[开放获取]    女阴硬化性苔藓诊疗专家共识

doi:10.35541/cjd.20201202

中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (5): 371-375.doi: 10.35541/cjd.20201202

[开放获取] 女阴硬化性苔藓诊疗专家共识

中国医疗保健国际交流促进会皮肤科分会

中国医疗保健国际交流促进会皮肤科分会

收稿日期:2020-12-17 修回日期:2021-01-17 发布日期:2021-04-29
通讯作者: 常建民 E-mail:changjm0417@126.com

Expert consensus on the diagnosis and treatment of vulvar lichen sclerosus

Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare

Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare

Received:2020-12-17 Revised:2021-01-17 Published:2021-04-29
Contact: Chang Jianmin E-mail:changjm0417@126.com

摘要/Abstract

摘要： 【摘要】女阴硬化性苔藓是一种反复发作的慢性炎症性疾病，几乎各年龄阶段均可发生，绝经期、围绝经期和青春期前女性更常见。典型损害为象牙白/瓷白色硬化萎缩斑，晚期可发生外阴、尿道、肛门结构畸变，造成性生活、排尿及排便困难。中国医疗保健国际交流促进会皮肤科分会组织多位专家在借鉴国内外临床研究和诊疗指南的基础上，补充了中国专家的经验和观点，制定女阴硬化性苔藓中国专家共识。

关键词: 外阴硬化性苔藓, 诊断, 治疗, 共识

Abstract: 【Abstract】 Vulvar lichen sclerosus （VLS） is a recurrent chronic inflammatory disease that can occur in women of almost all ages, especially menopausal, perimenopausal and prepubertal women. The typical skin lesions include ivory-/porcelain-white sclerotic atrophic plaques, and anatomical distortion of the vulva, urethra and anus in the late stage, which can lead to difficulties in sexual activities, urination and defecation. The Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare organized several Chinese experts to develop this Chinese expert consensus on the diagnosis and treatment of VLS, based on clinical researches and guidelines for the diagnosis and treatment of VLS in China and other countries as well as experience and perspectives of Chinese experts.

Key words: Vulvar lichen sclerosus, Diagnosis, Treatment, Consensus

中国医疗保健国际交流促进会皮肤科分会. [开放获取] 女阴硬化性苔藓诊疗专家共识[J]. 中华皮肤科杂志, 2021,54(5):371-375. doi:10.35541/cjd.20201202

Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare. Expert consensus on the diagnosis and treatment of vulvar lichen sclerosus[J]. Chinese Journal of Dermatology, 2021, 54(5): 371-375.doi:10.35541/cjd.20201202

