Clinical analysis of children with pathological phimosis treated by circumcision / 中华泌尿外科杂志

Objective:To investigate the clinical characteristics of pathological phimosis and analyze the correlation between pathological phimosis and balanitis xerotica obliterans(BXO) in children.Methods:The clinical data of 45 children who underwent circumcision and histopathologic evaluation in our hospital from July 2018 to August 2022 were retrospectively analyzed. According to the results of the pathological examination, lichen sclerosis et atrophicus cases were classified as the BXO group, and other cases were classified as the non-BXO group. The two groups' age, history, and symptoms were recorded and compared. The management of meatal stenosis and the effect of topical steroids were described.Results:There were 33 patients in the BXO group, aged (7.42±2.46)years old, of which 91% (30/33) were 5-11 years old. There were 12 patients in the non-BXO group, aged (10.42±2.88) years old. The difference of age between the two groups was statistically significant ( P< 0.05). But there was no significant difference between the BXO group and non-BXO group in the history of balanoposthitis(28 cases vs. 7 cases), history of foreskin dilated(15 cases vs. 3 cases), frequent urination (18 cases vs. 10 cases), urgent urination(12 cases vs. 4 cases), urination pain(17 cases vs. 3 cases), dysuria(21 cases vs. 5 cases), pruritus(25 cases vs. 7 cases), penile pain(7 cases vs. 1 case), ballooning(7 cases vs. 6 cases), and spraying (14 cases vs. 2 cases)( P > 0.05). All 8 cases of meatal stenosis were in the BXO group. Three cases underwent meatal dilatation and indwelling catheter was left for 5-10 days, and topical steroid was used on the third day after surgery. The remaining cases were treated with topical steroids after a pathological diagnosis of BXO. Among the 4 cases with partial urethral meatus involvement, 3 had good results after treatment, and 1 had no significant improvement and underwent meatal dilatation twice later. In 1 case, meatal stenosis was found two weeks after surgery, but no meatal abnormality was found during operation. All patients recovered smoothly during a median follow-up of 12.2 (5.4, 21.8) months. Conclusions:BXO is the main cause of pathologic phimosis in boys, and the diagnosis is based on histopathology. The main complication of BXO is meatal stenosis, which should be detected as early as possible and treated in time.

Comparative analysis of fractional CO 2 laser, focused ultrasound and simple drug treatment of gynecological vulva white lesions / 中国医师杂志

Objective:To investigate the effects of fractional CO 2 laser, focused ultrasound and simple drug treatment of gynecological vulva white lesions. Methods:A prospective study was conducted on 126 patients with white lesions of the vulva admitted to Hainan Cancer Hospital from August 2018 to December 2020. They were divided into drug group, focused ultrasound group and fractional CO 2 laser group by random number table method, with 42 patients in each group. The drug group was treated with mometasone furoate cream or dexamethasone acetate cream, and the focused ultrasound group was treated with focused ultrasound; the fractional CO 2 laser group was treated with fractional CO 2 laser. The serum interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and human epidermal growth factor (EGF) levels before and after treatment, and Visual Analogue Scale (VAS) and Dermatology Life Quality Index (DLQI) scores of the three groups were compared. Results:Before treatment, there was no significant difference in the levels of IL-2, TNF-α, CRP and EGF among the three groups (all P>0.05). After treatment, the levels of IL-2, TNF-α, CRP and EGF in the three groups were significantly decreased, and the levels of IL-2, TNF-α, CRP and EGF in the focused ultrasound group and fractional CO 2 laser group were lower than those in the drug group, with statistically significant difference (all P<0.05). Before treatment, there was no significant difference in the white lesions, dry pruritus, sexual pain and chapped skin scores of the three groups (all P>0.05); After treatment, scores of all dimensions of the three groups were significantly decreased, and scores of all dimensions of the focused ultrasound group and fractional CO 2 laser were lower than those of the drug group, with statistical significance (all P<0.05). Before treatment, there was no significant difference in the scores of symptoms and feelings, daily activities and interpersonal relationship of the three groups (all P>0.05); After treatment, scores of all dimensions of the three groups were significantly decreased, and scores of all dimensions of the focused ultrasound group and fractional CO 2 laser were lower than those of the drug group, with statistical significance (all P<0.05). Conclusions:Fractional CO 2 laser has a remarkable effect in the treatment of gynecological vulva white lesions, which can reduce the level of inflammatory factors in patients, improve the pain condition, and improve the quality of life.

