Gambichler Thilo, Erdogan Gülgün, Weyer-Fahlbusch Sera S, Susok Laura
Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
Department of Dermatology, Christian Hospital Unna, Unna, Germany.
Int J Womens Dermatol. 2024 Jul 16;10(3):e169. doi: 10.1097/JW9.0000000000000169. eCollection 2024 Oct.
Pigmented lesions such as melanosis have rarely been reported in patients with vulvar lichen sclerosus (VLS) that is typically characterized by hypopigmented lesions.
We aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients.
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.
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 ( = .0018) and negatively correlated with the use of pulsed high-dose corticosteroids plus low-dose methotrexate (PHDC-LDM, = .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, = .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, = .018).
The study includes the retrospective monocentric design.
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.
色素沉着性病变如黑变病在以色素减退性病变为典型特征的外阴硬化性苔藓（VLS）患者中鲜有报道。
我们旨在对一大群VLS患者的肛门生殖器黑变病进行系统分析。
我们分析了198例VLS女性患者的临床资料。所有患者的肛门生殖器病变均在标准化体位和光照条件下进行专业拍照。根据一个易于使用的临床评分系统对结构改变进行严重程度分级。使用改良的黄褐斑面积和严重程度指数以及图像分析软件来评估色素沉着的面积和强度。
根据临床评分，79例（198例中的39.9%）患者为1级疾病，78例（198例中的39.4%）为2级，37例（198例中的18.7%）为3级，4例（198例中的2%）为4级疾病。198例患者中约111例（56.1%）有肛门生殖器黑变病，改良的黄褐斑面积和严重程度指数中位数为3.6（0.4 - 14）。单因素分析显示，肛门生殖器黑变病与局部使用雌激素呈正相关（P = 0.00l8），与脉冲高剂量皮质类固醇加低剂量甲氨蝶呤（PHDC - LDM）联合使用呈负相关（P = 0.021）。多因素分析显示，局部激素治疗的使用是肛门生殖器黑变病存在的一个强有力的独立预测因素（比值比：4.57，95%置信区间：1.66 - 12.57，P = 0.0033），而使用PHDC - LDM是肛门生殖器黑变病不存在的独立预测因素（比值比：0.35，95%置信区间：0.15 - 0.84，P = 0.018）。
本研究采用回顾性单中心设计。
肛门生殖器黑变病在VLS患者中是一种非常常见但迄今报道较少的临床发现。它可能是由用于VLS治疗的局部雌激素使用引起的。相比之下重度疾病且接受PHDC - LDM治疗的患者发生肛门生殖器黑变病的可能性似乎较小。
