Genitaler Lichen sclerosus et atrophicus der Frau^[*]

Kernaussagen

Der Lichen sclerosus et atrophicus ist eine oft verkannte Erkrankung mit dem potenziellen Risiko einer malignen Entartung. Deshalb ist eine genaue Diagnostik zur Vermeidung der Diagnoseverschleppung notwendig. Bei Verdacht auf Dysplasie oder Malignität sollte immer eine Biopsie erfolgen.

Die Standardtherapie erfolgt mit topischen Glukokortikoiden. Sollten diese nicht den gewünschten Erfolg bringen, kann ein Therapieversuch mit topischen Calcineurin-Inhibitoren erfolgen. Begleitend sollten rückfettende Salben verwendet werden.

Chirurgische Verfahren sind lediglich bei sehr gut selektiertem und symptomatischem Patientenkollektiv oder bei Nachweis einer Dysplasie oder eines Karzinoms durchzuführen.

^* Erstveröffentlichung in Frauenheilkunde up2date 2014; 8: 211 – 225

• Literatur

• 1 Cooper SM, Gao XH, Powell JJ et al. Does treatment of vulvar lichen sclerosus influence its prognosis?. Arch Dermatol 2004; 140: 1-11
• 2 Green C, Guest J, Ngu W. Long-term follow-up of women with genital lichen sclerosus. Menopause Int 2013; [Epub ahead of print]
• 3 Farrell AM, Marren P, Dean D et al. Lichen sclerosus: evidence that immunological changes occur at all levels of the skin. Br J Dermatol 1999; 140: 1087-1092
• 4 Harrington CI, Dunsmore IR. An investigation into the incidence of auto-immune disorders in patients with lichen sclerosus and atrophicus. Br J Dermatol 1981; 104: 563-566
• 5 Birenbaum DL, Young RC. High prevalence of thyroid disease in patients with lichen sclerosus. J Reprod Med 2007; 52: 28-30
• 6 Cooper SM, Ali I, Baldo M et al. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol 2008; 144: 1432-1435
• 7 Marren P, Yell J, Charnock FM et al. The association between lichen sclerosus and antigens of the HLA system. Br J Dermatol 1995; 132: 197-203
• 8 Wallace HJ. Lichen sclerosus et atrophicus. Transactions of the St Johnʼs Hospital. Dermatol Soc 1971; 57: 9-30
• 9 Goldstein AT, Marinoff SC, Christopher K et al. Prevalence of vulvar lichen sclerosus in a general gynecology practice. J Reprod Med 2005; 50: 477-480
• 10 Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777-1783
• 11 Handfield-Jones SE, Hinde FR, Kennedy CT. Lichen sclerosus et atrophicus in children misdiagnosed as sexual abuse. Br Med J (Clinical research ed) 1987; 294: 1404-1405
• 12 Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol 2007; 178: 2268-2276
• 13 Reyes MC, Cooper K. An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis. J Clin Pathol 2014; 67: 290-294
• 14 Ueda Y, Enomoto T, Kimura T et al. Two distinct pathways to development of squamous cell carcinoma of the vulva. J Skin Cancer 2011; 2011: 951250
• 15 van Seters M, ten Kate FJ, van Beurden M et al. In the absence of (early) invasive carcinoma, vulvar intraepithelial neoplasia associated with lichen sclerosus is mainly of undifferentiated type: new insights in histology and aetiology. J Clin Pathol 2007; 60: 504-509
• 16 Leibowitch M, Neill S, Pelisse M et al. The epithelial changes associated with squamous cell carcinoma of the vulva: a review of the clinical, histological and viral findings in 78 women. Br J Obstet Gynaecol 1990; 97: 1135-1139
• 17 Vilmer C, Cavelier-Balloy B, Nogues C et al. Analysis of alterations adjacent to invasive vulvar carcinoma and their relationship with the associated carcinoma: a study of 67 cases. Eur J Gynaecol Oncol 1998; 19: 25-31
• 18 Chi CC, Kirtschig G, Baldo M et al. Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev 2011; 12 CD008240
• 19 Neill SM, Lewis FM, Tatnall FM et al. British Association of Dermatologists guidelines for the management of lichen sclerosus 2010. Br J Dermatol 2010; 163: 672-682
• 20 Bracco GL, Carli P, Sonni L et al. Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. J Reprod Med 1993; 38: 37-40
• 21 Luger T, Paul C. Potential new indications of topical calcineurin inhibitors. Dermatology (Basel, Switzerland) 2007; 215 (Suppl. 01) 45-54
• 22 Nissi R, Eriksen H, Risteli J et al. Pimecrolimus cream 1 % in the treatment of lichen sclerosus. Gynecol Obstet Investig 2007; 63: 151-154
• 23 Hengge UR, Krause W, Hofmann H et al. Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus. Br J Dermatol 2006; 155: 1021-1028
• 24 Ormerod AD. Topical tacrolimus and pimecrolimus and the risk of cancer: how much cause for concern?. Br J Dermatol 2005; 153: 701-705
• 25 Jones RW, Scurry J, Neill S et al. Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics. Am J Obstet Gynecol 2008; 198: 496.e1-496.e3