Nodular Vulvar Lesions.

A woman in her 30s presented with mildly itchy skin nodules in the vulvar region for 1 year, which occurred during pregnancy and increased gradually in size and number without any treatments. What is your diagnosis?

Vulvar lichen sclerosus in girls and adult females: A single-center retrospective study of 744 patients in China.

Vulvar lichen sclerosus (VLS) is a chronic, inflammatory disease which is accompanied by itching and pain, affecting the patient's daily life and sexual activity. However, the disease characteristics of children and adults are not completely the same. Currently, there are few studies in China that compare the characteristics of VLS between girls and adult female patients. The aim of this study was to compare the epidemiology, clinical features, and combined autoimmune diseases of VLS patients between girls and adult females, and to help clinicians better understand VLS in different age groups. We enrolled 744 female patients for analysis, divided by age into a child group (<18 years) and an adult group (≥18 years). Among girl patients, 94.6% had preadolescent onset, while among adult female patients, only 4.6% had preadolescent onset, which was a statistically significant difference. The highest percentage of adult female patients had onset during their child-bearing period (75.4%), while 20% had postmenopausal onset, with a significant difference when the three onset states were compared. White patches were equally common in both girl and adult female patients' external genital area, while mossy lesions and labia minora atrophy were more common in adult female patients. Involvement of the clitoris, labia minora, and vaginal opening area were more common in adult patients. The perianal area was more commonly involved in girl patients. We found eight cases (1.2%) of secondary squamous cell carcinoma in adult female patients. We also found that 13 patients had concurrent lichen sclerosus lesions on the vulva and extragenital region, including two girls and 11 adult females. Extragenital lichen sclerosus (EGLS) occurred mostly in the torso. Clinicians should be aware of these differences so that early diagnosis and treatment of the disease can be achieved, to avoid irreversible anatomical alterations and the risk of cancer.

Causal Association Between Diabetes, Body Mass Index and Lichen Sclerosus: A Bidirectional Two-Sample Mendelian Randomization Analysis.

Background: Previous observational studies have found that lichen sclerosus (LS) is associated with metabolic statuses, such as diabetes mellitus (DM) and body mass index (BMI). However, there are also some studies showing that LS is not related to DM and BMI. The mechanism behind observational results is still unclear. Therefore, the causality of this relationship remains unknown. In this study, a bidirectional two-sample Mendelian randomization (MR) was conducted to investigate the correlation between DM, BMI, and LS. Methods: The instrumental variables related to DM (including type 1 and type 2 diabetes), and BMI were identified from genome-wide association studies (GWAS) and a GWAS meta-analysis. The GWAS data for LS was from obtained the eighth edition of the FinnGen biological database released in 2022. Inverse variance weighted (IVW), weighted median, and MR-Egger methods were used to conduct a bidirectional two-sample MR analysis. Thereafter, the heterogeneity and horizontal pleiotropy were examined to determine whether the results were affected by a single-nucleotide polymorphism (SNP). Results: We found a lack of evidence for the causal association of DM, and BMI on LS in inverse variance weighted (type 1 diabetes, OR=0.97, 95% CI=0.91-1.04, p=0.429; type 2 diabetes, OR=0.91, 95% CI=0.82-1.00, p=0.0511; BMI, OR=0.92, 95% CI=0.73-1.15, p=0.4554). In the other direction, the results also showed that LS had no significant causal effect on DM and BMI. Conclusion: This MR analysis demonstrated no significant causal relationship between DM and BMI with LS in both directions, which contradicts previous observational studies reporting a positive association. Potential confounding factors may contribute to previously observed associations, and further research is necessary.

Removal of dyes from wastewater using Eucalyptus wood fiber loaded nanoscale zero-valent iron: Characterization and removal mechanism.

Wood fiber as a natural and renewable material has low cost and plenty of functional groups, which owns the ability to adsorb dyes. In order to improve the application performance of wood fiber in dye-pollution wastewater, Eucalyptus wood fiber loaded nanoscale zero-valent iron (EWF-nZVI) was developed to give EWF magnetism and the ability to degrade dyes. EWF-nZVI was characterized via FTIR, XRD, zeta potential, VSM, SEM-EDS and XPS. Results showed that EWF-nZVI owned a strong magnetism of 96.51 emu/g. The dye removal process of EWF-nZVI was more in line with the pseudo-second-order kinetics model. In addition, the Langmuir isotherm model fitting results showed that the maximum removal capacities of Congo red and Rhodamine B by EWF-nZVI were 714.29 mg/g and 68.49 mg/g at 328 K, respectively. After five adsorption-desorption cycles, the regeneration efficiencies of Congo red and Rhodamine B were 74 % and 42 % in turn. The dye removal mechanisms of EWF-nZVI included redox degradation (Congo red and Rhodamine B) and electrostatic adsorption (Congo red). In summary, EWF-nZVI is a promising biomass-based material with high dye removal capacities. This work is beneficial to promote the large-scale application of wood fiber in water treatment.

