Clearance in vulvar lichen sclerosus: a realistic treatment endpoint or a chimera?
|
|
- Joleen Simon
- 5 years ago
- Views:
Transcription
1 DOI: /jdv JEADV SHORT REPORT Clearance in vulvar lichen sclerosus: a realistic treatment endpoint or a chimera? A. Borghi,* A. Virgili, S. Minghetti, G. Toni, M. Corazza Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Universita degli Studi di Ferrara, Ferrara, Italy *Correspondence: A. Borghi. alessandro.borghi@unife.it Abstract Background According to the current guidelines, the aim of vulvar lichen sclerosus (VLS) treatment was to improve symptoms and signs, not to cure. Objective To assess (i) the rate of patients with VLS who achieved complete clearance of symptoms or objective features, or both, with a pharmacological treatment and (ii) the predictive value of therapeutic response to the demographic and clinical features. Methods We retrospectively included patients with VLS who had undergone any topical treatment for 12 weeks; demographics, history, VLS-related symptoms and objective features recorded at baseline and on completion of treatment were collected and elaborated. The primary study endpoint was to assess the rate of patients achieving complete clearance of global subjective score (GSS), or in global objective score (GOS), and in both scores. Results One hundred and ninety-six patients were included; 24 (12.2%) were asymptomatic at baseline, and nine (4.6%) dropped out. After treatment, 78 patients (47.3%) achieved GSS = 0, 40 (21.4%) achieved GOS = 0, and 23 (13.9%) achieved complete clearance of both symptoms and signs. Lower symptom scores at baseline and shorter disease duration were associated with the achievement of symptom clearance at the end of the treatment. Earlier disease onset, diagnosis and beginning of study treatment as well as lower baseline GOS were significantly associated with complete recovery of VLS signs and clearance of both symptoms and signs. Conclusion A relevant part of patients who undergo a topical treatment is not completely cured of VLS. It may be hypothesized that these patients, in spite of a significant improvement, may still have substantial residual disease and, as a result, its effect on their quality of life. Received: 1 February 2017; Accepted: 28 July 2017 Conflicts of interest None declared. Financial disclosure None declared. Introduction In our previous studies on the active treatment of vulvar lichen sclerosus (VLS), complete clearance of symptoms and objective features was not assessed, as it was considered an arduous treatment target in this chronic disease. 1 4 This study purposely investigated the occurrence of complete clearance in a large cohort of patients with VLS treated with different pharmacological therapies. Materials and methods Study design and objectives This study was set up as a single-centre retrospective cohort study. The aim was to assess: (i) the rate of patients with VLS achieving complete clearance of symptoms, objective features or both, with a active treatment phase (ATP); (ii) the predictive demographic and clinical features on achieving VLS clearance. Study patients All adult patients with a clinical and, when available, histological diagnosis of VLS who had undergone any topical pharmacological treatment for a ATP, between January 2012 and June 2016 at our Vulva Unit, were retrospectively evaluated for inclusion. Most of these treatment courses were part of comparative studies, with or without randomization. Patients were excluded from the study in the presence of the following: clinical or histological features showing possible resemblance to other
2 Clearance in vulvar lichen sclerosus 97 diseases such as lichen planus, vulvar intraepithelial neoplasia or plasma cell vulvitis; lack of agreement between clinical and histological features; treatment with non-pharmacological actives; and active vulvar infectious diseases or carcinoma. One hundred and ninety-six patients were included. Their treatments are reported in Table 1. Study assessment The data were recorded as follows: (i) age at the beginning of treatment; (ii) age at the onset of VLS; (iii) age at diagnosis; (iv) disease duration; (v) previous with topical corticosteroids. Subjective evaluation of the following two symptoms, itching and burning, was obtained for each patient using a visual analogue scale (VAS, which includes a numeric rating scale 0 10). A Table 1 Treatment regimens of the patients included in the study Patients (n.) Treatment regimen ( duration) % of MMF ointment once daily, at tapering regimen, as previously described 1, % of MMF ointment once daily for five consecutive days per week % of CP ointment once daily, at tapering regimen, as previously described 1, % of MMF ointment and 0.05% of tretinoin cream, for five consecutive days per week % of tretinoin cream once daily, every other day MMF, mometasone furoate; CP, clobetasol propionate. global subjective score (GSS) was obtained by summing each symptom parameter (highest GSS = 20). As dyspareunia was not evaluated in 99 study patients (50.5%) who avoided sexual activity for reasons other than disease-related pain, this symptom was considered only in the sexually active patients (97, 49.5%). The objective parameters were considered as follows: (i) leukoderma (pallor), (ii) hyperkeratosis and (iii) purpuric lesions and itching-related excoriations; although it is not universally regarded as a specific VLS sign, (iv) erythema was considered as well. Objective assessment of each sign was performed using the following 4-point scale: 0 = absent, 1 = mild, 2 = moderate and 3 = severe. A global objective score (GOS) was obtained by summing each clinical parameter (highest GOS = 12). Objective and subjective patient assessment was performed in consensus by the same investigators at baseline and at the 12- week control visit. The investigators were either blinded or unblinded to treatment depending on the design of the studies from which the patients had been retrospectively recruited (i.e. comparative or non-comparative studies, with or without blinded investigators). Main outcome measures The primary study outcome was to assess the rate of patients achieving complete clearance of symptoms, i.e. GSS = 0, in objective features; GOS = 0; and in both scores, i.e. GSS and GOS = 0. The secondary outcome was to analyse whether demographic or clinical features may condition the achievement of VLS clearance with topical treatments. Statistical analyses Binary data were analysed with chi-squared or Fisher s exact test according to conditions. Quantitative data were analysed by means of t-test, in the case of normality and homoscedasticity, or by means of Mann Whitney U-test. Statistical significance was defined as P < Data were analysed using R statistical program. Results Figure 1 Four cases who achieved a clearance of objective features active treatment phase with (a) 0.1% of mometasone furoate ointment, at tapering regimen; (b) 0.05% of clobetasol propionate ointment, at tapering regimen; (c) 0.1% of mometasone furoate ointment and 0.05% of tretinoin cream, for five consecutive days per week, (d) 0.025% of tretinoin cream once daily, every other day. Baseline (a, b, c, d) and treatment (a 0, b 0,c 0,d 0 ) in the same patients Patient characteristics Demographic and disease features of the study patients, both at baseline and treatment, are reported in Table 2. Twentyfour patients (12.2%) were asymptomatic at baseline; i.e., they had GSS = 0 at treatment initiation. Efficacy evaluations During the treatment courses, nine patients (4.6%) dropped out because they were lost to follow-up; among these patients, two were asymptomatic at baseline.