Clinical and histopathological spectrum of genital lichen sclerosus in 133 cases: Focus on the diagnosis of pre-sclerotic disease

Background: Early inflammatory lesions of lichen sclerosus are histopathologically difficult to diagnose until the hallmark of the disease i.e., papillary sclerosis becomes visible in histological sections. Pre-sclerotic and late or resolved phases of the disease have not been extensively studied. Methods: We retrospectively reviewed all cases diagnosed as genital lichen sclerosus over a ten-year period from 2006 to 2016, correlating the clinical findings with the histological features. Results: A total of 133 cases of genital lichen sclerosus (90 males and 43 females) were identified. Both genders demonstrated a similar histological spectrum. Fifty eight (44%) cases were identified as having pre-sclerotic lichen sclerosus, 64 (48%) as having progressive disease and 11 (8%) cases were classified as fully resolved with atrophy. Asymptomatic vitiligoid lesions were identified in 19 (14%) cases of which 12 were male. Low-grade squamous cell carcinoma was seen within the areas affected by long-standing lichen sclerosus, in four patients (3%, 2 male). Limitations: We studied only haematoxylin and eosin stained sections. The presence of basement membrane thickening could have been better illustrated with the periodic acid–Schiff stain. Conclusion: The pathogenesis of lichen sclerosus probably involves an immune reaction to the basement membrane at the epidermal interface and around the adnexa. The initial band of inflammation shifts gradually downwards from the epidermal interface into the dermis destroying the vascular channels and appendages, resulting in excessive deposition of altered extracellular matrix. Basilar infiltration of lymphocytes along with a grossly vacuolated or thickened basement membrane is proposed as the characteristic diagnostic feature of the pre-sclerotic stage. Greater awareness of the clinicopathological spectrum of lichen sclerosus should enable early diagnosis and treatment, thereby preventing structural damage and possible malignant transformation in chronic cases

Dermoscopic features of 79 cases of childhood vulvar lichen sclerosus / 中华皮肤科杂志

Objective:To investigate dermoscopic features of childhood vulvar lichen sclerosus.Methods:From January 2019 to May 2021, 79 female children with vulvar lichen sclerosus were collected from Kunming Children′s Hospital, and their dermoscopic features at first and return visits were analyzed retrospectively.Results:Among the 79 female children with vulvar lichen sclerosus, their age ranged from 2.4 to 12 years, the age at onset was 5.6 ± 2.12 years, the course of disease was 14.23 ± 12.36 months, and 30 children received regular follow-up and treatment. Among 329 skin lesions at the first visit, characteristic vascular shapes were observed in 149 (45.3%) , including linear vessels in 129, punctate vessels in 25, coiled vessels in 19, and hairpin-like vessels in 12; degenerative structures and pigment abnormalities were seen in 207 (62.92%) , including bluish-gray pigmented structures in 136, brown pigmented structures in 51, pepper-like patterns in 15, etc.; yellowish-white structureless areas were found in 280 (85.1%) , follicular keratotic plugs in 97 (29.5%) , and reddish-violet globules and patches in 66 (20%) . Among 238 skin lesions at the return visit, characteristic vascular shapes were observed in 100 (42%) , including linear vessels in 87, dendritic vessels in 21 and punctate vessels in 4, and no hairpin-like vessels were observed; degenerative structures and pigment abnormalities were seen in 154 (64.70%) , including brown pigmented structures in 93, bluish-gray pigmented structures in 57, and pepper-like patterns in 4; yellowish-white structureless areas were found in 165 (69.3%) , follicular keratotic plugs in 62 (26.1%) , and reddish-violet globules and patches in 8 (3.4%) . The prevalence rates of bluish-gray pigmented structures, yellowish-white structureless areas, reddish-violet globules and patches, punctate vessels, hairpin-like vessels, and coiled vessels in the skin lesions were all significantly lower at the return visit than at the first visit (all P < 0.05) , while the prevalence rate of the brown pigmented structure was significantly higher at the return visit than at the first visit ( P < 0.05) . Conclusion:Under a dermoscope, yellowish-white structureless areas are a highly specific characteristic of childhood vulvar lichen sclerosus, and therapeutic effect can be monitored by observing changes in dermoscopic features, including brown pigmented structures, bluish-gray pigmented structures, yellowish-white structureless areas, reddish-violet globules and patches, and vascular structures. Dermoscopy shows favorable application value in auxiliary diagnosis and follow-up observation of childhood vulvar lichen sclerosus.

