دورية أكاديمية
[Clinical and pathological analysis of 345 cases of vulvar lichen sclerosus and a preliminary study on the frequency of maintenance treatment].
| العنوان: | [Clinical and pathological analysis of 345 cases of vulvar lichen sclerosus and a preliminary study on the frequency of maintenance treatment]. |
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| المؤلفون: | Sun XY; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China., Xiao YP; Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China., Sun YX; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China., Zhang Q; Medical Center of Diagnosis and Treatment for Cervical Disease, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China., Cong Q; Medical Center of Diagnosis and Treatment for Cervical Disease, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China. |
| المصدر: | Zhonghua fu chan ke za zhi [Zhonghua Fu Chan Ke Za Zhi] 2024 Jan 25; Vol. 59 (1), pp. 56-63. |
| نوع المنشور: | English Abstract; Journal Article |
| اللغة: | Chinese |
| بيانات الدورية: | Publisher: Chinese Medical Association Country of Publication: China NLM ID: 16210370R Publication Model: Print Cited Medium: Print ISSN: 0529-567X (Print) Linking ISSN: 0529567X NLM ISO Abbreviation: Zhonghua Fu Chan Ke Za Zhi Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Peking : Chinese Medical Association Original Publication: Beiping [1953?]- |
| مواضيع طبية MeSH: | Vulvar Lichen Sclerosus*/drug therapy , Vulvar Lichen Sclerosus*/complications , Vulvar Lichen Sclerosus*/pathology , Hypopigmentation*/chemically induced , Hypopigmentation*/complications , Hypopigmentation*/drug therapy, Female ; Humans ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Clobetasol/adverse effects ; Retrospective Studies ; Mometasone Furoate/therapeutic use ; Pruritus/chemically induced ; Pruritus/complications ; Pruritus/drug therapy ; Atrophy/chemically induced ; Atrophy/complications ; Atrophy/drug therapy |
| مستخلص: | Objective: To analyze and summarize the clinical and pathological characteristics, management, and efficacy of patients with vulvar lichen sclerosus (VLS) through a single center large sample study, and preliminarily to explore the frequency of maintenance treatment medication for VLS. Methods: The clinical data of VLS patients in Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2021 were retrospectively collected. The clinicopathological characteristics (patients' age, course of disease, complicated disease history, family history, symptoms, signs and pathology), treatment and effects were retrospectively analyzed. The patients in the maintenance treatment stage were followed up regularly to explore the minimum frequency of individual medication to maintain the stability of the disease. Results: (1) General situation: a total of 345 patients with VLS were included in this study. The average age was (50.4±14.7) years (ranged from 8 to 84 years old), prevalence was highest in the 50-59 years group (30.1%, 104/345). Immune diseases occurred in 18.6% (33/177) of patients, 24.3% (43/177) of patients had allergic skin diseases, and 5.6% (10/177) of the patients' immediate family members had chronic vulvar pruritus or vulvar hypopigmentation. (2) Clinical features: the most common symptom was vulvar pruritus (96.1%, 196/204) among 204 patients with recorded symptoms. The most common sign was hypopigmentation of the vulva (96.3%, 206/214). The most common involved sites were labia minora (70.3%, 142/202), labia majora (67.8%, 137/202), and labial sulcus (59.4%, 120/202). The cumulative number of sites involved in 62 vulvar atrophy patients (2.7±1.1) was significantly higher than that in 152 non-atrophy patients (2.2±1.0; t =3.48, P =0.001). The course of vulvar atrophy was (9.3±8.5) years, which was significantly longer than that of non-atrophy patients [(6.6±5.6) years; t =2.04, P =0.046]. (3) Pathological features: among the 286 patients with electronic pathological sections, the most common pathological feature in the epidermis was epithelial nail process passivation (71.3%, 204/286). The common pathological features in the dermis were interstitial collagenization (84.6%, 242/286), and inflammatory cell infiltration (73.8%, 211/286). (4) Treatment: 177 patients received standardized treatment after diagnosis and were followed up regularly in our hospital. In the initial treatment stage, 26.0% (46/177) of the patients were treated with 0.05% clobetasol propionate cream, and 74.0% (131/177) of the patients were treated with 0.1% mometasone furoate ointment. The complete remission rates of the two methods were respectively 80.4% (37/46) and 74.0% (97/131), and there was no statistically significant difference ( χ²= 0.76, P =0.385). During maintenance treatment, 27.1% (48/177) of the patients took the medication twice a week, 35.0% (62/177) took the medication once a week, and 37.9% (67/177) took the medication once every 10 days. During follow-up after 6 months of maintenance treatment, there were no patients with recurrence of pruritus or progression of vulvar signs. Conclusions: The majority of VLS patients have itching, hypopigmentation, involvement of labia minora and labia majora, progressive atrophy, and inflammatory infiltration of dermis. Local treatments of mometasone furoate and clobetasol propionate have good initial therapeutic effects. The frequency exploration of individualized maintenance treatment could minimize the occurrence of adverse reactions when ensuring the stability of the patients' condition. |
| معلومات مُعتمدة: | 20ZR1470900 Nature Science Foundation of Shanghai |
| فهرسة مساهمة: | Local Abstract: [Publisher, Chinese] 目的： 探讨外阴硬化性苔藓（VLS）的临床病理特征及治疗，并初步探讨其维持治疗频率。 方法： 收集2018年至2021年于复旦大学附属妇产科医院诊断为VLS的患者共345例，回顾性分析其临床病理特征、治疗方法及效果，对病情稳定的患者进行维持治疗并定期随访，探究维持治疗的最低用药频率。 结果： （1）一般情况：345例VLS患者的确诊年龄为（50.4±14.7）岁（范围：8~84岁），其中50~59岁年龄段的占比最高（30.1%，104/345）。177例有合并疾病和相关家族史记录的患者中，18.6%（33/177）合并自身免疫性疾病，24.3%（43/177）合并过敏性皮肤疾病，5.6%（10/177）患者的女性直系亲属有长期外阴瘙痒或皮肤色素减退病史。（2）临床特征：204例有症状记录的患者中，最常见的症状为外阴瘙痒（96.1%，196/204）；214例有体征记录的患者中，最常见体征为外阴色素减退（96.3%，206/214）；202例有病变累及部位记录的患者中，常见累及部位依次为小阴唇（70.3%，142/202）、大阴唇（67.8%，137/202）、阴唇沟（59.4%，120/202）。62例外阴萎缩患者的病变累及部位数［（2.7±1.1）个］显著多于152例非萎缩患者［（2.2±1.0）个； t =3.48， P =0.001］；外阴萎缩患者的病程为（9.3±8.5）年，显著长于非萎缩患者［（6.6±5.6）年； t =2.04， P =0.046］。（3）病理特征：286例有电子病理图片的患者中，表皮层中最常见的病理特征为上皮钉突钝化（71.3%，204/286），真皮层中常见的病理特征依次为间质胶原化（84.6%，242/286）、炎细胞浸润（73.8%，211/286）。（4）治疗：177例患者在确诊后进行了规范治疗并在本院定期随访。初始治疗阶段，26.0%（46/177）患者使用0.05%丙酸氯倍他索乳膏，74.0%（131/177）患者使用0.1%糠酸莫米松软膏治疗；两种药物的完全缓解率分别为80.4%（37/46）、74.0%（97/131），两者比较，差异无统计学意义（ χ²= 0.76， P =0.385）。维持治疗期间，27.1%（48/177）的患者每周2次用药，35.0%（62/177）每周1次用药，37.9%（67/177）每10天1次用药；维持治疗6个月后随访，无瘙痒复发或外阴体征进展患者。 结论： 绝大多数VLS患者有外阴瘙痒、色素减退、大小阴唇受累、进行性外阴萎缩、表皮层和真皮层炎症浸润后改变，初始治疗局部使用糠酸莫米松和丙酸氯倍他索治疗均具有良好的疗效，个体化的维持治疗频率在保证患者病情稳定的情况下可最大程度减少副反应的发生。. |
| المشرفين على المادة: | ADN79D536H (Clobetasol) 04201GDN4R (Mometasone Furoate) |
| تواريخ الأحداث: | Date Created: 20240116 Date Completed: 20240118 Latest Revision: 20240118 |
| رمز التحديث: | 20240118 |
| DOI: | 10.3760/cma.j.cn112141-20230909-00094 |
| PMID: | 38228516 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 0529-567X |
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| DOI: | 10.3760/cma.j.cn112141-20230909-00094 |