The Need of Differential Diagnosis Between Vulvar Lichen Sclerosus and Autoimmune Dermatoses in Adolescent Girls.

INTRODUCTION: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which can manifest in prepubertal or adolescent patients. The prevailing theories point to autoimmune and genetic factors. The primary symptoms of VLS typically include vulvar itching, discomfort, dysuria, and constipation. Physical examination often reveals a characteristic figure 8 pattern, involving the labia minora, clitoral hood, and perianal region. However, these symptoms and the age of onset are nonspecific and require differentiation from autoimmune dermatoses such as bullous diseases, pemphigus diseases, epidermolysis bullosa acquisita, and dermatitis herpetiformis. We performed this study to distinguish VLS from autoimmune dermatoses, and in doing so, uncover the underlying causes of chronic vulvar changes. This knowledge will enable healthcare providers to offer appropriate medical care to affected patients. METHODS: The study was conducted between July 2020 and February 2021, with a sample of 55 girls aged 2-18 years who did not have any systemic diseases. The study group was composed of 20 girls previously diagnosed with vulvar lichen sclerosus, while the control group included 35 girls without VLS. Questionnaires regarding the medical history of the children were completed by their legal guardians. Blood samples were collected and analyzed biochemically to assess human immunoglobulin A (IgA), IgG, and IgM antibodies against various substrates, including the desmosome of stratum spinosum, basement membrane zone, desmoglein 1 (DSG1), desmoglein 3 (DSG3), BP180-NC16A-4X, BP230gC, pemphigoid antigen, collagen type VII NC1, transitional epithelium, gliadin (GAF-3X), endomysium (EMA), and cellular nucleus (ANA). RESULTS: The analysis of the study group revealed that the most commonly observed signs and symptoms included: itching, soreness, burning sensations, and excoriation, as well as erythema or/and pallor of the skin and perineal mucosa. Among the assessed antibodies, only anti-GAF3x antibodies and ANA antibodies were detected. However, the results did not reach statistical significance (p > 0.5).

The Potential Coexistence of Autoimmune Thyroid Diseases and Pediatric Vulvar Lichen sclerosus.

INTRODUCTION: Vulvar lichen sclerosus (VLS), a chronic inflammatory skin disorder, often coexists with autoimmune thyroid disease (AITD). VLS presents with subtle symptoms including vulvar itching and discomfort. Clinically, a "Figure 8" pattern involving the labia minora, clitoral hood, and perianal region is often observed. It is prevalent both in pre-pubertal girls and women aged 40-60, and the link between VLS and AITD remains unclear, with proposed causes including autoimmune, hormonal or genetic factors, and environmental triggers. This study addresses the lack of research on the association in children, aiming to investigate the largest group of underage girls to date. AIM: This study aimed to investigate the coexistence of thyroid autoimmune diseases in girls diagnosed with vulvar lichen sclerosus (VLS) and to assess the presence of antibodies for specific thyroid autoimmune diseases. MATERIALS AND METHODS: Our study was conducted from July 2020 to February 2021, involving a sample of 55 girls aged 2-18 years old, all free from systemic diseases. The study group comprised 20 girls previously diagnosed with vulvar lichen sclerosus (VLS), while the control group included 35 girls without VLS. Legal guardians completed questionnaires detailing the medical history of their children. Blood samples were collected from all participants and subjected to biochemical analysis. The presence of human IgG antibodies against thyroid peroxidase and IgG antibodies against thyroglobulin was assessed using the immunoenzymatic method with commercially available ELISA kits. RESULTS: In the study group, common symptoms included itching, soreness, burning sensation, excoriation, and erythema or pallor of the skin and perineal mucosa. An evaluation of anti-thyroglobulin and anti-thyroid peroxidase antibodies revealed no statistical significance between the study and control groups (anti-TG p = 0.379, anti-TPO p = 0.96). Family history of autoimmune diseases showed no significant correlation with anti-thyroid antibodies in girls. Although no significant relation between VLS occurrence and antibody levels was found, it emphasizes the need for multidisciplinary medical care. Further research with larger patient groups is necessary.

The Impact of COVID-19 Pandemic on Female Sexual Function.

Introduction: The outbreak of the COVID-19 pandemic affected many aspects of life involving sexual functioning. Methods: This prospective, noninterventional, observational research was performed from July 2020 to August 2020, involving a total of 644 patients. Female sexual function index (FSFI) scores of those women were compared in relation to results of our research from April 2020. Questionnaires were collected concerning socio-demographic characteristics of patients as well as the impact of the COVID-19 pandemic on their lives. Results: Every domain significantly decreased in the first month of the lockdown. Before the pandemic, the total FSFI was reported at 30.1 ± 4.4, while in the first month of the pandemic it was at 25.8 ± 9.7 (p < 0.001). The lowest FSFI score was reported by women who lived in average conditions. There was a statistically significant increase in the overall FSFI score in the fifth month of the pandemic (27.5 ± 6.8) when compared to the FSFI score in the first month of the pandemic (25.8 ± 9.7). The scores in arousal, lubrication, orgasm and pain were reported as higher (respectively p < 0.001, p < 0.001, p < 0.001, p < 0.05), while desire was reported lower (p < 0.001). The satisfaction score remained almost the same (p < 0.05). Conclusions: Our study indicates a significant decrease in FSFI scores across all domains. There are still many questions whether the statue from the vaccinated person or convalescents affects the sense of security and, thus, increases sexual satisfaction.

Female Sexual Function in Twin Pregnancy.

INTRODUCTION: The incidence of twin pregnancy is estimated at 1 per 80 single pregnancies. As the topic of sexual function among women with multiple pregnancy is insufficiently developed, we believe it is appropriate to raise this subject. METHODS: A prospective study was conducted on 100 women during subsequent trimesters of pregnancy. RESULTS: From a group of 100 women, 54 women were primiparous, while 46 women had a history of previous delivery. The mean overall FSFI (female sexual function index) was found to be 24.3 ± 6.1. Mean FSFI was the highest in the first trimester at 25.6. The result decreased successively to 24.8 ± 7 and 22.6 ± 8.4 in the second and third trimesters, respectively. The patient's place of residence had a crucial impact on their FSFI score. The results were considerably higher for residents of small and medium towns or cities-24.4 ± 3.8 and 25.9 ± 4.9, respectively-while for those living in rural areas, the FSFI reached only 21.7 ± 5.4. CONCLUSIONS: The present study shows that the FSFI decreased throughout twin pregnancy. The lowest observed FSFI occurred in the third trimester, while the highest FSFI occurred during the first trimester.

Pediatric Vulvar Lichen Sclerosus-A Review of the Literature.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which may present in a prepubertal or adolescent patient. The most popular theories are its autoimmune and genetic conditioning, although theories concerning hormonal and infectious etiology have also been raised. The most common presenting symptoms of VLS is vulva pruritus, discomfort, dysuria and constipation. In physical examination, a classic "Figure 8" pattern is described, involving the labia minora, clitoral hood, and perianal region. The lesions initially are white, flat-topped papules, thin plaques, or commonly atrophic patches. Purpura is a hallmark feature of VLS. The treatment includes topical anti-inflammatory agents and long-term follow-up, as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with a history of lichen sclerosus. This article reviews vulvar lichen sclerosus in children and provides evidence-based medicine principles for treatment in the pediatric population. A systematic search of the literature shows recurrence of VLS in children. Maintenance regimens deserve further consideration.