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Physician-administered clinical score of vulvar lichen sclerosus: A study of 36 cases.

Naswa S, Marfatia YS - Indian J Sex Transm Dis (2015 Jul-Dec)

Bottom Line: Advanced disease severely affects the quality of life and is associated with increased risk of vulvar squamous cell carcinoma (SCC).One case had well-differentiated SCC clitoris at presentation.Early diagnosis and prompt treatment is the key to prevent sequelae and complications of VLS.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Cosmetic Dermatology, Fortis Hospital, Mumbai, Maharashtra, India.

ABSTRACT

Introduction: Vulvar lichen sclerosus (VLS) often remains undetected for years due to lack of awareness, as well as private nature of the disease. Advanced disease severely affects the quality of life and is associated with increased risk of vulvar squamous cell carcinoma (SCC). The aim of this study was to assess the usefulness of a physician-administered clinical scoring system for the clinical diagnosis and evaluation of VLS. To the best of our knowledge, this is the first study using the clinical score developed by Günthert et al on the VLS patients.

Materials and methods: The study conducted was an observational cross-sectional study of 36 cases attending Dermatology OPD of Government Medical College with clinically proven and previously untreated VLS enrolled over a 1 year period. Cases were retrospectively subjected to evaluation by physician-administered clinical score based on 6 clinical features, viz. erosions, agglutination, hyperkeratosis, stenosis, fissures, and atrophy.

Results: The average age of 36 clinically diagnosed VLS cases was 56.4 years. Most common clinical features were hyperkeratosis and atrophy found in 86.11% cases followed by erosions (75%) with one-third cases having grade 2 (severe) changes. One case had well-differentiated SCC clitoris at presentation. The mean physician-administered clinical score was 5.583, and 80.56% cases had clinical score ≥4 validating the clinical diagnosis.

Discussion: Early diagnosis and prompt treatment is the key to prevent sequelae and complications of VLS. The physician-administered clinical score can be a useful tool to diagnose and later evaluate the response of treatment and prognosis of VLS cases.

No MeSH data available.


Related in: MedlinePlus

A 65-year-old patient with vulvar lichen sclerosus score 9 showing grade 2 erosions, grade 2 hyperkeratosis, grade 2 fissures, grade 1 agglutination, grade 1 atrophy, and grade 1 stenosis
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Figure 1: A 65-year-old patient with vulvar lichen sclerosus score 9 showing grade 2 erosions, grade 2 hyperkeratosis, grade 2 fissures, grade 1 agglutination, grade 1 atrophy, and grade 1 stenosis

Mentions: The presence and severity of each of the six clinical features were assessed [Table 2]. Most common features were hyperkeratosis and atrophy found in 86.11% cases with at least one-third cases having grade 2 (severe changes). Erosions were seen in 75% cases corresponding with intractable itching, found as the most common presenting symptom [Figure 1]. One case had well-differentiated SCC clitoris at presentation.


Physician-administered clinical score of vulvar lichen sclerosus: A study of 36 cases.

Naswa S, Marfatia YS - Indian J Sex Transm Dis (2015 Jul-Dec)

A 65-year-old patient with vulvar lichen sclerosus score 9 showing grade 2 erosions, grade 2 hyperkeratosis, grade 2 fissures, grade 1 agglutination, grade 1 atrophy, and grade 1 stenosis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660559&req=5

Figure 1: A 65-year-old patient with vulvar lichen sclerosus score 9 showing grade 2 erosions, grade 2 hyperkeratosis, grade 2 fissures, grade 1 agglutination, grade 1 atrophy, and grade 1 stenosis
Mentions: The presence and severity of each of the six clinical features were assessed [Table 2]. Most common features were hyperkeratosis and atrophy found in 86.11% cases with at least one-third cases having grade 2 (severe changes). Erosions were seen in 75% cases corresponding with intractable itching, found as the most common presenting symptom [Figure 1]. One case had well-differentiated SCC clitoris at presentation.

Bottom Line: Advanced disease severely affects the quality of life and is associated with increased risk of vulvar squamous cell carcinoma (SCC).One case had well-differentiated SCC clitoris at presentation.Early diagnosis and prompt treatment is the key to prevent sequelae and complications of VLS.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Cosmetic Dermatology, Fortis Hospital, Mumbai, Maharashtra, India.

ABSTRACT

Introduction: Vulvar lichen sclerosus (VLS) often remains undetected for years due to lack of awareness, as well as private nature of the disease. Advanced disease severely affects the quality of life and is associated with increased risk of vulvar squamous cell carcinoma (SCC). The aim of this study was to assess the usefulness of a physician-administered clinical scoring system for the clinical diagnosis and evaluation of VLS. To the best of our knowledge, this is the first study using the clinical score developed by Günthert et al on the VLS patients.

Materials and methods: The study conducted was an observational cross-sectional study of 36 cases attending Dermatology OPD of Government Medical College with clinically proven and previously untreated VLS enrolled over a 1 year period. Cases were retrospectively subjected to evaluation by physician-administered clinical score based on 6 clinical features, viz. erosions, agglutination, hyperkeratosis, stenosis, fissures, and atrophy.

Results: The average age of 36 clinically diagnosed VLS cases was 56.4 years. Most common clinical features were hyperkeratosis and atrophy found in 86.11% cases followed by erosions (75%) with one-third cases having grade 2 (severe) changes. One case had well-differentiated SCC clitoris at presentation. The mean physician-administered clinical score was 5.583, and 80.56% cases had clinical score ≥4 validating the clinical diagnosis.

Discussion: Early diagnosis and prompt treatment is the key to prevent sequelae and complications of VLS. The physician-administered clinical score can be a useful tool to diagnose and later evaluate the response of treatment and prognosis of VLS cases.

No MeSH data available.


Related in: MedlinePlus