3 98 Borghi et al. Table 2 Demographic and clinical data at baseline and a treatment of the patients included in the study Baseline After treatment Number of patients (%) 196 (100%) 187* (95.4%) Mean age, years Mean value (range) (16 89) [SD] [12.67] Mean age at VLS onset, years Mean value (range) (12 83) [SD] [13.08] Mean age at diagnosis of VLS, years Mean value (range) (16 86) [SD] [12.64] Mean duration of VLS, months Mean value, 4.83 (range) (0 60) [SD] [6.56] Previous treatment with corticosteroids, Patients, n. (%) 87/196 (44.4%) Histology Patients, n. (%) 135/196 (68.9%) Itching Patients, n. (%) 164/196 (83.7%) 68/187 (36.4%) Mean value, (range) (1 10) (1 10) [SD] [3.46] [1.94] Burning Patients, n. (%) 131/196 (66.8%) 68/187 (36.4%) Mean value, (range) (1 10) (1 10) [SD] [3.67] [1.77] Dyspareunia Patients, n. (%) 59/97 (60.8%) 41/94 (43.6%) Mean value, (range) (2 10) (0 10) [SD] [2.44] [2.94] GSS Mean value, (range) (0 20) (0 20) [SD] [6.19] [3.31] Leukoderma (pallor) Patients, n. (%) 186/196 (94.9%) 126/187 (67.4%) Mean value (range) (0 3) (0 3) [SD] [1.03] [0.83] Erythema Patients, n. (%) 83/196 (42.3%) 52/187 (27.8%) Mean value (range) (1 3) (1 2) [SD] [0.86] [0.55] Table 2 Continued Baseline After treatment Hyperkeratosis Patients, n. (%) 146/196 (74.5%) 30/187 (16%) Mean value, (range) (1 3) (1 2) [SD] [1.07] [0.49] Purpuric lesions and itching-related excoriations Patients, n. (%) 170/196 (86.7%) 20/187 (10.7%) Mean value, (range) (1 3) (1 3) [SD] [1.29] [0.43] GOS Mean value, (range) (1 11) (1 8) [SD] [2.64] [1.41] *Nine patients dropped out because they were lost to follow-up. Sexually active patients. Three patients dropped out among those with sexual activity. Calculated as VAS from 0 to 10. Calculated from 0 to 3. GSS, global subjective score (0 20); GOS, global objective score (0 12); VLS, vulvar lichen sclerosus; SD, standard deviation;, not applicable. Regarding the main study efficacy outcome, at the end of the ATP: (i) 78 patients (47.3% of the 165 patients symptomatic at baseline who completed the treatment) achieved GSS = 0; (ii) 40 patients (21.4% of the 187 patients who completed the treatment) achieved GOS = 0 (Fig. 1); and (iii) 23 patients (13.9% of the 165 patients who referred symptoms at baseline and completed the treatment) achieved complete clearance of both symptoms and signs. Among the 59 patients complaining of dyspareunia, 18 (30.5%) reported a resolution of this symptom and 17 (28.8%) full symptom clearance at the end of treatment. Relevance of demographics and clinical features on clearance Demographics and clinical data at baseline of patients who reached, or did not reach, clearance of (i) symptoms, (ii) signs and (iii) both symptoms and signs at the end of the treatment are reported and compared in Table 3. Lower scores of itching, burning and GSS at baseline, shorter mean disease duration and a lower mean score of pallor before treatment were found to be significantly associated with complete clearance of symptoms at the end of treatment (Table 3). Earlier disease onset, diagnosis and initiation of study treatment were significantly associated with complete clearance of VLS signs (Table 3). Lower baseline scores of clinical features were significantly related to the achievement of complete objective healing treatment, too.
4 Clearance in vulvar lichen sclerosus 99 Table 3 Comparison of demographic and clinical data between patients who achieved or did not achieve (a) symptom clearance (i.e. GSS = 0 vs. GSS 1); (b) sign clearance (i.e. GOS = 0 vs. GSS 1); (c) symptom and sign clearance (i.e. GSS and GOS = 0 vs. GSS and GOS 1) 12 weeks of treatment Number of patients* GSS = 0 GSS 1 P GOS = 0 GOS 1 P Overall clearance GOS = 0) Not clearance GOS 1) 78/165 (47.3%) 87/165 (52.7%) 40/187 (21.4%) 147/187 (78.6%) 23/165 (13.9) 142/165 (86.1%) Mean age, years Mean value (range) (16 86) (17 89) (40 80) (16 89) (40 80) (16 89) [SD] [14.07] [11.76] [12.39] [12.63] [13.37] [12.67] Mean age at VLS onset, years Mean value (range) (12 83) (17 83) (37 75) (12 83) (37 73) (12 83) [SD] [14.36] [12.57] [12.47] [13.01] [13.18] [13.27] Mean age at diagnosis of VLS, years Mean value (range) (16 86) (17 84) (37 78) (16 89) (37 73) (16 86) [SD] [14.13] [11.91] [11.99] [12.39] [12.38] [12.88] Mean duration of VLS, months Mean value (range) (0 23) (0 60) (0 23) (0 60) (0 23) (0 60) [SD] [4.70] [7.99] [5.73] [6.90] [6.30] [6.83] Previous treatment with corticosteroids Patients, n. (%) 22/78 (28.21%) 48/87 (55.17%) < /40 (50%) 63/147 (42.86%) /23 (39.13%) 61/142 (42.96%) 0.73 Itching Patients, n. (%) 73/78 (93.58%) 83/87 (95.40%) 34/40 (85%) 123/147 (83.67%) 21/23 (91.30%) 135/142 (95.07%) Mean value (range) (0 10) (0 10) (0 10) (0 10) (0 10) (0 10) [SD] [2.97] [2.75] [3.47] [3.47] [3.21] [2.85] Burning Patients, n. (%) 28/78 (35.89%) 72/87 (82.75%) 21/40 (52.5%) 101/147 (68.70%) 12/23 (52.17%) 110/142 (77.46%) Mean value < (range) (0 10) (0 10) (0 10) (0 10) (0 10) (0 10) [SD] [3.53] [3.45] [3.71] [3.64] [4.04] [3.45] GSS Patients, n. (%) 78/78 (100%) 87/87 (100%) 35/40 (87.5%) 130/147 (88.43%) 23/23 (100%) 142/142 (100%) Mean value, < (range) (1 20) (2 20) (0 20) (0 20) (2 20) (1 20) [SD] [5.17] [5.08] [5.76] [6.27] [5.44] [5.22] Leukoderma (pallor) Patients, n. (%) 75/78 (96.15%) 83/87 (95.40%) 38/40 (95%) 139/147 (94.55%) 23/23 (100%) 135/142 (95.07%) Mean value < (range) (0 3) (0 3) (0 3) (0 3) (1 3) (0 3) [SD] [0.68] [1.26] [0.74] [1.07] [0.57] [1.09] Erythema Patients, n. (%) 44/78 (56.41%) 37/87 (42.52%) 12/40 (30%) 67/147 (45.57%) 7/23 (30.43%) 62/142 (43.66%) Mean value (range) (0 3) (0 3) (0 2) (0 3) (0 1) (0 3) [SD] [0.86] [0.83] [0.52] [0.91] [0.47] [0.88] P
5 100 Borghi et al. Table 3 Continued Hyperkeratosis GSS = 0 GSS 1 P GOS = 0 GOS 1 P Overall clearance GOS = 0) Not clearance GOS 1) Patients, n. (%) 53/78 (67.94%) 46/87 (52.87%) 20/40 (50%) 94/147 (63.94%) 17/23 (73.91%) 82/142 (57.74%) 0.83 Mean value, (range) (0 3) (0 3) (0 2) (0 3) (0 2) (0 3) [SD] [1.05] [1.04] [0.86] [1.08] [0.79] [1.09] Purpuric lesions and itching-related excoriations Patients, n. (%) 52/78 (66.66%) 39/87 (44.82%) 17/40 (42.5%) 80/147 (54.42%) 12/23 (52.17%) 79/142 (55.63%) Mean value, (range) (0 3) (0 3) (0 3) (0 3) (0 2) (0 3) [SD] [0.98] [0.56] [0.83] [1.38] [0.76] [1.37] GOS Patients, n. (%) 78/78 (100%) 87/87 (100%) 40/40 (100%) 147/147 (100%) 23/23 (100%) 142/142 (100%) Mean value, < (range) (1 11) (1 18) (1 6) (1 11) (1 6) (1 11) [SD] [2.42] [2.83] [1.67] [2.70] [1.50] [2.74] *24 patients were asymptomatic at baseline; i.e., they had GSS = 0 at treatment initiation, and nine patients dropped out because they were lost to follow-up. Two patients among those who dropped out were asymptomatic at baseline. Calculated as VAS from 0 to 10; calculated from 0 to 3; GSS, global subjective score (0 20); GOS, global objective score (0 12). Mann Whitney test; P value was calculated for differences in mean values or rates of patients. VLS, vulvar lichen sclerosus; SD, standard deviation. P Complete clearance of both symptoms and signs was associated with earlier VLS onset, diagnosis and treatment, as well as with lower GOS at baseline. Discussion The ultimate goal for patients with VLS undergoing specific treatments is to be free from the distressing symptoms and sexual dysfunction caused by the disease. 5 Achieving objective normality of skin colour and texture is another key endpoint of treatment. 6 However, according to the current guidelines, the aim of VLS treatment is not to cure, but simply to improve symptoms and objective features. 7,8 It may be hypothesized that patients who respond to treatment, even with significant improvement, but without complete clearance, may still have substantial residual disease and its resultant effect on their quality of life. This study specifically addressed the issue of the occurrence of VLS clearance with a topical treatment. The results of our study indicate that less than half of the patients reached complete resolution of VLS-related symptoms, namely itching and burning, on completion of a treatment. The rate of patients who reached complete resolution of objective features was even lower than this, i.e. 21%. Only about 14% of the study patients achieved complete resolution of both symptoms and signs. These findings strongly support the view that clearance of VLS is a hard treatment outcome, despite the significant improvement of symptoms and signs on completion of the treatment (Table 2). In accordance with previous experiences, 6 it may be hypothesized that treatment courses that are longer than the conventional duration of the active phase may be necessary to increase the likelihood of complete clearance. Prospective comparative studies are needed to assess the treatment duration aimed to achieve a complete VLS resolution. Our results also showed that with treatments of duration, as previously reported, 8 10 complete clearance of symptoms is a more realistic outcome than the clearance of objective features. Among the sexually active patients, the rate of those who reported resolution of dyspareunia was lower in comparison with the patients who achieved resolution of itching (OR = , 95% CI , P < 0.001) and burning (OR = , 95% CI , P = 0.02) on completion of treatment. It is worthy of note that the patients who achieved complete resolution of VLS-related symptoms had had a less severe overall symptom profile than those who did not. Clearance of symptoms was associated with both shorter duration of disease and lower scores of pallor. Younger age, both at diagnosis and at treatment administration, was found to be associated with clearance of objective features. Moreover, higher objective scores prior to beginning treatment were found to inversely affect the complete reversal of cutaneous changes.