Lesiones ampollares en una paciente con morfea panesclerótica discapacitante de la infancia / Bullous lesions in a patient with panesclerotic morphea of the childhood

La morfea ampollar es un tipo enfrecente de esclerodermia localizada que se caracteriza por presentar ampollas sobre placas escleróticas. La presencia de este tipo de lesiones obliga a descartar la variante extraenital de liquen esclerodemias localizadas, es posible hallar ambas afecciones. Se describe el caso de una paciente de 19 años con diagnóstico de morfea panesclerótica y liquen escleroso ampollar.

Bollous morphea is an infreqent type of morphea characterized for developing bullae on sclerodermiformic plaques. The presence of bullae forces to discard lichen sclerosus, a disease that usually develops in the genital zone, the extragenital variant could belong to the same spectrum that localized sclerodermiformic diseases. We present a 19 year old female patient with the diagnosis of panesclerotic morphea and bullous lichen sclerosus.

Liquen escleroso atrófico con vitiligo en pediatría / Lichen Sclerosus Atrophicus with Vitiligo in Pediatrics

RESUMEN Fundamento: el liquen escleroso es una dermatosis inflamatoria crónica de la piel y semimucosas. Afecta principalmente la vulva y la región perianal, la localización extragenital vista entre un 15 y un 20 % de los casos es rara en la infancia. Objetivo: describir una serie de 8 pacientes en edad pediátrica con padecimiento de liquen escleroso en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. Métodos: se realizó un estudio descriptivo, retrospectivo, de serie de casos de 8 pacientes seguidos en consulta externa de dermatología del Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. La información se extrajo de las historias clínicas de los pacientes. Se tuvo en cuenta la edad expresada en años, sexo, raza, afectación genital, tiempo de evolución en años, síntomas asociados, otras enfermedades asociadas: vitiligo, dermatomiositis, esclerodermia, lupus eritematoso, tipo de lesiones, morfea, fenómeno de koebner y el tratamiento. Resultados: se describieron 8 casos todos en pacientes pediátricos con edad media de 8 años y de evolución de 3,1 años, predominó el sexo femenino, el 37,5 % de la serie presentaron lesiones extragenitales y vitiligo en el 62,5 %, hubo retraso diagnóstico en un paciente. Conclusiones: el liquen escleroso es una patología que afecta la calidad de vida de los pacientes, su posible repercusión sexual, urinaria y su potencial riesgo de carcinoma epinocelular, por lo que se hace necesario realizar un diagnóstico oportuno de este padecimiento.

ABSTRACT Background: lichen sclerosus is a chronic inflammatory dermatosis of the skin and semi-mucous membranes. It mainly affects the vulva and the perianal region, the extragenital location seen between 15 and 20 % of cases, is rare in childhood. Objective: to describe 8 pediatric patients with lichen sclerosus at the Paquito González Cueto Cienfuegos University Pediatric Hospital. Methods: a descriptive, retrospective study of 8 patients followed in the dermatology outpatient clinic of the Paquito González Cueto University Pediatric Hospital in Cienfuegos was carried out. The information was extracted from the medical records of the patients. Age expressed in years, sex, race, genital involvement, evolution time in years, associated symptoms, other associated diseases were taken into account: vitiligo, dermatomyositis, scleroderma, lupus erythematosus, type of lesions, morphea, koebner and treatment. Results: 8 cases were described, all in pediatric patients with a mean age of 8 years and an evolution of 3.1 years, predominantly female, 37.5 % of the series had extragenital lesions and vitiligo 62.5 %, there were diagnostic delay in a patient. Conclusions: lichen sclerosus is a pathology that affects the quality of life of patients, its possible sexual and urinary repercussions and its potential risk of epinocellular carcinoma, for which it is necessary to make a timely diagnosis.