Vulvar-vaginal-gingival-otic syndrome.

In order to retrospectively analyse the multi-site involvement pattern of erosive lichen planus patients, we retrospectively reported the clinical and medical data of three patients with erosive lichen planus which involving their vulva, vagina, gingiva, and ear canal. We confirmed the existence of otic lichen planus, and found that it is more common in patients with vulvovaginal-gingival syndrome of erosive lichen planus. Therefore, we propose 'vulvovaginal-gingival-otic syndrome' to further describe this rare compound pattern of lichen planus.

Quality of life and burden of disease of vulvar lichen sclerosus: A single-center retrospective study in China.

OBJECTIVE: This study examined the quality of life and burden of disease of vulvar lichen sclerosus (VLS) patients in three states of menstruation to better understand VLS. METHODS: A total of 607 VLS patients were enrolled into this retrospective study. According to the ages of onset, menarche and menopause, the patients were divided into three groups: prepubertal group (n = 96), reproductive group (n = 400) and postmenopausal group (n = 111). Data were collected by direct interview and clinical examination. RESULTS: A total of 93% of patients had itching, with a median numerical rating scale score of five. In the prepubertal group, the median score was three. Nocturnal itching occurred in 49.6% patients. Nearly half of the patients (45.9%) thought the itching affected their sleep. However, this ratio was very different in the prepubertal group (20.7%). Some patients (12.8%) cleaned their vulva more than seven times per week. Only 17.2% of patients experienced no effect on their sex life. The median dermatology life quality index score in all patients was six, but it was only three in the prepubertal group. The median number of hospital visits was two times, and the number of clinic visits was three times. Previous expenses, in median, were 2000 RMB. For 84.3% patients, the gynecologic clinic was their first choice. CONCLUSION: VLS places great physical, mental and economic burdens on patients. Patients in the prepubertal group had milder symptoms and dermatology life quality index score. VLS should arouse the attention of patients and specialists.

Interstitial Granulomatous Drug Reaction Due to Chemotherapy.

Interstitial granulomatous drug reaction (IGDR) is a drug-related disease with distinctive clinical and histopathological features uncommon in clinical practice. Chemotherapeutics-related IGDR has rarely been reported. Here, we describe one case of interstitial granulomatous drug reaction due to chemotherapy.

A Case of Granuloma Faciale Successfully Treated with Minocycline.

Granuloma faciale (GF) is a rare chronic inflammatory dermatosis in clinical practice. The etiology is not yet clear, and it often occurs on the face. The progression of skin lesions is slow and persistent, with almost no self regression and a risk of recurrence, which may lead to disfigurement. We reported a 61-year-old male with GF who had poor reaction with topical corticosteroids and calcineurin inhibitors, but the lesions were significantly improved after systematic application of minocycline. This report describes the good clinical effect of minocycline on GF.

Efficacy of photodynamic therapy in cutaneous leishmaniasis: A systematic review.

OBJECTIVE: To systematically review the efficacy of photodynamic therapy (PDT) in the treatment of cutaneous leishmaniasis (CL). METHODS: PubMed, Embase and Cochrane Library databases were searched for articles published by November 16, 2022, with no time restrictions. 'Cutaneous leishmaniasis' and 'photodynamic therapy' were searched using predefined search strings. INCLUSION CRITERIA: (i) Randomized control trials; (ii) controlled clinical trials; (iii) case series; (iv) case reports; (v) participants were humans; (vi) clinical diagnosis was CL; (vii) treatment method used was PDT; and (viii) articles published in English. RESULTS: In total, 303 articles were identified, including 14 papers meeting the criteria. The number of patients in each study ranged from 1 to 60 and the age ranged from 1 to 82 years. Aminolevulinic acid and methyl aminolevulinate were used as photosensitizers. Red light and sunlight were used as light sources. All reported satisfactory clinical effects. Side effects of treatment included burning sensation, pain and pigmentation after treatment. However, they were tolerable and temporary. The follow-up time ranged between 9 weeks and 24 months. A total of two patients recurred, but one did not recur after another round of PDT during the follow-up period. CONCLUSIONS: The present study suggests that PDT is a safe and effective method for the treatment of CL, with tolerable side effects and good efficacy. As an alternative treatment method of CL, PDT has great potential. However, to verify the efficacy and specific mechanism of PDT for the optimal treatment strategy of CL, further research with larger sample sizes and longer follow-up times are needed.