6 Clearance in vulvar lichen sclerosus 101 Earlier diagnosis and initiation of treatment, as well as the younger age of patients and a lower global objective score at baseline, were the main predictive factors for complete clearance of both symptoms and signs. All these findings highlight the favourable effect of adequate and early treatment of VLS on its response to treatment and the course of the disease, as previously found. 6 A worst clinical picture, intense symptom presentation, advanced patient age and long-lasting disease seem to conspire against the possibility of a complete cure. The main limitation of this study is its retrospective design. All of the patients included were identified from a tertiary referral clinic; as such, the results of this study may not be representative of all the patient population. Sclerosis scarring and tissue atrophy were not included in the assessment of VLS response as they are not reversible to medical, or are only scarcely so. In this retrospective analysis, different pharmacological treatments and regimens have been grouped together. A comparison of VLS response to among the different treatment groups was not performed due to their numerical inhomogeneity. In conclusion, a topical treatment, although highly effective in ameliorating both symptoms and objective changes, is unlikely to induce a complete cure of VLS. As a result, a relevant part of the patients labelled as responders are not actually clear of the disease, and this may account for a divergence between physicians and patients perspectives regarding treatment outcome and satisfaction. 11 Acknowledgement The Authors would like to thank Ms. Silvia Giari for statistical guidance. References 1 Virgili A, Borghi A, Toni G, Minghetti S, Corazza M. First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability. Br J Dermatol 2014; 171: Borghi A, Corazza M, Minghetti S, Toni G, Virgili A. Continuous vs. tapering application of the potent topical corticosteroid mometasone furoate in the treatment of vulvar lichen sclerosus: results of a randomized trial. Br J Dermatol 2015; 173: Borghi A, Corazza M, Minghetti S, Virgili A. Topical tretinoin in the treatment of vulvar lichen sclerosus: an advisable option? Eur J Dermatol 2015; 25: Borghi A, Corazza M, Minghetti S, Toni G, Virgili A. Avocado and soybean extracts as active principles in the treatment of mild-to-moderate vulvar lichen sclerosus: results of efficacy and tolerability. J Eur Acad Dermatol Venereol 2015; 29: Schwegler J, Schwarz J, Eulenburg C et al. Health-related quality of life and patient-defined benefit of clobetasol 0.05% in women with chronic lichen sclerosus of the vulva. Dermatology 2011; 223: Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatol 2015; 151: Kirtschig G, Becker K, G unthert A et al. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2015; 29: e1 e43. 8 van der Meijden WI, Boffa MJ, Ter Harmsel WA et al European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2017; 31: Neill SM, Lewis FM, Tatnall FM, Cox NH. British Association of Dermatologists guidelines for the management of lichen sclerosus Br J Dermatol 2010; 163: Virgili A, Borghi A, Minghetti S, Corazza M. Mometasone fuoroate 0.1% ointment in the treatment of vulvar lichen sclerosus: a study of efficacy and safety on a large cohort of patients. J Eur Acad Dermatol Venereol 2014; 28: van Cranenburgh OD, Nijland SB, Lindeboom R et al. Patients with lichen sclerosus experience moderate satisfaction with treatment and impairment of quality of life: results of a cross-sectional study. Br J Dermatol 2017; 176:
Asymptomatic Undiagnosed Lichen Sclerosus
Asymptomatic Undiagnosed Lichen Sclerosus Lynette J. Margesson MD FRCPC Assistant Professor of Obstetrics & Gynecology and Surgery(Dermatology) Geisel School of Medicine at Dartmouth Lebanon, NH, USA Disclosures
More informationVaginal involvement in genital erosive lichen planus
Acta Obstetricia et Gynecologica. 2010; 89: 966 970 SHORT REPORT Vaginal involvement in genital erosive lichen planus ANNE LISE ORDING HELGESEN 1,2,3, PETTER GJERSVIK 3,4, PETER JEBSEN 5, ROLF KIRSCHNER
More informationLichen planus. Information for patients Gynaecology
Lichen planus Information for patients Gynaecology page 2 of 8 What is lichen planus? Lichen planus is a non-cancerous, inflammatory skin condition that causes an itchy, non-infectious rash (small purple
More informationThe use of CO2 laser for patients with Lichen sclerosus
The use of CO2 laser for patients with Lichen sclerosus Dr. Christina Kuhler-Obbarius, Elisabeth Kunkel, Dr. Matthias Theden-Schow, Hamburg, Germany Our clinical center located in Hamburg includes eight
More informationDisorders of the vulva
Vulval lesions Disorders of the vulva Terminology standardised by the International Society for the Study of Vulvovaginal Disease(ISSVD) Classification 1.Nonneoplastic epithelial disorders of vulva Lichen
More informationBritish Association of Dermatologists guidelines for the management of lichen sclerosus 2018
British Association of Dermatologists guidelines for the management of lichen sclerosus 2018 WEB APPENDIX SUPPLEMENTARY INFORMATION Appendix A: Review Protocol Appendix B: Clinical Evidence summary Appendix
More informationLichen sclerosus. Lichen planus
Lichen sclerosus Lichen planus Dr Fiona Lewis, Consultant Dermatologist, Heatherwood and Wexham Park NHS Foundation Trust & St John s Institute of Dermatology, GSTT Outline Typical features of lichen sclerosus
More informationLevel of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?
Contact Dermatitis Original Article COD Contact Dermatitis Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful? Monica Corazza, Annarosa Virgili, Giulia
More informationVulval intraepithelial neoplasia. Information for patients Gynaecology
Vulval intraepithelial neoplasia Information for patients Gynaecology page 2 of 8 What is vulval intraepithelial neoplasia? Vulval intraepithelial neoplasia (VIN) is not cancer. VIN is a disease of the
More informationSummary. Accepted for publication 18 May Key words genital lichen planus, oral lichen planus, vulval lichen planus
CLINICAL AND LABORATORY INVESTIGATIONS DOI 10.1111/j.1365-2133.2006.07480.x Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study P. Belfiore, O. Di
More informationLichen sclerosus (LS) is an uncommon inflammatory. Constipation as a Feature of Anogenital Lichen Sclerosus in Children
Mandi L. Maronn, MD*, and Nancy B. Esterly, MD ABSTRACT. Objective. To call attention to constipation as a frequent sign of lichen sclerosus (LS) in girls. Methods. A focused questionnaire was sent to
More informationWHITE PAPER SmartXide 2 V 2 LR. MonaLisa Touch Dual Probe Therapy for the Treatment of Lichen Sclerosus and Vaginal Atrophy
WHITE PAPER SmartXide 2 V 2 LR MonaLisa Touch Dual Probe Therapy for the Treatment of Lichen Sclerosus and Vaginal Atrophy DEKA White Paper SMARTXIDE 2 V 2 LR November 2015 MonaLisa Touch Dual Probe Therapy
More informationVulval dermatoses. Dr Fiona Lewis, Consultant Dermatologist St John s Institute of Dermatology, London & Heatherwood & Wexham Park Hospital, Slough
Vulval dermatoses Dr Fiona Lewis, Consultant Dermatologist St John s Institute of Dermatology, London & Heatherwood & Wexham Park Hospital, Slough Pigmentation Vulvodynia Ulcers Genetic Pruritus VULVAL
More informationThis PDF is available for free download from a site hosted by Medknow Publications
Net Study Comparison of clinical efficacy of topical tazarotene.1% cream with topical clobetasol propionate.5% cream in chronic plaque psoriasis: A double-blind, randomized, right-left comparison study
More informationSetting The setting was tertiary care. The economic study was carried out in Turin, Italy.
Ciclosporin vs. clobetasol in the topical management of atrophic and erosive oral lichen planus: a double-blind, randomized controlled trial Conrotto D, Carbone M, Carrozzo M, Arduino P, Broccoletti R,
More informationLichen sclerosus. Information for patients Gynaecology
Lichen sclerosus Information for patients Gynaecology page 2 of 8 What is lichen sclerosus? Lichen sclerosus is a skin condition that most often affects the vulva (the outer folds of skin around your vagina).