Urethral carcinoma accompanied by urethral stricture due to male genital lichen sclerosus / 中华泌尿外科杂志

Objective:To investigate the characteristics and the management of male genital lichen sclerosus (MGLSc)accompanied by urethral carcinoma.Methods:A retrospective analysis was performed on 16MGLSc accompanied by urethral carcinoma patients who were referred to Shanghai Sixth People’s Hospital between June 2000 and August 2019. The average age was 53.7 (45-69) years. All of the patients had a mean history of MGLSc 15(6-35) years, anterior urethral stricture received urethral dilatation and other inappropriate urethrotomy treatment for 10 (8-15) years. There were 5 cases of solid mass 4.5 (3-7) cm in scrotum, accompanied by obviously pain. There were 11 cases of infective masses 6(4-10)cm in the perineum, and the masses were ulcerated with purulent secretions and residue-like pus mixed with necrotic tissues draining from the wounds. Urethrocutaneous fistula developed in 9 cases, and the secretions in the fistula cannot heal. The diseased tissue was confirmed by pathology as the metastasis of invasive urothelial carcinoma in 12 patients and urethral squamous cell carcinoma in 4 patients. 9 cases of tumor invaded corpus spongiosum or corpus cavernosum, 5 cases invaded corpus spongiosum or corpus cavernosum, with enlarged firm one side inguinal node. 2 cases of tumor invaded corpus cavernosum, beyond prostatic capsule and bladder neck, bilateral palpable inguinal lymph nodes metastasis were found, one case found tumor involved the left testis. 9 cases were T 2-3N 0M 0, 5 cases T 2-3N 1M 0, 1 case T 3N 2M 0, 1 case T 4N 2M 1. 5 patients with substantial tumors located in the scrotum, penile-sparing scrotum tumor, urethral tumor resection and urethrostomy was performed in 2 patients. Partial phallectomy, urethral tumor resection and perineal urethrostomy were performed in 3 patients. 11 patients with urethral cancer complicated with perineal infectious mass, 2 patients underwent extensive resection of the tumor and suprapubic cystostomy. 8 cases with perineal tumor infection complicated with urethrocutaneous fistulas formation, of which 2 patients received perineal mass, urethral tumor, fistula resection and suprapubic cystostomy, 4 patients with unilateral inguinal lymph node metastasis and received perineal mass, urethral tumor, fistula, lymph node resection and suprapubic cystostomy. 2 patients with bilateral inguinal node metastasis underwent total phallectomy and urethrectomy, inguinal lymph node resection and suprapubic cystostomy. One case of perineal infectious mass with urethral cutaneous fistula and unilateral inguinal lymph node metastasis (T 2-3N 1M 0) gave up tumor resection. Results:The pathological examination of surgical resection of the glans and urethra showed typical MGLSc manifestations as epithelial keratinization, basal cell vacuoles degeneration, dermis lymphocyte infiltration. The pathological examination of the surgical excised diseased urethra and surrounding tumor tissue showed invasive urothelial carcinoma in 12 patients. Immunohistochemical staining showed positive expression of P53, Ki-67 and GATA3. 4 patients of urethral squamous carcinoma and immunohistochemical staining showed positive expression of Ki-67, P40 and GATA3. All patients received cisplatin combined with gemcitabine chemotherapy for an average of 4.8 (2-6)courses and received local radiotherapy (50-70Gy/5w). The mean postoperative survival time of the 16 patients was 26 (3-48) months, and the survival time of urethral transitional cell carcinoma and squamous cell carcinoma was 29 (18-48) months and 18 (3-24) months, respectively. All patients died of tumor metastasis, with 6 patients of lung metastsis, 2 patients of lumbar and bone metastasis, 3 patients of liver metastasis, 2 patients of brain metastasis and 3 patients of lung combined with bone metastasis.Conclusions:MGLSc can cause urethal stricture and urethral carcinoma. The clinical manifestations are dysuria, urinary tumor, repeated infection and urethral fistula. Tumor excision and urinary diversion are common surgical methods. Urethral transitional cell carcinoma and squamous cell carcinoma are common pathological types. Postoperative combined radiotherapy and chemotherapy can be used, but the overall prognosis is poor.

