Male genital lichen sclerosus associated with urological interventions and microincontinence: a case series of 21 patients.

BACKGROUND: Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory cutaneous disease associated with significant morbidity and squamous cell carcinoma of the penis. Consideration of all of the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin is the most likely pathomechanism. MGLSc never occurs in men who were circumcised at birth, and has been associated with trauma, instrumentation and anatomical abnormalities, e.g. frank hypospadia that results in microincontinence. AIM: To describe 21 patients who developed MGLSc following urological diagnoses and procedures. METHODS: We conducted a retrospective review of patients with a diagnosis of MGLSc whose symptoms related to urological procedures who attended or saw one of the authors (CBB) privately during the period June-October 2018. RESULTS: In total, 21 patients (mean age 59 years) were identified. The referrals came from the local urology departments, primary care or extramural dermatology services. Most of the patients were uncircumcised men. All had developed symptoms and signs of MGLSc within 5 years following their urological procedure; on examination, 30% of the patients were found to have damp penile skin due to microincontinence. Of the 21 patients, 10 had undergone radical prostatectomy for prostate cancer, 4 had a diagnosis of Peyronie disease, 4 had undergone multiple cystoscopies and urethroscopies, 2 had undergone surgery on the bladder neck and 1 had undergone implantation of a penile prosthesis to treat erectile dysfunction. CONCLUSION: This case series further strengthens the urinary occlusion hypothesis for the causation of MGLSc. It is important to recognize that urological interventions can create incompetence of the naviculomeatal valve post voiding. In uncircumcised men, this creates a risk factor for MGLSc that was not previously present. Occlusion, the phenomenon of koebnerization and currently unelucidated epithelial susceptibility factors lead to inflammation, sclerosis and cancer. Patients and urologists should be aware of these possibilities and preventative measures instituted, e.g. adaptive voiding habits and barrier protection.

Lichen sclerosus associated with Nd:YAG laser therapy.

Laser is the most efficient and popular method in hair removal. The most common side effects of laser assisted hair removal are pain, erythema, edema, hypopigmentation, hyperpigmentation, blistering, crusting, erosions, purpura, folliculitis, and scar formation ( 1 ). Herein, for the first time we describe a case of lichen sclerosus (LS) following hair removal with long pulsed 1064 nm Nd:YAG laser therapy.

Underestimation of genital lichen sclerosus incidence in boys with phimosis: results from a systematic review.

PURPOSE: Previous histological studies have shown a variable incidence of genital lichen sclerosus (LS). However, the results of these studies were inconsistent. To overcome the limitation of individual studies, we performed this systematic review to explore the true incidence of LS. METHODS: A comprehensive search of Pubmed, Embase, Web of Science and Cochrane Library was performed including cross-referencing independently by two assessors. RESULTS: A total of 22 articles published from 1980 to 2017 were included in our study. The proportion of LS in those with phimosis had been described in many literature studies, ranging from 2 to 95%. The actual incidence of LS is thought to be clinically underestimated by as much as 50%. CONCLUSIONS: The true incidence of LS in boys is more common than previously realized. LS may be observed in foreskin with or without phimosis. The presence of acquired phimosis may be an aggravating factor in the incidence of LS. The diagnosis LS must be based on biopsy for acquired phimosis because clinical findings underestimated the incidence of LS.

Male genital lichen sclerosus in recipients of bone marrow transplants.

We describe two patients who received haematopoietic stem cell marrow transplantation, and developed male genital lichen sclerosus (MGLSc), one of whom also had squamous carcinoma in situ (Bowen disease). MGLSc has previously been associated with graft-versus-host disease. Various aetiological factors for LSc have been proposed, including a role for chronic occluded epithelial exposure to urine. A number of factors imply that the risk of malignant transformation in this bone marrow transplant group is likely to be higher than the overall figure of 2-9% cited for MGLSc. It is vital, therefore, that clinicians involved in the care of those with haematological malignancies are adequately prepared to examine the genitals of their patients, and to recognize and refer any suspect penile lesions.