More informationTopical interventions for genital lichen sclerosus (Review)
Chi CC, Kirtschig G, Baldo M, Brackenbury F, Lewis F, Wojnarowska F This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2011,
More informationSTUDY. Influence of Treatment of Erosive Lichen Planus of the Vulva on Its Prognosis
STUDY Influence of Treatment of Erosive Lichen Planus of the Vulva on Its Prognosis Susan M. Cooper, MRCP; Fenella Wojnarowska, DM, FRCP Objective: To record the clinical features, symptomatic response
More informationUV-A1 Phototherapy vs Clobetasol Propionate, 0.05%, in the Treatment of Vulvar Lichen Sclerosus A Randomized Clinical Trial
Research Original Investigation UV-A1 Phototherapy vs Clobetasol Propionate,.5%, in the Treatment of Vulvar Lichen Sclerosus A Randomized Clinical Trial Sarah Terras, MD; Thilo Gambichler, MD; Rose K.
More informationBritish Association of Dermatologists Undergraduate Award Essay Prize Who should look after genital skin disease in the 21 st century?
Who should look after genital skin disease in the 21 st century? Sethuparvathy Jayakumar, 4 th year medical student, King s College London GKT School of Medical Education Genital skin disease is a broad
More informationManagement of benign vulval dermatoses in primary care
PRESCRIBING IN PRACTICE Management of benign vulval dermatoses in primary care MITESH PATEL AND DAVID NUNNS SPL Vulval dermatoses can be difficult to manage in primary care, and GPs need to be aware of
More informationThe Geography Of Vulval Pain. Chronic Vulval Pain. Can you tell if its. Nociceptive, Inflammatory or Pathological?
The Geography Of Vulval Pain Chronic Vulval Pain Can you tell if its Nociceptive, Inflammatory or Pathological? Dr Micheline Byrne, The Jefferiss Wing, St Mary s Hospital Dominant symptoms in vulval patients
More informationClincialTrials.gov Identifier: sanofi-aventis. Sponsor/company:
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription Sponsor/company: sanofi-aventis ClincialTrials.gov
More informationVIN/VAIN O C T O B E R 3 RD J M O R G A N
VIN/VAIN O C T O B E R 3 RD 2 0 1 8 J M O R G A N Vaginal Intraepithelial Neoplasia VAIN I, II, III Incidence 0.1/100,000 women in US Mean age 50s (J Womens Health (Larchmt) 2009:18:1731) (J Obstet Gynaecol
More informationEffectiveness of treating non-specific pruritus vulvae with topical steroids: A randomized controlled trial
European Journal of General Practice. 2009; 15: 2933 ORIGINAL ARTICLE Effectiveness of treating non-specific pruritus vulvae with topical steroids: A randomized controlled trial ANTOINE L. M. LAGRO-JANSSEN
More informationAnne Arundel Medical Center Informed Consent
Informed Consent Title: Exploratory Trial of Autologous Platelet Rich Plasma (PRP) Intradermal Injections for the Treatment of Vulvar Lichen Sclerosus Investigator: Andrew Goldstein, M.D. Telephone Study
More informationPatient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus
ORIGINAL RESEARCH WOMEN S SEXUAL HEALTH Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus Anne N. Flynn, MD,* Michelle King, MSc, Mollie Rieff,
More informationMALE GENITAL (PENIS) LICHEN SCLEROSUS
MALE GENITAL (PENIS) LICHEN SCLEROSUS What are the aims of this leaflet? This leaflet has been written to help you understand more about male genital lichen sclerosus (also known as balanitis xerotica
More informationPsoriasis is a lifelong condition, with onset
THERAPEUTICS FOR THE CLINICIAN Clobetasol Propionate Lotion in the Treatment of Moderate to Severe Plaque-Type Psoriasis Jacques Decroix, MD; Henrik Pres, MD; Nicolaï Tsankov, MD; Michel Poncet, PhD; Stéphanie
More informationConflicts of interest
Vulvar Cases 2 nd PANHELLANIC CONGRESS on Lower Genital Tract Disorders December 14-16 Grand Hyatt Athens Lynette J. Margesson MD FRCPC Assistant Professor of Obstetrics & Gynecology and Surgery(Dermatology)
More informationJournal Watch. Characteristics of primary cutaneous lymphoma according to WHO-EORT
Hong Kong J. Dermatol. Venereol. (2013) 21, 155-160 Reviewed by YK Lai, CY Chan, CK Kwan, WY Leung, YM Wat Sturge-Weber eber syndrome and port- wine stains caused by somatic mutation in GNAQ Shirley MD,
More informationField vs Lesional Therapies for AKs 3/2/2019, 9:00-12 AM
Dilemmas and Challenges in Skin Cancer Therapies and Management Field vs Lesional Therapies for AKs 3/2/2019, 9:00-12 AM Roger I. Ceilley, M.D. Clinical Professor of Dermatology The University of Iowa
More information4/3/2017 DIAGNOSIS AND THERAPY OF RECURRENT VULVOVAGINAL SYMPTOMS BACTERIAL VAGINOSIS EPIDEMIOLOGY OBJECTIVES
DIAGNOSIS AND THERAPY OF RECURRENT VULVOVAGINAL SYMPTOMS KELLY HODGES, MD (NO DISCLOSURES) OBJECTIVES REVIEW THE TWO MOST COMMON CAUSES OF RECURRENT ABNORMAL DISCHARGE (CANDIDA AND BV) REVIEW THE MOST
More informationUsing Your ESP* in Pharmacy: How to Improve Treatment Adherence and Patient Outcomes in Psoriasis (*Expanded Scope of Practice)
Using Your ESP* in Pharmacy: How to Improve Treatment Adherence and Patient Outcomes in Psoriasis (*Expanded Scope of Practice) Patient Case Study in Psoriasis Patient Case Study in Psoriasis William Smith,
More informationVulval Intraepithelial Neoplasia (VIN)
Vulval Intraepithelial Neoplasia (VIN) Exceptional healthcare, personally delivered What is it? Vulval intraepithelial neoplasia (VIN) is a condition where there are pre-cancerous cells in the skin of
More informationWhat are the symptoms of a vulval skin condition?
