ABSTRACT
Abstract: Lichen sclerosus is an uncommon inflammatory dermatosis with preferential involvement of the urogenital region. The extragenital involvement is uncommon and is characterized by small rounded macules or papules, pearly white in color. The coexistence of lichen sclerosus and scleroderma plaques in most cases with extragenital location has been reported in the literature. We report a case of lichen sclerosus associated with scleroderma in children, highlighting the importance of dermoscopy in diagnosis.
Subject(s)
Humans , Female , Child , Scleroderma, Localized/pathology , Scleroderma, Localized/diagnostic imaging , Lichen Sclerosus et Atrophicus/pathology , Lichen Sclerosus et Atrophicus/diagnostic imaging , Dermoscopy/methods , Scleroderma, Localized/complications , Skin/pathology , Skin/diagnostic imaging , Lichen Sclerosus et Atrophicus/complications , Erythema/pathology , Erythema/diagnostic imagingABSTRACT
Objective To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. Material and methods We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. Results The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35%, idiopathic etiology in 29% and prior hypospadia repair in 18%. Postoperative failure occurred in 3 patients, with a final success of 82.4%. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). Conclusions The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis. .
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Perineum/surgery , Urethra/surgery , Urethral Stricture/surgery , Ostomy/methods , Urologic Surgical Procedures/methods , Urethra/diagnostic imaging , Radiography , Regression Analysis , Reproducibility of Results , Retrospective Studies , Risk Factors , Analysis of Variance , Follow-Up Studies , Treatment Failure , Lichen Sclerosus et Atrophicus/complications , Balanitis Xerotica Obliterans/complications , Middle AgedABSTRACT
JUSTIFICATIVA E OBJETIVOS: O líquen escleroso e atrófico (LEA) é doença inflamatória crônica, caracterizada por máculase pápulas branco-nacaradas com espículas córneas, que podem confluir formando áreas homogêneas de hipopigmentação. Sua etiologia é desconhecida, porém há evidências de que esta seja multifatorial com base autoimune. Foram descritos como fatores desencadeantes: infecções genitais prévias, alterações hormonais e trauma local. Pode acometer todas as faixas etárias de ambos os sexos, sendo dez vezes mais comum no sexo feminino. O objetivo deste estudo foi apresentar caso de LEA em paciente pré-pubere com história de possível abuso sexual. RELATO DO CASO: Paciente do sexo feminino, 10 anos, branca, sem comorbidades, foi referenciada ao serviço de dermatologia do Hospital Naval Marcílio Dias para avaliação de lesão branco-nacarada, assintomática na região genital. A responsável pela menor relatou que havia observado a lesão há sete dias. Referia história de abuso sexual em investigação, há oito meses. Ausência de história pessoal e familiar de doença autoimune. Ao exame dermatológico: placas hipocrômico-atróficas, assintomáticas, de superfície apergaminhada, bem delimitadas, simétricas, localizadas nos grandes lábios. CONCLUSÃO: O LEA é doença inflamatória crônica, mais comum em nossa prática do que previamente reportado, cuja etiologia é desconhecida. Existem estudos que comprovam a associação entre LEA e o trauma. Seu reconhecimento nos estágios iniciais permite o tratamento precoce evitando evolução para craurose vulvar na mulher e balanite xerótica obliterante no homem, sendo estas, lesões pré-malignas. O LEA é um exemplo de afecção dermatológica que necessita de abordagem multidisciplinar. As lesões genitais em pacientes jovens devem ser avaliadas por urologistas, pediatras, cirurgiões gerais, ginecologistas, além dos dermatologistas...
BACKGROUND AND OBJECTIVES: Lichen sclerosous etatrophicus (LSA) is a chronic inflammatory disease characterized by pearly white macules and papules with horny spicules which can coalesce to form homogeneous areas of hypopigmentation.Its etiology is unknown, but there is evidence that it is multifactorial with an autoimmune basis. Triggering factors were described: hormonal changes, local trauma, and previous genitalin fections. LSA can affect all age groups and both genders, but its incidence is ten times higher in female than in male patients. The purpose of this study is to report a case of LSA in a prepubertal patient with history of possible sexual abuse. CASE REPORT: Female patient, ten years old, white, no comorbidities,was sent to the dermatology department of Hospital Naval Marcílio Dias for evaluation of ivory-white asymptomatic lesion located in genital area. The person responsible for the minor patient reported that the lesion was observed seven days before. There was referred history of sexual abuse under investigation,eight months before. There is no personal or family history of autoimmune disease. At dermatological examination: asymptomatic, parchment-like surface, well-defined, symmetrical, hypochromicatrophic plaques located in the labia majora. CONCLUSION: Lichen sclerosous et atrophicus (LSA) is a chronic inflammatory disease, more common in our practice than previously reported, whose etiology is unknown. There are studies showing the association between LSA and trauma. Its recognitionin the first stages allows an early treatment avoiding the progression to kraurosis vulvae in women, and balanitis xerotic aobliterans in men, which represent premalignant lesions. The LSA is an example of a dermatological condition that requires multidisciplinary approach. Along with the dermatologist examination,genital lesions in young patients should be evaluated by urologists, pediatricians, general surgeons, and gynecologists...
Subject(s)
Humans , Female , Child , Genitalia, Female/injuries , Lichen Sclerosus et Atrophicus/complicationsSubject(s)
Biopsy , Child , Erythema/etiology , Female , Humans , Lichen Sclerosus et Atrophicus/complications , Thigh , ThoraxABSTRACT
Se reportan 21 pacientes portadoras de liquen escleroso vulval tratadas con testosterona al 2 por ciento o acetato de clostebol entre 1988 y 1995. Un 77,8 y 80 por ciento alcanzaron respuesta completa o parcial a los 3 meses de tratamiento con el uso de testosterona al 2 por ciento y acetato de clostebol, respectivamente. Un 53,3 por ciento abandonó el tratamiento y control antes del año. Los resultados obtenidos no avalan el uso de testosterona al 2 por ciento ni de acetato de clostebol. La revisión de la literatura muestra que el uso de propionato de clobetasol al 0,05 por ciento tendría una mayor tasa de éxito terapéutico y de control de la enfermedad a largo plazo que el uso de andrógenos tópicos
Subject(s)
Humans , Adult , Middle Aged , Female , Lichen Sclerosus et Atrophicus/drug therapy , Testosterone/pharmacology , Administration, Topical , Autoimmune Diseases/complications , Clobetasol/pharmacology , Lichen Sclerosus et Atrophicus/complications , Lichen Sclerosus et Atrophicus/diagnosis , Pruritus Vulvae/etiology , Refusal to Treat/statistics & numerical data , Testosterone/administration & dosage , Vulvar Diseases/drug therapyABSTRACT
O líquem escleroso e atrófico (LEA) e a esclerodermia sao dermatoses que se assemelham clínica e histologicamente, dificultando muitas vezes um diagnóstico preciso em muitos casos. Foi a partir do atendimento a um paciente que apresentava lesoes clínicas de LEA e esclerodermia, ou seja, dessa dificuldade, que tentamos estudar as duas entidades, buscando na literatura cientistas que trouxeram técnicas novas com resoluçoes definitivas.