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.

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.

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.

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.

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.

Concomitant morphea and lichen sclerosus et atrophicus in the same plaque at the site of intramuscular drug injection: an interesting case presentation.

Morphea and lichen sclerosus et atrophicus (LSA) are two diseases that show considerable clinical and histopathological similarity and have been known to coexist in the same patient. Whether the two conditions are different entities or part of the same spectrum has been a topic of debate. This article describes a very rare and interesting case of concomitant morphea and LSA in a 50-year-old female in the same plaque following intramuscular drug injection in the deltoid region of the right arm. The coexistence of morphea and LSA in the same lesion has rarely been reported, thus compelling us to report this case.

Genital lichen sclerosus developing around 'ectopic' urethral orifices supports the role of occlusion and urine in its pathogenesis.

Several factors such as genetic susceptibility, autoimmunity, hormones, infections, local trauma, urine, and occlusion have been speculated to play a role in the pathogenesis of lichen sclerosus. We report two male patients with lichen sclerosus around 'ectopic' urethral openings and the opposing surfaces of the penile shaft and scrotum, providing further evidence in support of urine and occlusion as contributing factors in the development of lichen sclerosus.

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.

Liquen escleroso genitaly extragenital: a propósito de 4 casos / Genital and extragenital lichen sclerosus: report of 4 cases

El liquen escleroso (LE) es una enfermedad mucocutánea inflamatoria crónica de etiología desconocida. Se lo ha vinculado con diversos factores inmunológicos, genéticos, hormonales, infecciosos y traumáticos. Se presenta generalmente en mujeres entre la cuarta y quinta década de la vida y su localización habitual es la genital. Las formas extragenitales son poco frecuentes y asientan en tronco, cuello y extremidades. Debido a que los síntomas que provoca en el área genital, como el prurito, dispareunia, dolor y disuria alteran la calidad de vida del paciente, es fundamental realizar un diagnóstico en forma temprana y el tratamiento adecuado. Presentamos cuatro casos de LE genital y extragenital.

Lichen sclerosus is a chronic inflammatory mucocutaneous disease of unknown aetiology. It has been linked to various immunological, genetic, hormonal, infectious and traumatic factors. It usually appears in women between fourth and fifth decade of life and usual location is genital area. Extragenital forms are rare and located on trunk, neck and extremities. Because the symptoms affecting genital area, such as itch, dyspareunia, pain and dysuria, may cause a high impact on the quality of life of patients, early diagnosis and appropiate treatment are essential. Four cases of genital and extragenital lichen sclerosus are reported.