Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus
Background:. Pigmented lesions such as melanosis have rarely been reported in patients with vulvar lichen sclerosus (VLS) that is typically characterized by hypopigmented lesions. Objective:. We aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients. Methods:. We anal...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2024-10-01
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| Series: | International Journal of Women's Dermatology |
| Online Access: | http://journals.lww.com/10.1097/JW9.0000000000000169 |
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| author | Thilo Gambichler, MD Gülgün Erdogan, MD Sera S. Weyer-Fahlbusch, MD Laura Susok, MD |
| author_facet | Thilo Gambichler, MD Gülgün Erdogan, MD Sera S. Weyer-Fahlbusch, MD Laura Susok, MD |
| author_sort | Thilo Gambichler, MD |
| collection | DOAJ |
| description | Background:. Pigmented lesions such as melanosis have rarely been reported in patients with vulvar lichen sclerosus (VLS) that is typically characterized by hypopigmented lesions.
Objective:. We aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients.
Methods:. We analyzed the clinical data of 198 female patients with VLS. The anogenital lesions of all patients were professionally photographed in a standardized position and illumination. Severity classification of architectural findings followed an easy-to-use clinical score. A modified Melasma Area and Severity Index and an image analysis software were used to evaluate the area and intensity of pigmentation.
Results:. According to the clinical score, 79 (198/39.9%) patients showed grade 1 disease, 78 (198/39.4%) grade 2, 37 (198/18.7%) grade 3, and 4 (198/2%) grade 4 disease. About 111 (56.1%) of the 198 patients had anogenital melanosis with a median modified Melasma Area and Severity Index of 3.6 (0.4–14). Univariate analysis revealed that anogenital melanosis was positively correlated with the use of topical estrogens (P = .0018) and negatively correlated with the use of pulsed high-dose corticosteroids plus low-dose methotrexate (PHDC-LDM, P = .021). On multivariable analysis, the use of topical hormone therapy turned out to be a strong independent predictor for the presence of anogenital melanosis (odds ratio: 4.57, 95% confidence interval: 1.66–12.57, P = .0033), whereas PHDC-LDM use was an independent predictor for the absence of anogenital melanosis (odds ratio: 0.35, 95% confidence interval: 0.15–0.84, P = .018).
Limitations:. The study includes the retrospective monocentric design.
Conclusion:. Anogenital melanosis is a very frequent and so far, under-reported clinical finding in VLS patients. It is likely caused by the use of topical estrogens employed for VLS treatment. In contrast, patients with more severe disease and PHDC-LDM treatment appear to develop less likely anogenital melanosis. |
| format | Article |
| id | doaj-art-18582f3af7fe4e31aa5ab6b9eede4427 |
| institution | OA Journals |
| issn | 2352-6475 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wolters Kluwer |
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| series | International Journal of Women's Dermatology |
| spelling | doaj-art-18582f3af7fe4e31aa5ab6b9eede44272025-08-20T02:18:01ZengWolters KluwerInternational Journal of Women's Dermatology2352-64752024-10-01103e16910.1097/JW9.0000000000000169202410000-00008Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosusThilo Gambichler, MD0Gülgün Erdogan, MD1Sera S. Weyer-Fahlbusch, MD2Laura Susok, MD3a Department of Dermatology, Ruhr-University Bochum, Bochum, Germanya Department of Dermatology, Ruhr-University Bochum, Bochum, Germanyc Department of Dermatology, Dortmund Hospital, University Witten/Herdecke, Dortmund, Germanya Department of Dermatology, Ruhr-University Bochum, Bochum, GermanyBackground:. Pigmented lesions such as melanosis have rarely been reported in patients with vulvar lichen sclerosus (VLS) that is typically characterized by hypopigmented lesions. Objective:. We aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients. Methods:. We analyzed the clinical data of 198 female patients with VLS. The anogenital lesions of all patients were professionally photographed in a standardized position and illumination. Severity classification of architectural findings followed an easy-to-use clinical score. A modified Melasma Area and Severity Index and an image analysis software were used to evaluate the area and intensity of pigmentation. Results:. According to the clinical score, 79 (198/39.9%) patients showed grade 1 disease, 78 (198/39.4%) grade 2, 37 (198/18.7%) grade 3, and 4 (198/2%) grade 4 disease. About 111 (56.1%) of the 198 patients had anogenital melanosis with a median modified Melasma Area and Severity Index of 3.6 (0.4–14). Univariate analysis revealed that anogenital melanosis was positively correlated with the use of topical estrogens (P = .0018) and negatively correlated with the use of pulsed high-dose corticosteroids plus low-dose methotrexate (PHDC-LDM, P = .021). On multivariable analysis, the use of topical hormone therapy turned out to be a strong independent predictor for the presence of anogenital melanosis (odds ratio: 4.57, 95% confidence interval: 1.66–12.57, P = .0033), whereas PHDC-LDM use was an independent predictor for the absence of anogenital melanosis (odds ratio: 0.35, 95% confidence interval: 0.15–0.84, P = .018). Limitations:. The study includes the retrospective monocentric design. Conclusion:. Anogenital melanosis is a very frequent and so far, under-reported clinical finding in VLS patients. It is likely caused by the use of topical estrogens employed for VLS treatment. In contrast, patients with more severe disease and PHDC-LDM treatment appear to develop less likely anogenital melanosis.http://journals.lww.com/10.1097/JW9.0000000000000169 |
| spellingShingle | Thilo Gambichler, MD Gülgün Erdogan, MD Sera S. Weyer-Fahlbusch, MD Laura Susok, MD Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus International Journal of Women's Dermatology |
| title | Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus |
| title_full | Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus |
| title_fullStr | Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus |
| title_full_unstemmed | Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus |
| title_short | Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus |
| title_sort | treatment induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus |
| url | http://journals.lww.com/10.1097/JW9.0000000000000169 |
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