Risk of Vulvar Squamous Cell Carcinoma in Lichen Sclerosus and Lichen Planus: A Systematic Review.

OBJECTIVES: The objectives of this study were to determine: 1) the prevalence of lichen sclerosus (LS) and lichen planus (LP) present in association with vulvar squamous cell carcinoma (VSCC), and 2) the incidence and absolute risk of developing VSCC in LS and LP. METHODS: A search was performed of MEDLINE, EMBASE and CINAHL databases. Three independent reviewers screened articles published before September 1, 2020, first on title/abstract and then on the full text. Women with a history of VSCC, human papillomavirus, smoking, or autoimmune disease were excluded. Newcastle-Ottawa observational study scales were used to assess the risk of bias and methodological quality of the included studies. Of the 3132 studies assessed, 31 were selected for analysis. Due to study heterogeneity, a qualitative synthesis was conducted. RESULTS: The prevalence of LS and LP in association with VSCC ranged from 0% (95% CI 0-5) to 83% (95% CI 36-100) and 1% (95% CI 0-7) to 33% (95% CI 4-78), respectively. The incidence of VSCC ranged from 1.16 (95% CI 0.03-6.44) to 13.67 (95% CI 5.50-28.17) per 1000 person-years for LS. The absolute risk of developing VSCC in patients ranged from 0.0% (95% CI 0.0-5.52) to 21.88% (95% CI 9.28-39.97) with LS and was 1.16% (95% CI 0.1-4.1) with LP. Incidence was not calculable for LP owing to study characteristics. CONCLUSIONS: This review provides evidence that there is an increased risk of developing VSCC in women with LS, while associations with LP are less clear. Early identification, treatment, and long-term follow-up are essential to prevent potential malignant progression of these vulvar dermatoses.

Certolizumab Pegol in Plaque Psoriasis: Considerations for Pregnancy.

Psoriasis is a chronic, immune-mediated skin condition which commonly affects women of childbearing age. Certolizumab pegol (CZP) is an anti-tumor necrosis factor-alpha (anti-TNFα) agent that has demonstrated long-term safety and efficacy in treating moderate-to-severe plaque psoriasis. Previously, there has been limited safety data surrounding its use in pregnancy. The objective of this article is to review pivotal clinical trial data for CZP and explore safety considerations for this agent in pregnancy. This review demonstrates that CZP offers a safe and effective treatment option for women during childbearing years based on pharmacokinetics and available safety data. The observed occurrence of major congenital malformations and miscarriages appears to be no greater than the background occurrence of those in the general population, and risks to the mother are minimal based on its known safety profile. The use of CZP for treatment of plaque psoriasis should be considered and discussed with patients considering childbearing or whom are currently pregnant or breastfeeding.

Evaluación multidisciplinaria del feto con hidrocefalia: protocolo de estudio y resultados / Multidisciplinary evaluation offetus with hydrocephalia. Protocol and results

El objetivo fue realizar el diagnóstico de confirmación-exclusión de hidrocefalia fetal, estudiar su etiología e identificar las anomalías asociadas. Se estudiaron 67 casos con diagnóstico de sospecha de hidrocefalia a una edad gestacional media de 30 semanas. Se efectuaron estudios seriados de ultrasonografía de alta definición, serología TORCH y estudio cromosómico del feto. Se realizó correlación diagnóstica de los resultados al nacimiento. La hidrocefalia se exluyó en 14 y se confirmó en 53. De éstos, 6 (11.3 por ciento) se clasificaron como hidrocefalia aislada y 47 (88.7 por ciento) con anomalías asociadas. En este grupo, 15 presentaron únicamente malformación intracraneana y 32, anomalías intra y extracraneanas combinadas así como las alteraciones cromosómicas identificadas. El diagnóstico de hidrocefalia se corroboró en todos los casos y el de anomalías asociadas en la mayoría de ellos. La hidrocefalia fetal se puede diagnósticar con certeza. El diagnóstico de anomalías asociadas presenta dificultades que se pueden reducir con las exploraciones ultrasonográficas seriadas y la participación multidisciplinaria