Information for you Published in December 2013 Skin conditions of the vulva About this information This information is for you if you want to know about skin conditions affecting the vulva. If you are
More informationVulval disease in children
Vulval disease in children SYDNEY MEDICAL SCHOOL NORTHERN Associate Professor Gayle Fischer MBBS MD FACD gayle.fischer@sydney.edu.au I have no conflict of interests Range of vulval diseases in children
More informationDupixent (dupilumab)
Dupixent (dupilumab) Line(s) of Business: HMO; PPO; QUEST Integration Effective Date: TBD POLICY A. INDICATIONS The indications below including FDA-approved indications and compendial uses are considered
More informationClinical Study Polydeoxyribonucleotide Dermal Infiltration in Male Genital Lichen Sclerosus: Adjuvant Effects during Topical Therapy
Dermatology Research and Practice Volume 213, Article ID 65479, 7 pages http://dx.doi.org/1.1155/213/65479 Clinical Study Polydeoxyribonucleotide Dermal Infiltration in Male Genital Lichen Sclerosus: Adjuvant
More informationPsoriasi e rischio CV
Psoriasi e rischio CV Claudio Borghi Dipartimento di Scienze Mediche e Chirurgiche Università di Bologna David Plunkert 5 Biggest Heart Risks for Men Plos Med, 2006 Sequenza di eventi che causano malattie
More informationPatient reported outcomes in chronic skin diseases: ehealth applications for clinical practice van Cranenburgh, O.D.
UvA-DARE (Digital Academic Repository) Patient reported outcomes in chronic skin diseases: ehealth applications for clinical practice van Cranenburgh, O.D. Link to publication Citation for published version
More informationScottish Medicines Consortium
Scottish Medicines Consortium imiquimod 5% cream (Aldara) No. (385/07) Meda Pharmaceuticals Ltd 04 April 2008 The Scottish Medicines Consortium has completed its assessment of the above product and advises
More informationSTUDY. 1% Pimecrolimus, 0.005% Calcipotriol, and 0.1% Betamethasone in the Treatment of Intertriginous Psoriasis
STUDY 1% Pimecrolimus, 0.005% Calcipotriol, and 0.1% Betamethasone in the Treatment of Intertriginous Psoriasis A Double-blind, Randomized Controlled Study Alexander Kreuter, MD; Anna Sommer, MD; Julia
More informationASCCP 2016 Annual Meeting. Post Test. Hope K. Haefner, MD The University of Michigan Center for Vulvar Diseases
ASCCP 2016 Annual Meeting Post Test Hope K. Haefner, MD The University of Michigan Center for Vulvar Diseases haefner@umich.edu Disclosure Hope Haefner, MD was previously on the advisory board of Merck
More informationPharmacologic Treatment of Atopic Dermatitis
J KMA Pharmacotherapeutics Pharmacologic Treatment of Atopic Dermatitis Chun Wook Park, MD Department of Dermatology, Hallym University College of Medicine E mail : dermap@paran.com J Korean Med Assoc
More informationAcitretin for Severe Lichen Sclerosus of Male Genitalia: A Randomized, Placebo Controlled Study
Acitretin for Severe Lichen Sclerosus of Male Genitalia: A Randomized, Placebo Controlled Study D. Ioannides, E. Lazaridou,* Z. Apalla, E. Sotiriou, S. Gregoriou and D. Rigopoulos From the First Department
More informationClinical Scoring System to Detect Malignant and Premalignant Vulval Lesions
The Journal of Obstetrics and Gynecology of India (January February 2014) 64(1):41 46 DOI 10.1007/s13224-013-0458-3 ORIGINAL ARTICLE Clinical Scoring System to Detect Malignant and Premalignant Vulval
More informationTreatment of Bowenoid and Basaloid Vulvar Intraepithelial Neoplasia 2/3 with Imiquimod 5% Cream DO NOT DUPLICATE
The Journal of Reproductive Medicine Treatment of Bowenoid and Basaloid Vulvar Intraepithelial Neoplasia 2/3 with Imiquimod 5% Cream Claudia Marchitelli, M.D., Graciela Secco, M.D., Myriam Perrotta, M.D.,
More information6/30/2015 GENITAL HPV GENITAL HPV. Gardasil 9
GENITAL HPV Most common sexually transmitted infection in the US More than 50% of adults infected with at least one type >50% of new infections occur in ages 15-21 More than 40 types transmitted through
More informationLichen Sclerosus. Exceptional healthcare, personally delivered
Lichen Sclerosus Exceptional healthcare, personally delivered Lichen Sclerosus (LS) is an itchy skin condition usually affecting genital skin, but it can occur elsewhere. It affects women more often than
More informationDOI /j x
THERAPEUTICS DOI 10.1111/j.1365-2133.2007.07883.x Miconazole as adjuvant therapy for oral lichen planus: a double-blind randomized controlled trial G. Lodi, M. Tarozzi, A. Sardella, F. Demarosi, L. Canegallo,
More informationMedication Policy Manual. Topic: Dupixent, dupilumab Date of Origin: March 10, Committee Approval: March 10, 2017 Next Review Date: May 2018
Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Policy No: dru493 Topic: Dupixent, dupilumab Date of Origin: March 10, 2017 Committee Approval: March 10, 2017
More informationDisclosures Dr. Lynette Margesson
Management of Vulvar Pruritus 2 nd PANHELLANIC CONGRESS on Lower Genital Tract Disorders December 14-16 Grand Hyatt Athens Lynette J. Margesson MD FRCPC Assistant Professor of Obstetrics & Gynecology and
More informationAnal intraepithelial neoplasia. Information for patients Gynaecology
Anal intraepithelial neoplasia Information for patients Gynaecology What is anal intraepithelial neoplasia? Anal intraepithelial neoplasia (AIN) is not cancer. AIN describes the presence of abnormal cells
More informationPage 1 of 5 Menopause and the decision to replace hormones August FREE health seminars How MonaLisa Touch can help Microneedling Menopause and the decision to replace hormones Menopause is a much misunderstood
More informationOCCG SERVICE SPECIFICATION (2017/18)
OCCG SERVICE SPECIFICATION (2017/18) Primary Care Service for Skin Cancers: Dermatology Shared Care Monitoring for Melanoma, Lichen Sclerosus and Squamos Cell Carcinoma 1. Background For patients who have
More informationRameshwar Gutte and Uday Khopkar
Extragenital unilateral lichen sclerosus et atrophicus in a child: a case report Rameshwar Gutte and Uday Khopkar Department of Dermatolgy, Seth GSMC and KEM Hospital, Parel, Mumbai-400012, India Egyptian
More informationAnnie Chou Internal Medicine PGY3 University of British Columbia. Rocky Mountain Internal Medicine Conference November 24, 2011
Annie Chou Internal Medicine PGY3 University of British Columbia Rocky Mountain Internal Medicine Conference November 24, 2011 Role of the ECG in STEMI Diagnosis of myocardial infarction Localization of
More informationComparative efficacy of topical mometasone furoate 0.1% cream vs topical tacrolimus 0.03% ointment in the treatment of atopic dermatitis
Original Article Comparative efficacy of topical mometasone furoate 0.1% cream vs topical tacrolimus 0.03% ointment in the treatment of atopic dermatitis Md Alauddin Khan *, Lubna Khondker **, Dilshad
More informationClinically Microscopically Pathogenesis: autoimmune not lifetime
Vulvar Diseases: Can be divided to non-neoplastic and neoplastic diseases. The neoplastic diseases are much less common. Of those, squamous cell carcinoma is the most common. most common in postmenopausal
More informationfluorouracil 0.5% / salicylic acid 10% cutaneous solution (Actikerall ) SMC No. (728/11) Almirall S.A.