Sclerotic atrophic plaques associated with a tattoo.

Lichen sclerosus is a chronic inflammatory disease, usually of the anogenital area, that causes intractable itching and soreness. Less commonly, it may have extragenital involvement in 15 to 20% of cases. Lichen sclerosus has been reported at sites of injury as a Koebner phenomenon. We report a case of lichen sclerosus at the site of a tattoo with simultaneous genital involvement.

Peristomal lichen sclerosus: the role of occlusion and urine exposure?

BACKGROUND: Lichen sclerosus (LS) is a chronic inflammatory skin disorder that typically affects the anogenital area. It presents with ivory-white atrophic patches or plaques with associated telangiectasia and occasional purpura. It has rarely been described as affecting abdominal stomas. OBJECTIVES: To investigate possible aetiological factors responsible for the development of this condition. METHODS: All patients with peristomal LS were identified at a specialist stoma dermatology clinic and studied using a standardized pro forma. RESULTS: We identified 12 patients with peristomal LS. The mean age was 72·3 years (range 47-85 years). With the exception of one patient, all our other patients had urostomies. Treatment was effective in the majority of cases. CONCLUSIONS: Peristomal LS, in our experience, is most commonly found around urostomies, and we speculate that in addition to the possible role of local trauma and occlusion, certain - as yet unidentified - constituents in the urine possibly play a role in its aetiology. It tends to respond well to corticosteroids and has not been associated with malignant transformation.

Lichen sclerosus and atopy in boys: coincidence or correlation?

BACKGROUND: Lichen sclerosus (LS) is a sclerosing skin disease of presumably autoimmune origin affecting mainly the anogenital area. The aetiology is not completely understood. Comorbidity between genital LS and atopy in girls has been described but so far no controlled study has been performed. OBJECTIVES: A prospective epidemiological case-control study was designed to clarify if there is comorbidity between genital LS and atopic skin diathesis (AD) in boys. METHODS: The study included a total of 92 boys aged between 1 and 17 years. The disease group consisted of 48 boys who underwent surgery for phimosis that was histologically confirmed as LS. The control group included 44 boys who were circumcised for phimosis for other medical reasons. Both groups were examined and the parents were interviewed following the criteria of the validated Diepgen atopy score. Patients with a score > 9 were assumed to have AD. RESULTS: Within the LS group (median age 8·7 years) 12 boys were diagnosed with AD (25%), while there were only three boys with AD (7%) in the control group (median age 5·3 years). The difference was significant using an age-adjusted logistic regression (P < 0·05). Prior to our study nine boys of the LS group (19%) and four boys of the control group (9%) had already been diagnosed with AD. CONCLUSIONS: We have demonstrated a significant comorbidity between LS and AD in boys. AD seems to be a priming precondition for the development of LS in boys.

Extragenital lichen sclerosus arising in tattooed skin.

Lichen sclerosus (LSc) is a chronic inflammatory condition commonly affecting the anogenital area, with extragenital involvement seen in less than 1%-20% of cases. Concomitant extragenital and genital LSc is extremely rare in male patients. The Koebner phenomenon is a recognised feature of LSc; here we present a rare case of extragenital LSc occurring in tattooed skin.

Lichen sclerosus following genital piercing.

Male genital lichen sclerosus (MGLSc) is a chronic inflammatory dermatosis that predominantly affects uncircumcised males. Several aetiological factors have been described, with growing evidence supporting chronic urine exposure of susceptible epithelium being crucial to its pathogenesis. We describe a 45-year-old man with a 2-year history of MGLSc at the site of a urethrocutaneous fistula secondary to a penile piercing. To our knowledge, this is the first documented case of MGLSc occurring at the site of a genital piercing.

Risk factors for genital lichen sclerosus in men.