Established Genital and Extragenital Lichen Sclerosus:A Clinicopathological Analysis / 中国医学科学院学报

Objective To investigate the clinicopathological characteristics of established genital and extragenital lichen sclerosus(LS)and compare the differences between them. Method The clinicopathological data of 55 patients with established genital and extragenital LS diagnosed by pathological examination in the Department of Dermatology of Beijing Hospital were retrospectively analyzed. Results The 55 patients included 11 males and 44 females.Among them,38,15,and 2 patients had genital lesions,extragenital lesions,and both genital and extragenital lesions,respectively.Extragenital LS mainly involved the back(14.55%)and extremities(7.27%).Among the patients,28.30% were asymptomatic,and 73.58% and 24.53% felt itchy and painful,respectively.The asymptomatic patients had a higher proportion in extragenital cases(

Microablative fractional radiofrequency as a therapeutic option for vulvar lichen sclerosus: a pilot study

OBJECTIVES: To assess the clinical response to and the histomorphometric effects of microablative fractional radiofrequency (MFR) in women with symptomatic vulvar lichen sclerosus (VLS). METHODS: This was a pilot study on the use of MFR for the treatment of VLS. Upon recruitment and at each treatment session, all participants were examined and each of their symptoms were rated on a visual analog scale. After the procedure, the participants completed a satisfaction questionnaire. We compared the morphometric findings of vulvar biopsies performed at enrollment and after the last treatment session. The participants were divided into three groups according to previous treatment with corticosteroids: G1, no previous treatment; G2, treated for up to 5 years; and G3, treated for >5 years. RESULTS: This study included 26 women. After two to three sessions, most participants in all groups became either "asymptomatic" or "much better" than before treatment and were "very satisfied" or "satisfied" with the intervention. Pruritus and burning sensation were the most frequently reported symptoms. Nearly 40% of the participants in all groups reported complete remission of symptoms. The improvement was rated as moderate or higher by 80%, 76%, and 66% of the women in groups 1, 2, and 3, respectively. The improvement of symptoms persisted for 11 months (range, 7-16 months), on average, after the treatment. Type III collagen concentration significantly increased and was associated with important symptom improvement. Tissue trophism and vascularization also increased but did not reach statistical significance, probably because of the small number of cases. CONCLUSIONS: MFR may be an effective and safe treatment for symptomatic VLS.

A radiofrequência fracionada no tratamento de líquen escleroso vulvar: um relato de caso / Fractional radiofrequency in the treatment of vulvar lichen sclerosus: a case report

O líquen escleroso vulvar (LEV) é uma doença dermatológica crônica de etiologia incerta, caracterizada por prurido intenso e atrofia progressiva. O corticosteroide tópico de longo prazo é o tratamento de primeira linha para LEV. No entanto, esse tratamento requer a colaboração da paciente, está associado a efeitos colaterais adversos e algumas pacientes não respondem aos corticosteroides. O tratamento com tecnologias térmicas e fototérmicas tem sido estudado como terapia alternativa ou complementar para melhorar os sintomas de LEV e o trofismo cutâneo. A radiofrequência fracionada microablativa é usada em dermatologia para melhorar o trofismo tecidual. Também tem sido usada em pacientes ginecológicas para tratar a atrofia vulvovaginal, estimulando a neocolagênese dérmica e a neoelastogênese. Apresentamos o caso de uma mulher de 39 anos com LEV refratária que foi tratada com aplicações locais de radiofrequência fracionada microablativa. Ela apresentou melhora satisfatória dos sintomas e do trofismo vulvar em longo prazo, sem necessidade do uso de corticosteroides.(AU)