fluorouracil 0.5% / salicylic acid 10% cutaneous solution (Actikerall ) SMC No. (728/11) Almirall S.A. 09 September 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of the above
More informationcamellia sinensis (green tea) leaf extract 10% ointment (Catephen ) SMC No. (1133/16) Kora Healthcare
camellia sinensis (green tea) leaf extract 10% ointment (Catephen ) SMC No. (1133/16) Kora Healthcare 04 March 2016 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationUpdate of the role of Human Papillomavirus in Head and Neck Cancer
Update of the role of Human Papillomavirus in Head and Neck Cancer 2013 International & 12 th National Head and Neck Tumour Conference Shanghai, 11 13 Oct 2013 Prof. Paul KS Chan Department of Microbiology
More informationKey words: genotyping/hla-dq/hla-dr/lichen sclerosus/susceptibility J Invest Dermatol 125: , 2005
The Association Between HLA DR, DQ Antigens, and Vulval Lichen Sclerosus in the UK: HLA DRB1 12 and its Associated DRB1 12/DQB1 0301/04/09/010 Haplotype Confers Susceptibility to Vulval Lichen Sclerosus,
More informationClinical Study Report SLO-AD-1 Final Version DATE: 09 December 2013
1. Clinical Study Report RANDOMIZED, OPEN, PARALLEL GROUP, PHASE IIIB STUDY ON THE EVALUATION OF EFFICACY OF SPECIFIC SUBLINGUAL IMMUNOTHERAPY IN PAEDIATRIC PATIENTS WITH ATOPIC DERMATITIS, WITH OR WITHOUT
More informationAccess from the University of Nottingham repository:
Simpson, Rosalind C. and Nunns, David (2017) Skin diseases affecting the vulva. Obstetrics, Gynaecology and Reproductive Medicine, 27 (3). pp. 77-85. ISSN 1879-3622 Access from the University of Nottingham
More informationCONCORDANCE BETWEEN PRIMARY AND SECONDARY OUTCOMES IN COCHRANE REVIEWS AND CLINICAL TRIALS - JOCHEN SCHMITT -
CONCORDANCE BETWEEN PRIMARY AND SECONDARY OUTCOMES IN COCHRANE REVIEWS AND CLINICAL TRIALS - JOCHEN SCHMITT - Annual Cochrane Skin Group & CSG-COUSIN Meeting 2018 Amsterdam, 15th January Meta-epidemiological
More informationTo order reprints or e-prints of JDD articles please contact JDD
June 2017 534 VOLUME 16 ISSUE 6 Copyright 2017 ORIGINAL ARTICLE Journal of Drugs in Dermatology The Efficacy and Safety of Azelaic Acid 15% Foam in the Treatment of Truncal Acne Vulgaris Lauren K. Hoffman
More informationTreatment of Mild to Moderate Psoriasis with Reliéva, a Mahonia aquifolium Extract A Double-Blind, Placebo-Controlled Study
American Journal of Therapeutics 13, 121 126 (2006) Treatment of Mild to Moderate Psoriasis with Reliéva, a Mahonia aquifolium Extract A Double-Blind, Placebo-Controlled Study Steve Bernstein, Howard Donsky,*
More informationCommon Psychiatric disorders amongst patients with Psoriasis: A Tertiary Hospital based Case Control Study
Original article: Common Psychiatric disorders amongst patients with Psoriasis: A Tertiary Hospital based Case Control Study Dr. Rajeev Agarwal 1, Dr.Shweta Agarwal 2 1Assistant Professor, Career Institute
More informationA Vitiligo Update for Pharmacists: Current Practices and Future Advances
A Vitiligo Update for Pharmacists: Current Practices and Future Advances Dalal Hammoudi Halat, RPh, MSc, PhD Assistant Professor School of Pharmacy, Lebanese International University Disclosure Dalal Hammoudi
More informationPRESCRIBING INFORMATION. Cream 0.025% Topical Corticosteroid
PRESCRIBING INFORMATION Pr PROPADERM (beclomethasone dipropionate) Cream 0.025% Topical Corticosteroid Valeant Canada LP 2150 St-Elzear Blvd. West, Laval, Quebec, Canada H7L 4A8 Date of preparation: October
More informationEffects of Acupuncture on Chinese Adult Patients with Psoriatic Arthritis: A Prospective Cohort Study
Effects of Acupuncture on Chinese Adult Patients with Psoriatic Arthritis: A Prospective Cohort Study Peiyi Chen 1, Tiantian Xin 2* and Yingchun Zeng 3,4 1 School of Nursing, Guangzhou University of Chinese
More informationLichen planopilaris in a Latin American (Chilean) population: demographics, clinical profile and treatment experience
Original article CED Clinical and Experimental Dermatology Lichen planopilaris in a Latin American (Chilean) population: demographics, clinical profile and treatment experience F. Mardones 1 and J. Shapiro
More informationClinical Summary. treatment and prevention of hypertrophic scars have been well documented in the literature.
Introduction: Introduction: Since the introduction of silicone in the early 1980s, its therapeutic effects on predominantly the i, ii treatment and prevention of hypertrophic scars have been well documented
More informationYour Diagnosis Is? Test Your Knowledge of Various Vulvovaginal Conditions
Your Diagnosis Is? Test Your Knowledge of Various Vulvovaginal Conditions Hope K. Haefner, MD Professor University of Michigan Health System Ann Arbor, Michigan February, 2017 Industry Support and Financial
More informationAnogenital and Oral Dermatology Course
Dermatology course for health care professionals 5th Annual Anogenital and Oral Dermatology Course 14-15 May 2015 London, UK 1 Course details 5 th Annual Anogenital and Oral Dermatology Course 2015 Dates
More informationNews in erosive lichen planus of the vulva
News in erosive lichen planus of the vulva Anne Lise Helgesen Dermatologist, Postdoc, National Centre of Womens Health, Oslo University Hospital, Oslo, Norway - a great challenge WHY? No evidence based
More information2 SYNOPSIS. Study code : MC 9308 FR.
