Liu Jie, Hao Jianchun, Wang Yukun, Liu Yuehua, Xu Tao
Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China; Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, 100022, China.
Photodiagnosis Photodyn Ther. 2021 Mar;33:102109. doi: 10.1016/j.pdpdt.2020.102109. Epub 2020 Nov 24.
To date, there have been no satisfactory treatments to cure vulvar lichen sclerosus (LS). 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) has been introduced in the treatment of vulvar lichen sclerosus (VLS), but no dermoscopic assessment has been conducted.
The included patients received six ALA-PDT sessions at 2-week intervals. After the third and sixth treatment, all patients were evaluated for clinical and dermoscopic variables with numeric scores assigned to each parameter.
Twenty-four VLS patiens were included in this study. Both primary objective signs (lesion size and depigmentation) and subjective symptoms (itching and burning pain) were improved remarkably after the third treatment, and further improvements were obtained after the sixth treatment. Among the dermoscopic variables, the early changes were the decreased score of bright white or white-yellowish structureless areas and the increased score of vessels, and further changes of these two dermoscopic features were observed after the sixth treatment. There were no changes in pink structureless areas, white shiny streaks, follicular plugs, brown structureless areas, purple dots, and erosions after the third treatment, but after the sixth treatment, the scores of these dermoscopic features decreased significantly except that the score of brown structureless areas increased siginificantly. There was no change in the score of peppering blue-gray dots. Both pain and erosions during the treatment could be tolerated.
ALA-PDT is effective for VLS. In addition, dermoscopic assessment may be more precise for indicating minute changes invisible to unaided eyes which are useful to monitor the response to treatments.
迄今为止，尚无令人满意的治疗方法来治愈外阴硬化性苔藓（LS）。5-氨基酮戊酸光动力疗法（ALA-PDT）已被引入用于治疗外阴硬化性苔藓（VLS），但尚未进行皮肤镜评估。
纳入的患者每隔2周接受6次ALA-PDT治疗。在第三次和第六次治疗后，对所有患者的临床和皮肤镜变量进行评估，并为每个参数分配数值评分。
本研究纳入了24例VLS患者。第三次治疗后，主要客观体征（病变大小和色素脱失）和主观症状（瘙痒和灼痛）均有显著改善，第六次治疗后进一步改善。在皮肤镜变量中，早期变化是亮白色或白黄色无结构区域的评分降低和血管评分增加，第六次治疗后观察到这两个皮肤镜特征的进一步变化。第三次治疗后，粉色无结构区域、白色闪亮条纹、毛囊堵塞、棕色无结构区域、紫色斑点和糜烂无变化，但第六次治疗后，除棕色无结构区域评分显著增加外，这些皮肤镜特征的评分均显著降低。胡椒状蓝灰色斑点评分无变化。治疗期间的疼痛和糜烂均可耐受。
ALA-PDT对VLS有效。此外，皮肤镜评估可能更精确地显示肉眼不可见的微小变化，这有助于监测治疗反应。