Vulvar lichen sclerosus (VLS) is a chronic dermatological disease of unclear etiology characterized by severe itching and progressive atrophy. Long-term topical corticosteroid is the first-line treatment for VLS. However, this treatment requires patient compliance, is associated with adverse side effects, and some patients do not respond to corticosteroids. Treatment with thermal and photothermal technologies have been studied as alternative or complementary therapies to improve VLS symptoms and skin trophism. Microablative fractional radiofrequency (MFR) is used in dermatology to improve tissue trophism. It has also been used in gynecological patients to treat vulvovaginal atrophy by stimulating dermal neocollagenesis and neoelastinogenesis. We present the case of a 39-year-old woman with refractory VLS who was treated with local applications of microablative fractional radiofrequency. She had satisfactory, long-term, improvement of symptoms and vulvar trophism, and stopped using corticosteroids.(AU)

Liquen escleroso y atrófico extragenital en hombre con cáncer de próstata: ¿manifestación cutánea paraneoplásica? / Extragenital lichen sclerosus et atrophicus in man with prostate cancer: paraneoplastic skin manifestation?

Resumen Introducción: los síndromes esclerodermiformes se definen por la presencia de esclerosis cutánea, induración y pérdida de la elasticidad de la piel. Su diagnóstico diferencial incluye casos de escleroderma localizada, dentro de los cuales se describe el liquen escleroso y atrófico que, hasta la fecha, no se ha reconocido en el escenario de síndromes cutáneos paraneoplásicos. Resultados: se presenta el caso de un paciente con adenocarcinoma de próstata avanzado, quién desarrolló lesiones compatibles con liquen escleroso y atrófico extragenital durante el curso de su enfermedad oncológica, confirmadas por histopatología. Conclusiones: Se cuestiona la naturaleza paraneoplásica de esta entidad cutánea en este contexto clínico particular

Abstract Introduction: Scleroderma syndromes are defined by the presence of skin sclerosis, induration and loss of skin elasticity. Their differential diagnosis includes cases of localized scleroderma, within which lichen sclerosus et atrophicus are described, which, to date, have not been recognized in the setting of paraneoplastic skin syndromes. Results: We present the case of a patient with advanced adenocarcinoma of the prostate, who developed cutaneous lesions compatible with extragenital lichen sclerosus et atrophicus during the course of the cancer, confirmed by histopathology. Conclusions: The paraneoplastic nature of this skin entity is questioned in this particular clinical context.

Single-stage tubular urethral reconstruction using oral grafts is an alternative to classical staged approach for selected penile urethral strictures / 亚洲男科学杂志(英文版)

Penile urethral strictures have been managed by a staged surgical approach. In selected cases, spongiofibrosis can be excised, a neo-urethral plate created using buccal mucosa graft (BMG) and tubularized during the same procedure, performing a "two-in-one" stage approach. We aim to identify stricture factors which indicate suitability for this two-in-one stage approach. We assess surgical outcome and compare with staged reconstruction. We conducted an observational descriptive study. The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017. The minimum follow-up was 6 months. Outcomes were assessed clinically, radiologically, and by flow-rate analysis. Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention. Descriptive analysis of stricture characteristics and statistical comparison was made between groups. Of 425 penile urethroplasties, 139 met the inclusion criteria: 59 two-in-one stage and 80 staged. The mean stricture length was 2.8 cm (single stage) and 4.5 cm (staged). Etiology was lichen sclerosus (LS) 52.5% (single stage) and 73.8% hypospadias related (staged). 40.7% of patients had previous failed urethroplasties in the single-stage group and 81.2% in the staged. The most common stricture locations were navicular fossa (39.0%) and distal penile urethra (59.3%) in the single-stage group and mid or proximal penile urethra (58.7%) in the staged group. Success rates were 89.8% (single stage) and 81.3% (staged). A trend toward a single-stage approach for select penile urethral strictures was noted. We conclude that a single-stage substitution penile urethroplasty using BMG as a "two-in-one" approach is associated with excellent functional outcomes. The most suitable strictures for this approach are distal, primary, and LS-related strictures.