Performance and characterization of phenol-formaldehyde resin with crude bio-oil by model compound method.

In order to clarify the effects of crude bio-oil for phenol-formaldehyde resin, the phenol-formaldehyde resin with bio-oil model compounds (BMPF) were prepared by model compound method. The bonding strength and aging resistance of BMPF were determined, and their microstructure and chemical bonds were also analyzed by scanning electron microscope, Fourier transform infrared spectroscopy, and nuclear magnetic resonance analysis, respectively. The results showed that the components of crude bio-oil had various degrees of effects on the BMPF performance, and the most obvious one is the phenols. The phenols and the ketones of bio-oil had positive effects on the bonding strength. The ketones had the biggest effect on the surface smoothness of BMPF film. But all components of bio-oil could inordinately improve the aging resistance of BMPF. The structural analysis indicated that the effects of bio-oil components on the BMPF performance by changing the resin structure. The CH2 peak in FT-IR and the methylene bridges intensity in NMR of phenol-free BMPF and ketone-free BMPF were smaller, while the results of aldehyde-free BMPF and acid-free BMPF were opposite. And the influence degree of BMPF structure was basically consistent with that of BMPF performance. These results could provide a basis for the modification of phenol-formaldehyde resin by crude bio-oil.

Screening differential circular RNAs expression profiles in Vulvar Lichen Sclerosus.

BACKGROUND: Vulvar lichen sclerosus (VLS) is one of the most common clinical manifestations of vulva. Thirteen percent of women have symptomatic vulvar diseases. The aim of this study is to investigate the expression profile of circular RNA (circRNAs) in vulvar lichen sclerosus, and to identify the underlying core genes of VLS. METHODS: We removed rRNA for sequencing, and screened the differentially expressed messenger RNA (mRNAs), long non-coding RNA (lncRNAs) and single-stranded circRNA in 20 groups of VLS tissues and 20 groups of healthy female vulvar skin tissues. Bioinformatics analysis was used to analyze its potential functions. RESULTS: A total of 2545 differentially expressed mRNAs were assessed in VLS patients, of which 1541 samples were up-regulated and 1004 samples were down-regulated. A total of 1453 differentially expressed lncRNAs were assessed, of which 812 samples were up-regulated and 641 samples were down-regulated. A total of 79 differentially expressed circRNAs were assessed, of which 54 were up-regulated and 25 were down-regulated. The differential expression of circRNAs was closely related to biological processes and molecular functions. The differences in circRNAs were mainly related to the "human T-cell leukemia virus 1 infection" signaling pathway and the "axon guidance" signaling pathway. CONCLUSION: The profile of abnormal regulation of circRNA exists in VLS. According to biological informatics analysis, the dysregulation of circRNAs may be related to the pathogenesis and pathological process of VLS.

Aging Behaviors of Phenol-Formaldehyde Resin Modified by Bio-Oil under Five Aging Conditions.

The bio-oil phenol-formaldehyde (BPF) resin, prepared by using bio-oil as a substitute for phenol, has similar bonding strength but lower price to phenol-formaldehyde (PF) resin. As a common adhesive for outdoor wood, the aging performance of BPF resin is particularly important. The variations in mass, bonding strength, microstructure, atomic composition, and chemical structure of BPF resin under five aging conditions (heat treatment, water immersion, UV exposure, hydrothermal treatment, and weatherometer treatment) were characterized by scanning electron microscope, X-ray photoelectron spectroscopy, and Fourier transform infrared spectroscopy, respectively. Compared under five aging conditions, after aging 960 h, the mass loss of plywood and film was largest under hydrothermal treatment; the bonding strength of plywood, the surface roughness, and O/C ratio of the resin film changed most obviously under weatherometer treatment. FT-IR analysis showed that the decreased degree of peak intensity on CH2 and C-O-C characteristic peaks of BPF resin were weaker under water immersion, hydrothermal treatment, and weatherometer treatment than those of PF resin. The comparison of data between BPF and PF resins after aging 960 h showed that adding bio-oil could obviously weaken the aging effect of water but slightly enhance that of heat. The results could provide a basis for the aging resistance modification of BPF resin.

