus (LSA). Two cases exhibited mild histological changes suggestive of LSA. Two cases of normal-appearing histology without significant histological changes. Considering the relatively short duration of the disease and relatively small lesions in the last two cases, they may be considered to represent the initial stage of LSA. ( info) |