nach oben

Current Sexual Health Reports

Erschienen in:

07.03.2020 | Male and Female Surgical Interventions (C Carson and P Selph, Section Editors)

Medical and Surgical Management of Genital Lichen Sclerosus

verfasst von: Adam S. Baumgarten, Nicolas M. Ortiz, Steven J. Hudak

Erschienen in: Current Sexual Health Reports | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Lichen sclerosus (LS) is a chronic inflammatory skin condition that can cause debilitating sexual and urinary sequelae in men and women. In this review, we discuss the etiology, clinical presentation, and management options for genital LS.

Recent Findings

While medical and surgical management of LS has remained similar for quite some time, techniques such as the Kulkarni urethroplasty have made one stage reconstruction for panurethral LS strictures more feasible. Perineal urethrostomy has become an increasingly preferred treatment modality for complex LS patients. Current LS research has focused on the pathophysiology of the LS at the protein level and possible targets for treatment.

Summary

While exact etiology of LS remains unknown, many theories have been hypothesized. The mainstay of medical treatment includes topical steroids. Various reconstructive techniques may be used depending on patient symptoms, extent of involvement, and the location of disease. Non-genital skin grafts, such as buccal mucosa, are recommended in LS patients requiring grafting for urethral reconstruction. Genital skin flaps are not recommended, as they have a high failure rate in this setting. Long-term follow-up is recommended, as LS can be associated with the development of squamous cell carcinoma.

Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353(9166):1777–83.PubMedCrossRef

Val I, Almeida G. An overview of lichen sclerosus. Clin Obstet Gynecol. 2005;48(4):808–17.PubMedCrossRef

• Kirtschig G, Becker K, Gunthert A, Jasaitiene D, Cooper S, Chi CC, et al. Evidence-based (S3) guideline on (anogenital) lichen sclerosus. J Eur Acad Dermatol Venereol. 2015;29(10):e1–43 This European guideline focuses on anogentical lichen sclerosis. PubMedCrossRef

Lipscombe TK, Wayte J, Wojnarowska F, Marren P, Luzzi G. A study of clinical and aetiological factors and possible associations of lichen sclerosus in males. Australas J Dermatol. 1997;38(3):132–6.PubMedCrossRef

Das S, Tunuguntla HS. Balanitis xerotica obliterans--a review. World J Urol. 2000;18(6):382–7.PubMedCrossRef

Kiss A, Kiraly L, Kutasy B, Merksz M. High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol. 2005;22(4):305–8.PubMedCrossRef

•• Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, Brackenbury F, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018;178(4):839–53 This guideline from the British Association of Dermatologists provides evidence-based recommendaitons for the management of LS.PubMedCrossRef

Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol. 2007;178(6):2268–76.PubMedCrossRef

Wallace HJ. Lichen sclerosus et atrophicus. Trans St Johns Hosp Dermatol Soc. 1971;57(1):9–30.PubMed

10.

Kirtschig G. Lichen Sclerosus-presentation. Diagnosis and Management Dtsch Arztebl Int. 2016;113(19):337–43.PubMed

11.

Fergus KB, Lee AW, Baradaran N, Cohen AJ, Stohr BA, Erickson BA, et al. Pathophysiology, clinical manifestations, and treatment of lichen Sclerosus: A systematic review. Urology. 2019.

12.

Weigand DA. Microscopic features of lichen sclerosus et atrophicus in acrochordons: a clue to the cause of lichen sclerosus et atrophicus? J Am Acad Dermatol. 1993;28(5 Pt 1):751–4.PubMedCrossRef

13.

CB B. Diseases and disorders of the male genitalia. In: Fitzpatrick’s dermatology in general medicine, 7th ed. LA Goldsmith SK, BA Gilchrest, AS Paller, DJ Leffel, K Wolff, editor. New York: McGraw-Hill; 2007.

14.

Bunker CB. Male genital lichen sclerosus and tacrolimus. Br J Dermatol. 2007;157(5):1079–80.PubMedCrossRef

15.

Weide B, Walz T, Garbe C. Is morphoea caused by Borrelia burgdorferi? A review Br J Dermatol. 2000;142(4):636–44.PubMedCrossRef

16.

Drut RM, Gomez MA, Drut R, Lojo MM. Human papillomavirus is present in some cases of childhood penile lichen sclerosus: an in situ hybridization and SP-PCR study. Pediatr Dermatol. 1998;15(2):85–90.PubMedCrossRef

17.

Beattie PE, Dawe RS, Ferguson J, Ibbotson SH. UVA1 phototherapy for genital lichen sclerosus. Clin Exp Dermatol. 2006;31(3):343–7.PubMedCrossRef

18.

Neill SM, Lessana-Leibowitch M, Pelisse M, Moyal-Barracco M. Lichen sclerosus, invasive squamous cell carcinoma, and human papillomavirus. Am J Obstet Gynecol. 1990;162(6):1633–4.PubMedCrossRef

19.

Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14(1):27–47.PubMedCrossRef

20.

Neill SM, Lewis FM, Tatnall FM, Cox NH. British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. Br J Dermatol. 2010;163(4):672–82.PubMedCrossRef

21.

Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86(4):459–65.PubMedCrossRef

22.

Powell J, Robson A, Cranston D, Wojnarowska F, Turner R. High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol. 2001;145(1):85–9.PubMedCrossRef

23.

Bleeker MC, Visser PJ, Overbeek LI, van Beurden M, Berkhof J. Lichen Sclerosus: incidence and risk of vulvar squamous cell carcinoma. Cancer Epidemiol Biomark Prev. 2016;25(8):1224–30.CrossRef

24.

Heymann WR. Lichen sclerosus. J Am Acad Dermatol. 2007;56(4):683–4.PubMedCrossRef

25.

Thomas RH, Ridley CM, McGibbon DH, Black MM. Anogenital lichen sclerosus in women. J R Soc Med. 1996;89(12):694–8.PubMedPubMedCentralCrossRef

26.

Kagie MJ, Kenter GG, Hermans J, Trimbos JB, Fleuren GJ. The relevance of various vulvar epithelial changes in the early detection of squamous cell carcinoma of the vulva. Int J Gynecol Cancer. 1997;7(1):50–7.PubMedCrossRef

27.

Leibowitch M, Neill S, Pelisse M, Moyal-Baracco M. The epithelial changes associated with squamous cell carcinoma of the vulva: a review of the clinical, histological and viral findings in 78 women. Br J Obstet Gynaecol. 1990;97(12):1135–9.PubMedCrossRef

28.

Nasca MR, Innocenzi D, Micali G. Penile cancer among patients with genital lichen sclerosus. J Am Acad Dermatol. 1999;41(6):911–4.PubMedCrossRef

29.

Edmonds EV, Hunt S, Hawkins D, Dinneen M, Francis N, Bunker CB. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients. J Eur Acad Dermatol Venereol. 2012;26(6):730–7.PubMedCrossRef

30.

Venn SN, Mundy AR. Urethroplasty for balanitis xerotica obliterans. Br J Urol. 1998;81(5):735–7.PubMedCrossRef

31.

Liu JS, Walker K, Stein D, Prabhu S, Hofer MD, Han J, et al. Lichen sclerosus and isolated bulbar urethral stricture disease. J Urol. 2014;192(3):775–9.PubMedCrossRef

32.

Yesudian PD, Sugunendran H, Bates CM, O'Mahony C. Lichen sclerosus. Int J STD AIDS. 2005;16(7):465–73, test 74.PubMedCrossRef

33.

Funaro D, Lovett A, Leroux N, Powell J. A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2014;71(1):84–91.PubMedCrossRef

34.

Ayhan A, Guven S, Guvendag Guven ES, Sakinci M, Gultekin M, Kucukali T. Topical testosterone versus clobetasol for vulvar lichen sclerosus. Int J Gynaecol Obstet. 2007;96(2):117–21.PubMedCrossRef

35.

Ayhan A, Guven ES, Guven S, Sakinci M, Dogan NU, Kucukali T. Testosterone versus clobetasol for maintenance of vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia. Acta Obstet Gynecol Scand. 2007;86(6):715–9.PubMedCrossRef

36.

Sideri M, Origoni M, Spinaci L, Ferrari A. Topical testosterone in the treatment of vulvar lichen sclerosus. Int J Gynaecol Obstet. 1994;46(1):53–6.PubMedCrossRef

37.

Kim GW, Park HJ, Kim HS, Kim SH, Ko HC, Kim BS, et al. Topical tacrolimus ointment for the treatment of lichen sclerosus, comparing genital and extragenital involvement. J Dermatol. 2012;39(2):145–50.PubMedCrossRef

38.

Goldstein AT, Creasey A, Pfau R, Phillips D, Burrows LJ. A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2011;64(6):e99–104.PubMedCrossRef

39.

Bousema MT, Romppanen U, Geiger JM, Baudin M, Vaha-Eskeli K, Vartiainen J, et al. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study. J Am Acad Dermatol. 1994;30(2 Pt 1):225–31.PubMedCrossRef

40.

Lowenstein EB, Zeichner JA. Intralesional adalimumab for the treatment of refractory balanitis xerotica obliterans. JAMA Dermatol. 2013;149(1):23–4.PubMedCrossRef

41.

Rouzier R, Haddad B, Deyrolle C, Pelisse M, Moyal-Barracco M, Paniel BJ. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol. 2002;186(1):49–52.PubMedCrossRef

42.

Strother MC, Skokan AJ, Sterling ME, Butler PD, Kovell RC. Adult buried penis repair with Escutcheonectomy and Split-thickness skin grafting. J Sex Med. 2018;15(8):1198–204.PubMedCrossRef

43.

