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Frauenheilkunde up2date 2014; 8(3): 211-225
DOI: 10.1055/s-0033-1357942
Gynäkologische Spezialgebiete und Methoden
Georg Thieme Verlag KG Stuttgart · New York

Genitaler Lichen sclerosus – Diagnostik und Therapie

Felix Neis
,
Amir Yazdi
,
Katharina Rall
Further Information

Publication History

Publication Date:
24 June 2014 (online)

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Kernaussagen

Der Lichen sclerosus 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.

 

  • Literatur

  • 1 Cooper SM, Gao XH, Powell JJ et al. Does treatment of vulvar lichen sclerosus influence its prognosis?. Arch Dermatol 2004; 140: 702-706
    CrossrefSearch in Google Scholar
  • 2 Green C, Guest J, Ngu W. Long-term follow-up of women with genital lichen sclerosus. Menopause Int 2013; [Epub ahead of print]
    Search in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 5 Birenbaum DL, Young RC. High prevalence of thyroid disease in patients with lichen sclerosus. J Reprod Med 2007; 52: 28-30
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 8 Wallace HJ. Lichen sclerosus et atrophicus. Transactions of the St Johnʼs Hospital Dermatol Soc 1971; 57: 9-30
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 10 Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777-1783
    CrossrefSearch in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 12 Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol 2007; 178: 2268-2276
    CrossrefSearch in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 18 Chi CC, Kirtschig G, Baldo M et al. Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev 2011; (12) CD008240
    Search in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 21 Luger T, Paul C. Potential new indications of topical calcineurin inhibitors. Dermatology (Basel, Switzerland) 2007; 215 Suppl 1: 45-54
    Search in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 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
    CrossrefSearch in Google Scholar
  • 24 Ormerod AD. Topical tacrolimus and pimecrolimus and the risk of cancer: how much cause for concern?. Br J Dermatol 2005; 153: 701-705
    CrossrefSearch in Google Scholar
  • 25 Terras S, Gambichler T, Moritz RK et al. UV-A1 phototherapy vs clobetasol propionate, 0.05 %, in the treatment of vulvar lichen sclerosus: a randomized clinical trial. J Am Med Assoc Dermatol 2014;
    Search in Google Scholar
  • 26 Abramov Y, Elchalal U, Abramov D et al. Surgical treatment of vulvar lichen sclerosus: a review. Obstet Gynecol Surv 1996; 51: 193-199
    CrossrefSearch in Google Scholar
  • 27 Bradford J, Fischer G. Surgical division of labial adhesions in vulvar lichen sclerosus and lichen planus. J Lower Genital Tract Dis 2013; 17: 48-50
    CrossrefSearch in Google Scholar
  • 28 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
    CrossrefSearch in Google Scholar