Anatomically distinct fibroblast subsets determine skin autoimmune patterns.

The skin serves as a physical barrier and an immunological interface that protects the body from the external environment1-3. Aberrant activation of immune cells can induce common skin autoimmune diseases such as vitiligo, which are often characterized by bilateral symmetric lesions in certain anatomic regions of the body4-6. Understanding what orchestrates the activities of cutaneous immune cells at an organ level is necessary for the treatment of autoimmune diseases. Here we identify subsets of dermal fibroblasts that are responsible for driving patterned autoimmune activity, by using a robust mouse model of vitiligo that is based on the activation of endogenous auto-reactive CD8+ T cells that target epidermal melanocytes. Using a combination of single-cell analysis of skin samples from patients with vitiligo, cell-type-specific genetic knockouts and engraftment experiments, we find that among multiple interferon-γ (IFNγ)-responsive cell types in vitiligo-affected skin, dermal fibroblasts are uniquely required to recruit and activate CD8+ cytotoxic T cells through secreted chemokines. Anatomically distinct human dermal fibroblasts exhibit intrinsic differences in the expression of chemokines in response to IFNγ. In mouse models of vitiligo, regional IFNγ-resistant fibroblasts determine the autoimmune pattern of depigmentation in the skin. Our study identifies anatomically distinct fibroblasts with permissive or repressive IFNγ responses as the key determinant of body-level patterns of lesions in vitiligo, and highlights mesenchymal subpopulations as therapeutic targets for treating autoimmune diseases.

Artificial Intelligence-Aided Recognition of Pathological Characteristics and Subtype Classification of Superficial Perivascular Dermatitis.

Background: Superficial perivascular dermatitis, an important type of inflammatory dermatosis, comprises various skin diseases, which are difficult to distinguish by clinical manifestations and need pathological imaging observation. Coupled with its complex pathological characteristics, the subtype classification depends to a great extent on dermatopathologists. There is an urgent need to develop an efficient approach to recognize the pathological characteristics and classify the subtypes of superficial perivascular dermatitis. Methods: 3,954 pathological images (4 × and 10 ×) of three subtypes-psoriasiform, spongiotic and interface-of superficial perivascular dermatitis were captured from 327 cases diagnosed both clinically and pathologically. The control group comprised 1,337 pathological images of 85 normal skin tissue slides taken from the edge of benign epidermal cysts. First, senior dermatologists and dermatopathologists followed the structure-pattern analysis method to label the pathological characteristics that significantly contribute to classifying different subtypes on 4 × and 10 × images. A cascaded deep learning algorithm framework was then proposed to establish pixel-level pathological characteristics' masks and classify the subtypes by supervised learning. Results: 13 different pathological characteristics were recognized, and the accuracy of subtype classification was 85.24%. In contrast, the accuracy of the subtype classification model without recognition was 71.35%. Conclusion: Our cascaded deep learning model used small samples to deliver efficient recognition of pathological characteristics and subtype classification simultaneously. Moreover, the proposed method could be applied to both microscopic images and digital scanned images.

Study of melanocyte density and epidermal thickness in vulvar lichen sclerosus lesions.

OBJECTIVE: This study aimed to analyze changes in melanocyte density and epidermal thickness in vulvar lichen sclerosus (VLS). METHODS: Vulvar skin tissues were collected from 15 VLS female patients in Beijing Hospital, classified into early (n = 7) and late VLS (n = 8) groups according to pathological manifestations. Melanocyte density and full epidermal and cell-layer (from the bottom of the stratum corneum to that of the basal layer) thickness were calculated using an image analysis software. The control group was normal vulvar skin tissues from 15 females after plastic surgery. RESULTS: The early VLS (0.170 ± 0.071 µm) and late VLS (0.110 ± 0.035 µm) groups had significantly lower densities of epidermal melanocytes than the control group (0.275 ± 0.036) (F = 36.426, P < 0.001). The cell-layer thickness did not differ between the early VLS (154.603 ± 121.984 µm) and control (176.974 ± 80.296 µm) groups (P = 0.899) but significantly decreased in the late VLS group (83.455 ± 37.129 µm) compared to the control group (P = 0.003). CONCLUSIONS: Melanocyte density decreased in early and late VLS. The full epidermal and cell-layer thickness did not significantly change in early VLS, but the cell-layer thickness decreased in late VLS.