BACKGROUND: Lichen sclerosus (LS) is an inflammatory disease of the skin and mucous membranes. Its aetiology is still unknown. OBJECTIVES: To determine risk factors for genital LS in men. METHODS: In a case-control study, 73 patients with LS, consecutively diagnosed at the City Dispensary for Skin and Venereal Diseases in Belgrade, were compared with 219 male patients visiting the same institution because of tinea cruris. Univariate and multivariate logistic regression analyses were used for analysis of data collected. RESULTS: According to multivariate logistic regression analysis, risk factors for male LS were as follows: a personal history of genital injury [odds ratio (OR) 28·1, 95% confidence interval (CI) 5·2-150·8], vitiligo (OR 23·1, 95% CI 2·2-240·2), alopecia areata (OR 8·8, 95% CI 1·1-68·5) and hypercholesterolaemia (OR 3·1, 95% CI 1·1-8·2), and a family history of alopecia areata (OR 24·3, 95% CI 2·1-280·7), diseases of the thyroid gland (OR 9·1, 95% CI 2·3-36·2) and other autoimmune diseases (OR 8·6, 95% CI 1·3-58·6). CONCLUSIONS: The results of the present study are in line with the hypothesis that trauma of the penis is a possible trigger of symptoms in genetically predisposed individuals and that personal and family histories of autoimmune disorders are risk factors for male LS.

Development of lichen sclerosus et atrophicus while receiving a therapeutic dose of imatinib mesylate for chronic myelogenous leukemia.

BACKGROUND: Imatinib mesylate (Gleevec) is a selective Bcr-Abl protein tyrosine-kinase inhibitor, and it also inhibits the receptor tyrosine kinases for stem cell factor (c-kit) and platelet-derived growth factor (PDGFR). It is being investigated for use in the treatment of sclerosing dermatoses. OBSERVATION: A 44-year-old woman with a history of chronic myelogenous leukemia (CML) was referred for the evaluation of a pruritic eruption that developed over 6 months. Examination revealed atrophic plaques confined to the groin, vulva, axillae, inframammary region, trunk, antecubital and popliteal fossae, and posterior thighs bilaterally. A biopsy showed lichen sclerosus et atrophicus (LSetA). At the time of presentation, the patient was receiving imatinib mesylate 400 mg daily for CML. CONCLUSION: This is the first report of development of LSetA, a sclerosing dermatosis, while receiving a therapeutic dose of imatinib mesylate, a drug thought to have anti-sclerotic properties.

[Lichen sclerosus]. / Liquen escleroso.

Lichen sclerosus is a chronic inflammatory mucocutaneous disease that is highly bothersome for men and women of all ages. The exact etiology is unknown, although genetic and autoimmune factors, as well as infections, have been implicated in its pathogenesis. First-line treatment is highly potent topical corticosteroid therapy for short periods. Surgery is reserved for cases of phimosis, urethral stenosis, synechiae, and squamous cell carcinoma.

The color of skin: white diseases of the skin, nails, and mucosa.

White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.

Penile lichen sclerosus after allogeneic stem cell transplantation.

Graft-versus-host disease (GVHD) often complicates allogeneic stem cell transplantation (SCT) and affects mainly the gut, liver, lung and skin. The microscopic morphological features of late-phase sclerodermatous chronic GVHD in the skin, namely epidermal atrophy, lymphoplasmacytic infiltration, dense dermal fibrosis and adnexal atrophy, are histologically indistinguishable from those in sporadic systemic sclerosis, morphoea and the related condition of lichen sclerosus. Mucosal orifices including those of the genitourinary system may be severely affected. We present three SCT recipients with chronic GVHD and severe posthitis leading to phimosis requiring surgery. The excised prepuces showed features of lichen sclerosus including epidermal atrophy and a subepidermal zone of eosinophilic, homogeneous and hyalinized collagen above a band-like lymphoplasmacytic infiltrate. These cases add further evidence to support the notion that penile lichen sclerosus should be included within the expanding sclerodermoid spectrum of late-stage cutaneous chronic GVHD.