Bao Chengbei, Zhao Yan, Luo Renwei, Xu Qiuyun, Tong Zequn, Xiao Zhixun, Zhuang Zheyu, Dai Wenjia, Gu Bohan, Gong Ting, Cheng Bo, Ji Chao
Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China.
Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350000, Fujian, China.
Dermatol Ther (Heidelb). 2023 Dec;13(12):3071-3084. doi: 10.1007/s13555-023-01039-2. Epub 2023 Oct 15.
The treatment of genital lichen sclerosus (GLS) remains challenging. Baricitinib has been introduced in the treatment of GLS, but there's no imaging evaluation for GLS patients treated with it. No comparison of dermoscopy and reflectance confocal microscopy (RCM) assessments in GLS has been conducted. We performed this study to evaluate the efficacy and safety of baricitinib for GLS and to compare the value of dermoscopy and RCM assessments in GLS.
Participants were treated with baricitinib for 6 months and assessed at week 0, 2, 4, 6, 8, and every 4 weeks for the next 16 weeks. All patients were evaluated for clinical, dermoscopic, and RCM variables, with numeric scores assigned to each parameter.
Twenty-six GLS patients were included in this study. All patients achieved Investigator's Global Assessment score ≤ 1 (with ≥ 2-grade improvement) at week 20. The scores of pruritus and pain decreased since week 2 (both P < 0.05). The DLQI and VQLI scores significantly decreased since week 4 (both P < 0.0001). White structureless areas improved at week 2 and white shiny streaks and follicular plugs improved at week 4 under dermoscopic examination. Vessels (P < 0.001) and brown structureless areas (P = 0.003) increased at week 8. In RCM, inflammatory cells count significantly decreased at week 2 (100.03 ± 33.24, P < 0.0001), with substantial regression at week 8 (16.98 ± 5.54, P < 0.0001). Epidermal thickness increased at week 12 (157.44 ± 37.87 μm versus 134.13 ± 36.60 μm, P = 0.0284). Irregular papillae, spongiosis, and fiber structures improved at week 20, week 4, and week 6 (all P < 0.01). Transient hypercholesterolemia (11.54%), thrombocytosis (7.69%), and elevated alanine aminotransferase (7.69%) occurred during treatment.
Both dermoscopy and RCM can be useful and non-invasive adjuvant tools for the evaluation and therapeutic monitoring of GLS. We recommended white structureless areas under dermoscopy and inflammatory cells count under RCM as variables for dermatologic imaging evaluation for GLS. Baricitinib is effective and safe for GLS, while randomized controlled trials are warranted.
生殖器硬化性苔藓（GLS）的治疗仍然具有挑战性。巴瑞替尼已被用于GLS的治疗，但尚未对接受该药物治疗的GLS患者进行影像学评估。尚未对GLS的皮肤镜检查和反射式共聚焦显微镜（RCM）评估进行比较。我们开展这项研究以评估巴瑞替尼治疗GLS的疗效和安全性，并比较皮肤镜检查和RCM评估在GLS中的价值。
参与者接受巴瑞替尼治疗6个月，并在第0、2、4、6、8周进行评估，之后的16周每4周评估一次。所有患者均接受临床、皮肤镜和RCM变量评估，每个参数都赋予了数值评分。
本研究纳入了26例GLS患者。所有患者在第20周时达到研究者整体评估评分≤1（改善≥2级）。瘙痒和疼痛评分自第2周起下降（均P<0.05）。皮肤病生活质量指数（DLQI）和视觉功能生活质量指数（VQLI）评分自第4周起显著下降（均P<0.0001）。皮肤镜检查显示，白色无结构区域在第2周改善，白色发亮条纹和毛囊栓在第4周改善。血管（P<0.001）和棕色无结构区域（P=0.003）在第8周增加。在RCM中炎症细胞计数在第2周显著下降（100.03±33.24，P<0.0001），在第8周大幅消退（16.98±5.54，P<0.0001）。表皮厚度在第12周增加（157.44±37.87μm对134.13±36.60μm，P=0.0284）。不规则乳头、海绵形成和纤维结构在第20周、第4周和第6周改善（均P<0.01）。治疗期间出现短暂性高胆固醇血症（11.54%）、血小板增多症（7.69%）和丙氨酸转氨酶升高（7.69%）。
皮肤镜检查和RCM均可作为评估和治疗监测GLS的有用且非侵入性的辅助工具。我们推荐将皮肤镜检查下的白色无结构区域和RCM下的炎症细胞计数作为GLS皮肤影像学评估的变量。巴瑞替尼治疗GLS有效且安全，但仍需进行随机对照试验。