Belsante MJ, Selph JP, Peterson AC. The contemporary management of urethral strictures in men resulting from lichen sclerosus. Transl Androl Urol. 2015;4(1):22–8.PubMedPubMedCentral

44.

Morey AF, Lin HC, DeRosa CA, Griffith BC. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatotomy (first stage Johanson) maneuver. J Urol. 2007;177(1):184–7 discussion 7.PubMedCrossRef

45.

Malone P. A new technique for meatal stenosis in patients with lichen sclerosus. J Urol. 2004;172(3):949–52.PubMedCrossRef

46.

Virasoro R, Eltahawy EA, Jordan GH. Long-term follow-up for reconstruction of strictures of the fossa navicularis with a single technique. BJU Int. 2007;100(5):1143–5.PubMed

47.

Granieri MA, Zhao LC, Breyer BN, Voelzke BB, Baradaran N, Grucela AL, et al. Multi-institutional outcomes of minimally invasive harvest of rectal mucosa graft for anterior urethral reconstruction. J Urol. 2019;201(6):1164–70.PubMedCrossRef

48.

Dubey D, Sehgal A, Srivastava A, Mandhani A, Kapoor R, Kumar A. Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques. J Urol. 2005;173(2):463–6.PubMedCrossRef

49.

Kulkarni S, Barbagli G, Kirpekar D, Mirri F, Lazzeri M. Lichen sclerosus of the male genitalia and urethra: surgical options and results in a multicenter international experience with 215 patients. Eur Urol. 2009;55(4):945–54.PubMedCrossRef

50.

Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int. 2009;104(8):1150–5.PubMedCrossRef

51.

Peterson AC, Palminteri E, Lazzeri M, Guanzoni G, Barbagli G, Webster GD. Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans). Urology. 2004;64(3):565–8.PubMedCrossRef

52.

Fuchs JS, Shakir N, McKibben MJ, Scott JM, Viers B, Pagliara T, et al. Changing trends in reconstruction of complex anterior urethral strictures: from skin flap to Perineal Urethrostomy. Urology. 2018;122:169–73.PubMedCrossRef

53.

Patel CK, Buckley JC, Zinman LN, Vanni AJ. Outcomes for Management of Lichen Sclerosus Urethral Strictures by 3 different techniques. Urology. 2016;91:215–21.PubMedCrossRef

54.

French D, Hudak SJ, Morey AF. The "7-flap" perineal urethrostomy. Urology. 2011;77(6):1487–9.PubMedCrossRef

55.

Myers JB, McAninch JW. Perineal urethrostomy. BJU Int. 2011;107(5):856–65.PubMedCrossRef

56.

• Levy A, Browne B, Fredrick A, Stensland K, Bennett J, Sullivan T, et al. Insights into the pathophysiology of urethral stricture disease due to lichen Sclerosus: comparison of pathological markers in lichen Sclerosus induced strictures vs nonlichen Sclerosus induced strictures. J Urol. 2019;201(6):1158–63 This contemporary study is the first to investigate the pathophysiology of LS in urethral stricture disease at the protein level.PubMedCrossRef

57.

Levy AC, Moynihan M, Bennett JA, Sullivan T, Stensland K, Browne BM, et al. Protein Expression Profiles Among Lichen Sclerosus Urethral Strictures: Can Urethroplasty Success be Predicted? J Urol. 2019:101097ju0000000000000610.

58.

Simpson RC, Cooper SM, Kirtschig G, Larsen S, Lawton S, McPhee M, et al. Future research priorities for lichen sclerosus - results of a James Lind Alliance priority setting partnership. Br J Dermatol. 2019;180(5):1236–7.PubMedPubMedCentralCrossRef

Titel: Medical and Surgical Management of Genital Lichen Sclerosus
verfasst von: Adam S. Baumgarten
Nicolas M. Ortiz
Steven J. Hudak
Publikationsdatum: 07.03.2020
Verlag: Springer US
Erschienen in: Current Sexual Health Reports / Ausgabe 2/2020
Print ISSN: 1548-3584
Elektronische ISSN: 1548-3592
DOI: https://doi.org/10.1007/s11930-020-00258-4

Neu im Fachgebiet Urologie

25.04.2024 | Nierenkarzinom | Nachrichten

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Medical and Surgical Management of Genital Lichen Sclerosus

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Stufenschema weist Prostatakarzinom zuverlässig nach

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Urologie

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2020

Management of Urethral Injury During Penile Prosthesis Surgery

Testicular Implant Surgery: Indications and Technique

Male Genital Reconstruction in the Exstrophy-Epispadias Complex

The Role of Biofeedback in the Treatment of Sexual Dysfunction

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Stufenschema weist Prostatakarzinom zuverlässig nach

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Urologie