1/4. Successful carbon dioxide laser therapy for refractory anogenital lichen sclerosus.BACKGROUND: Lichen sclerosus is a chronic inflammatory dermatitis that often occurs in the anogenital area and presents a therapeutic challenge. Traditional medical management includes potent topical corticosteroids and is marked by variable results. OBJECTIVE: The objective was to describe the successful use of carbon dioxide laser ablation therapy in two women with refractory anogenital lichen sclerosus. methods: A case is reported and the literature is reviewed. RESULTS: Two women with medically recalcitrant anogenital lichen sclerosus were successfully treated with the carbon dioxide laser. Both patients tolerated the procedure well and had excellent surgical outcomes. CONCLUSION: Lichen sclerosus recalcitrant to medical therapy presents a therapeutic challenge This may be successfully treated with the carbon dioxide laser with excellent surgical results and minimal risk.- - - - - - - - - - ranking = 1keywords = lichen sclerosus, sclerosus, lichen (Clic here for more details about this article) |
2/4. Perianal and vulvar Crohn's disease presenting as suspected abuse.Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.- - - - - - - - - - ranking = 0.15451958854737keywords = lichen sclerosus, sclerosus, lichen (Clic here for more details about this article) |
3/4. Lichen sclerosus, genital trauma and child sexual abuse.OBJECTIVE: To describe the clinical features of lichen sclerosus affecting the genitalia of three unrelated prepubertal girls in whom concerns of sexual abuse had been raised. CLINICAL FEATURES: three girls ranging from 4 to 9 years of age presented with similar genital and anal findings. Their labial skin was atrophic with pale opalescent patches and a variable amount of labial bruising, haemorrhagic blistering and bleeding. In two, the perianal skin was involved in a similar fashion. In each case the hymen was normal with no sign of acute or chronic trauma. CONCLUSIONS: Lichen sclerosus affecting the genitalia of prepubertal females is an uncommon condition that may be mistaken for trauma associated with sexual abuse. An awareness of its clinical features is essential not only for those doctors who examine children for physical signs of sexual abuse but also for primary care doctors who may be confronted with an apparently abused child. Early recognition of this disease should, in the absence of other concerns, prevent unnecessary intervention by police and child protection workers.- - - - - - - - - - ranking = 0.33672576033675keywords = lichen sclerosus, sclerosus, lichen (Clic here for more details about this article) |
4/4. Squamous-cell carcinoma developing within anal lichen planus: report of a case.AIM: We present a case of squamous-cell carcinoma developing within perianal lichen planus. This is a chronic or recurrent cutaneous and/or mucosal dermatosis affecting less than 1 percent of the population. Neoplastic degeneration of cutaneous lichen planus is rare; only one case of squamous-cell carcinoma developing within perianal lichen planus has been described up until now in the international literature. CASE REPORT: Our case involved a 68-year-old woman with chronic, long-term lichen planus spreading all over the vulva and perianal region and the mucosa of the anal canal, where squamous-cell carcinoma developed within the perianal lichen planus. Treatment consisted of wide, circular excision of the perianal skin and mucosectomy of the anal canal up to as far as 1 cm above the dentate line. Reconstruction was performed by means of two V-Y bilateral subcutaneous flaps. CONCLUSION: Wide excision was performed not only to remove the squamous-cell carcinoma but also the lichen planus to prevent recurrence of metachronous or synchronous squamous-cell carcinoma. Follow-up at one year after surgery showed no local recurrence of either lichen planus or squamous-cell carcinoma, which suggests that surgical removal should be the therapy of choice for long-term, chronic perianal lichen planus that has proved to be resistant to medical therapy.- - - - - - - - - - ranking = 0.034872695367884keywords = lichen (Clic here for more details about this article) |