Single-stage tubular urethral reconstruction using oral grafts is an alternative to classical staged approach for selected penile urethral strictures / 亚洲男科学杂志(英文版)

Penile urethral strictures have been managed by a staged surgical approach. In selected cases, spongiofibrosis can be excised, a neo-urethral plate created using buccal mucosa graft (BMG) and tubularized during the same procedure, performing a 'two-in-one' stage approach. We aim to identify stricture factors which indicate suitability for this two-in-one stage approach. We assess surgical outcome and compare with staged reconstruction. We conducted an observational descriptive study. The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017. The minimum follow-up was 6 months. Outcomes were assessed clinically, radiologically, and by flow-rate analysis. Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention. Descriptive analysis of stricture characteristics and statistical comparison was made between groups. Of 425 penile urethroplasties, 139 met the inclusion criteria: 59 two-in-one stage and 80 staged. The mean stricture length was 2.8 cm (single stage) and 4.5 cm (staged). Etiology was lichen sclerosus (LS) 52.5% (single stage) and 73.8% hypospadias related (staged). 40.7% of patients had previous failed urethroplasties in the single-stage group and 81.2% in the staged. The most common stricture locations were navicular fossa (39.0%) and distal penile urethra (59.3%) in the single-stage group and mid or proximal penile urethra (58.7%) in the staged group. Success rates were 89.8% (single stage) and 81.3% (staged). A trend toward a single-stage approach for select penile urethral strictures was noted. We conclude that a single-stage substitution penile urethroplasty using BMG as a 'two-in-one' approach is associated with excellent functional outcomes. The most suitable strictures for this approach are distal, primary, and LS-related strictures.

Morphea: a practical review of its diagnosis, classification and treatment

Morphea, or localized scleroderma, is a rare disease of the connective tissue that manifests itself with localized sclerosis of the skin and, in some cases, with extracutaneous manifestations. Its etiology is not fully understood, but it is believed that there is genetic predisposition, in addition to environmental triggering factors. Classification of the disease is not simple due to its multiple presentations; however, it is useful in order to define the treatment, which should be individualized and started early to avoid cosmetic and functional complications. In this review, we summarize the most important practical aspects of the classification, diagnostic methods and evaluation of morphea activity, as well as available therapeutic options, with an emphasis on existing clinical evidence regarding their efficacy and safety.

Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed.

Liquen escleroso y atrófico de localización extragenital / Extragenital lichen sclerosus et atrophicus

RESUMEN El liquen escleroso y atrófico (LEA), es una enfermedad muco-cutánea inflamatoria crónica cuya etiología es desconocida. Se lo ha vinculado con diversos factores: inmunológicos, genéticos, hormonales, infecciosos y traumáticos. Su localización habitual es la genital. Las formas extra genitales son poco frecuentes y suelen afectar tronco, cuello y extremidades. Se presenta un caso de liquen escleroso y atrófico de localización extra genital, en una paciente de 14 años de edad.

SUMMARY Lichen sclerosus et atrophic (LSA) is a chronic inflammatory mucocutaneous disease of unknown etiology. It has been linked to various immunological, genetic, hormonal, infectious and traumatic factors. Its usual location is the genital area. Extra-genital forms are infrequent and usually involve trunk, neck, and extremities. We present the case of a 14 years old female with lichen sclerosus et atrophic of extragenital localization.