MC9308 FR Study 19 December 2000 Page 15 of142 2 SYNOPSIS Study code : MC 9308 FR. Title: A comparative study of calcipotriol ointment in combination with narrow-band UVB (TL-01) phototherapy and placebo
More informationDiagnosis and Management of Vulvar Disorders
Diagnosis and Management of Vulvar Disorders Kelly H. Tyler, MD, FACOG, FAAD Assistant Professor The Ohio State University Department of Internal Medicine, Division of Dermatology Department of Obstetrics
More informationVulvodynia and vestibulectomy
Vulvodynia and vestibulectomy treatment of an important problem for a gynecologist Dr. Tolga Taşçı Associate Proffessor of Obstetrics and Gynecology Gynecologic Oncologist Okmeydanı Teaching and Research
More informationComparison of the narrow band UVB versus systemic corticosteroids in the treatment of lichen planus: A randomized clinical trial
Received: 10.7.2011 Accepted: 5.12.2011 Original Article Comparison of the narrow band UVB versus systemic corticosteroids in the treatment of lichen planus: A randomized clinical trial Fariba Iraji, 1
More informationQuality of Life of Saudi Patients with Dermatologic Disorders
Clinical Medicine and Diagnostics 2018, 8(1): 1-6 DOI: 10.5923/j.cmd.20180801.01 Quality of Life of Saudi Patients with Dermatologic Disorders Bassam Ahmed Almutlaq 1, Fatemah Kadhem Aljishi 2, Rawan Ahmed
More informationBJD British Journal of Dermatology. 1.0 Purpose and scope. 2.0 Methodology GUIDELINE
GUIDELINE BJD British Journal of Dermatology British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018* F.M. Lewis id, 1,2 F.M. Tatnall, 3 S.S. Velangi, 4 C.B. Bunker,
More informationCarcinoma midollare tiroideo familiare
12 AME Italian Meeting 6 Joint Meeting with AACE Carcinoma midollare tiroideo familiare Profilo genetico e stratificazione del rischio Maria Chiara Zatelli Sezione di Endocrinologia Dipartimento di Scienze
More informationEFFICACY AND SAFETY OF CLOBETASOL PROPIONATE SHAMPOO IN THERAPY OF PSORIASIS OF THE SCALP
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Platonova et al. SJIF Impact Factor 2.786 Volume 4, Issue 04, 238-246. Research Article ISSN 2278 4357 EFFICACY AND SAFETY OF CLOBETASOL PROPIONATE
More informationLimitations of nonsurgical treatment modalities. Nonsurgical Treatments (Table V) 1/31/2018
DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY James M. Grichnik M.D. Ph.D. Alternative Therapies James M Grichnik MD PhD Director, Scully-Welsh Cancer Center Indian River Medical Center grichnik@irmc.cc
More informationTopical betamethasone for the prevention of acute radiation dermatitis in breast cancer patients
Iran. J. Radiat. Res., 23; (2): 5 - Topical betamethasone for the prevention of acute radiation dermatitis in breast cancer patients F. Farhan, A. Kazemian, H. Alagheband Radiotherapy-Oncology Department,
More informationIt has been estimated that 90% of individuals
Famciclovir for Cutaneous Herpesvirus Infections: An Update and Review of New Single-Day Dosing Indications Manju Chacko, MD; Jeffrey M. Weinberg, MD Infections with herpes simplex virus (HSV) types 1
More informationKelly H. Tyler, MD, FACOG, FAAD S052 Gender Dermatology: Diagnosis and Treatment of Genital Skin Disorders Vulvar Dermatitis
Vulvar Dermatitis Kelly H. Tyler, MD, FACOG, FAAD Assistant Professor The Ohio State University Department of Internal Medicine, Division of Dermatology Department of Obstetrics and Gynecology Center for
More informationInformation leaflet on. Vulval Intraepithelial Neoplasia VIN
Information leaflet on Vulval Intraepithelial Neoplasia VIN What is wrong with me? You have been found to suffer from Vulval Intraepithelial Neoplasia or VIN. This is an uncommon skin condition, which
More informationThe no t-so-simple cutaneous wart
Salicylic acid is a commonly used over-the-counter treatment for nongenital warts. Clearance rates of up to 75% have been reported with salicylic acid. istockphoto 10 Clinical practice guide Dermatology
More informationThe Prevention and Management of Acute Skin Reactions Related to Radiation Therapy
Evidence-Based Series 13-7 IN REVIEW A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) The Prevention and Management of Acute Skin Reactions Related to Radiation
More informationLetter to the Editor: Nail Lichen Planus: A True Nail Emergency. Journal of the American Academy of Dermatology
Accepted Manuscript Letter to the Editor: Nail Lichen Planus: A True Nail Emergency Shari R. Lipner, MD, PhD PII: S0190-9622(19)30128-8 DOI: https://doi.org/10.1016/j.jaad.2018.11.065 Reference: YMJD 13102
More informationThe Case of Mrs. Virginia Jones* Asst. Professor Division of Gyne-Oncology University of British Columbia, Department of Gynecology Vancouver, Canada
Case title: Case authors: Case synopsis: The Case of Mrs. Virginia Jones* Dr. Leslie A. Sadownik Asst. Professor Division of Gyne-Oncology University of British Columbia, Department of Gynecology Vancouver,
More informationStatistical planning and analysis of a randomized trial on genital erosive lichen planus
1 Statistical planning and analysis of a randomized trial on genital erosive lichen planus 2 Background Genital erosive lichen planus (GELP) in women is a chronic inflammatory disease characterized by
More informationCore outcome sets for Clinical trials and Observational Studies in Vulvovaginal Disease
P a g e 1 JLGTD Editorial Core outcome sets for Clinical trials and Observational Studies in Vulvovaginal Disease I. Define the issue general concepts Clinical trials and observational studies in medical
More informationCommunity Gynaecology. Top Tips for GPs
Community Gynaecology Top Tips for GPs Top Tips for GPs Case Scenarios- common referral themes 6 topics What you can do in Primary Care to avoid or before referral. What we don t need to see Triage ensures
More informationGunasundari October 15, :57 PM 13:57 4 Color Fig(s):0 Art: GOX-D
Original Article Reconstructive Use of Platelet-rich Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosus AQ1 AQ2 Fariba Behnia-Willison, MBBS, MIS, FRANZCOG* Nina R. Pour, O&G SRMO-DRANZCOG
More informationDOI /j x
THERAPEUTICS DOI 10.1111/j.1365-2133.2007.08370.x The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial C. Choonhakarn, P. Busaracome, B. Sripanidkulchai*
More information