Extragenital Lichen Sclerosus Et Atrophicus along the Blaschko's Lines of the Forehead / 대한피부과학회지

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis presenting as white papules and atrophic patches in the anogenital region. Extragenital LSA is rare and commonly affects the neck, thighs, and the trunk. A 68-year-old woman presented with a well-demarcated, whitish linear plaque on the forehead that was observed several months prior to presentation. A biopsy specimen showed hyperkeratosis and thinning of the epidermis and homogenization of collagen in the papillary dermis with a subepidermal cleft. Mild periappendageal lymphocytic infiltration and eccrine gland atrophy secondary to thickening of collagen bundles were observed in the deep dermis. Based on the clinical and histopathological findings, this patient was diagnosed with extragenital LSA and concomitant morphea along the Blaschko's lines.

Lingual mucosal urethroplasty for one patient of long-segment urethral stricture caused by lichen sclerosus / 中华整形外科杂志

A 48-year-old male was suffered from slowly progressive dysuria over twenty years. Although multiple urethral dilatation was treated, the effect was unsatisfactory. He was diagnosed with penile lichen sclerosus related to urethral stricture due to the lichenification of glans penis, the stenosis of urethral meatus, and the long anterior urethral stricture shown by urethrography. Finally, the patient underwent an enlarged urethroplasty with lingual mucosal graft (17 cm in length), and obtained a good outcome. During the two-year postoperative follow-up, the patient maintained a satisfactory urination without any complication.

Dermoscopic features of vulvar lichen sclerosus / 中华皮肤科杂志

Objective To investigate the dermoscopic features of vulvar lichen sclerosus (VLS).Methods Seventeen patients with VLS,who visited the Department of Dermatology of Peking Union Medical College Hospital between August 2015 and June 2017 and underwent dermoscopy and skin histopathological examination,were enrolled into this study.The dermoscopic images of 75 skin lesions were collected and analyzed retrospectively.Results The common dermoscopic features in these VLS lesions included yellowish-white structureless areas (89.3％,67/75),reddish-violet globules or patches (77.3％,58/75),brownish or bluish-gray pigment structures (49％,37/75),shiny white streaks (40％,30/75),dotted vessels with irregular arrangement (28％,21/75),linear vessels (58.7％,44/75),hairpin-like vessels (6.7％,5/75),comma-like vessels (13％,10/75)and branching vessels (20％,15/75).Under dermoscopy,rosette sign could be observed in 3 (4％) lesions,comedo-like openings in 3 (4％) lesions,and keratotic plugs in 1 (1％) lesions.Conclusion Under dermoscopy,VLS is characterized by yellowishwhite structureless areas,reddish-violet globules or patches,pigment structures and vessels with various vessels.

Clinical analysis of 129 cases of vulvar lichen sclerosus / 中华皮肤科杂志

Objective To investigate clinical features of vulvar lichen sclerosus (VLS).Methods Clinical data were collected from patients with VLS in Department of Dermatology of Beijing Hospital,and analyzed retrospectively with respect to age,duration of disease,medical history,complications,clinical symptoms and signs,and features of skin lesions.Results A total of 129 patients with VLS were enrolled into this study from March 2016 to February 2017.The age of onset in these patients presented a normal distribution,with the highest frequency at the age range of 25-30 years.Of the 129 patients,only 18 (14％) developed VLS after menopause,and 12 (9.3％) were complica1ed by autoimmune diseases,especially thyroid diseases.Pruritus was reported as the main symptom in 122 (94.6％) of the 129 patients,and 51 (60％) reported that their sexual life had been affected.Labia minora was the most commonly involved site in 92 (71.3％)patients,but unilateral labia majus was rarely involved.The most common skin lesion was hypopigmentation (92.2％,119/129),followed by lichenification (55.0％,71/129) and skin atrophy (40.3％,52/129).Patients with skin atrophy had significantly longer duration of disease than those without skin atrophy (Z =3.124,P =0.002),and the incidence of skin atrophy was lower in the patients who had been treated with topical glucocorticoids or calcineurin inhibitors than those who had not received these treatment (x2 =5.074,P =0.024).Conclusions VLS is more common in women of childbearing age than in postmenopausal women,and basically characterized by pruritus and hypopigmentation.VLS commonly involves bilateral labia minora,and usually affects sexual life.