参考文献 39

［1］	Goldstein AT, Marinoff SC, Christopher K, et al. Prevalence of vulvar lichen sclerosus in a general gynecology practice［J］. J Reprod Med, 2005,50（7）:477⁃480.
［2］	文玮, 杨敏, 韩玉, 等. 129例女阴硬化性苔藓临床特征分析［J］. 中华皮肤科杂志, 2018,51（4）:283⁃287. doi: 10.3760/cma.j.issn.0412⁃4030.2018.04.009.
［3］	Marfatia Y, Surani A, Baxi R. Genital lichen sclerosus et atrophicus in females: an update［J］. Indian J Sex Transm Dis AIDS, 2019,40（1）:6⁃12. doi: 10.4103/ijstd.IJSTD_23_19.
［4］	Lee A, Bradford J, Fischer G. Long⁃term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women［J］. JAMA Dermatol, 2015,151（10）:1061⁃1067. doi: 10.1001/jamadermatol.2015.0643.
［5］	Kohn JR, Connors TM, Chan W, et al. Clinical outcomes and adherence to topical corticosteroid therapy in women with vulvar lichen sclerosus: a retrospective cohort study［J］. J Am Acad Dermatol, 2020,83（4）:1104⁃1109. doi: 10.1016/j.jaad.2020.05. 006.
［6］	Melnick LE, Steuer AB, Bieber AK, et al. Lichen sclerosus among women in the United States［J］. Int J Womens Dermatol, 2020,6（4）:260⁃262. doi: 10.1016/j.ijwd.2020.05.001.
［7］	杨敏, 鲍迎秋, 高小曼, 等. 女阴硬化性苔藓99例临床分析［J］. 中国皮肤性病学杂志, 2018,32（7）:780⁃783. doi: 10.13735/j.cjdv.1001⁃7089.201712079.
［8］	Tong LX, Sun GS, Teng JM. Pediatric lichen sclerosus: a review of the epidemiology and treatment options［J］. Pediatr Dermatol, 2015,32（5）:593⁃599. doi: 10.1111/pde.12615.
［9］	Trokoudes D, Lewis FM. Lichen sclerosus ⁃ the course during pregnancy and effect on delivery［J］. J Eur Acad Dermatol Venereol, 2019,33（12）:e466⁃e468. doi: 10.1111/jdv.15788.
［10］	Singh N, Ghatage P. Etiology, clinical features, and diagnosis of vulvar lichen sclerosus: a scoping review［J］. Obstet Gynecol Int, 2020,2020:7480754. doi: 10.1155/2020/7480754.
［11］	Xavier J, Vieira⁃Baptista P, Moreira A, et al. Vaginal lichen sclerosus: report of two cases［J］. Facts Views Vis Obgyn, 2017,9（3）:171⁃173.
［12］	Gadaldi K, Cazzaniga S, Feldmeyer L, et al. Genital lichen sclerosus in women: a histopathological analysis of 38 criteria［J］. J Eur Acad Dermatol Venereol, 2020,34（8）:e418⁃e420. doi: 10.1111/jdv.16368.
［13］	Borghi A, Corazza M, Minghetti S, et al. Dermoscopic features of vulvar lichen sclerosus in the setting of a prospective cohort of patients: new observations［J］. Dermatology, 2016,232（1）:71⁃77. doi: 10.1159/000439198.
［14］	罗毅鑫, 刘洁, 池诚, 等. 外阴硬化性苔藓的皮肤镜特征分析［J］. 中华皮肤科杂志, 2018,51（11）:809⁃811. doi: 10.3760/cma.j.issn.0412⁃4030.2018.11.007.
［15］	Bleeker MC, Visser PJ, Overbeek LI, et al. Lichen sclerosus: incidence and risk of vulvar squamous cell carcinoma［J］. Cancer Epidemiol Biomarkers Prev, 2016,25（8）:1224⁃1230. doi: 10.1158/1055⁃9965.EPI⁃16⁃0019.
［16］	Dell EA, Miest R, Lohse CM, et al. Vulvar neoplasms in 275 women with genital lichen sclerosus and impact of treatment: a retrospective chart review［J］. J Eur Acad Dermatol Venereol, 2018,32（9）:e363⁃e365. doi: 10.1111/jdv.14938.
［17］	Virgili A, Minghetti S, Borghi A, et al. Long⁃term maintenance therapy for vulvar lichen sclerosus: the results of a randomized study comparing topical vitamin E with an emollient［J］. Eur J Dermatol, 2013,23（2）:189⁃194. doi: 10.1684/ejd.2013.1987.
［18］	Kai A, Lewis F. Long⁃term use of an ultrapotent topical steroid for the treatment of vulval lichen sclerosus is safe［J］. J Obstet Gynaecol, 2016,36（2）:276⁃277. doi: 10.3109/01443615.2015. 1049252.
［19］	van der Meijden WI, Boffa MJ, Ter Harmsel WA, et al. 2016 European guideline for the management of vulval conditions［J］. J Eur Acad Dermatol Venereol, 2017,31（6）:925⁃941. doi: 10. 1111/jdv.14096.
［20］	Corazza M, Virgili A, Toni G, et al. Mometasone furoate in the treatment of vulvar lichen sclerosus: could its formulation influence efficacy, tolerability and adherence to treatment?［J］. J Dermatolog Treat, 2018,29（3）:305⁃309. doi: 10.1080/09546634. 2017.1360990.
［21］	Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018［J］. Br J Dermatol, 2018,178（4）:839⁃853. doi: 10.1111/bjd.16241.
［22］	Lee A, Fischer G. Diagnosis and treatment of vulvar lichen sclerosus: an update for dermatologists［J］. Am J Clin Dermatol, 2018,19（5）:695⁃706. doi: 10.1007/s40257⁃018⁃0364⁃7.
［23］	Murina F, Rehman S, Di Francesco S, et al. Vulvar lichen sclerosus: a comparison of the short⁃term topical application of clobetasol dipropionate 0.05% versus mometasone furoate 0.1%［J］. J Low Genit Tract Dis, 2015,19（2）:149⁃151. doi: 10.1097/LGT.0000000000000065.
［24］	Kirtschig G, Becker K, Günthert A, et al. Evidence⁃based （S3） guideline on （anogenital） lichen sclerosus［J］. J Eur Acad Dermatol Venereol, 2015,29（10）:e1⁃e43. doi: 10.1111/jdv.13136.
［25］	Corazza M, Borghi A, Minghetti S, et al. Clobetasol propionate vs. mometasone furoate in 1⁃year proactive maintenance therapy of vulvar lichen sclerosus: results from a comparative trial［J］. J Eur Acad Dermatol Venereol, 2016,30（6）:956⁃961. doi: 10. 1111/jdv.13166.
［26］	陈伟, 李珊山. 外阴硬化性苔藓67例临床分析［J］. 中国皮肤性病学杂志, 2017,31（4）:398⁃399. doi: 10.13735/j.cjdv.1001⁃7089.201609036.
［27］	Anderson K, Ascanio NM, Kinney MA, et al. A retrospective analysis of pediatric patients with lichen sclerosus treated with a standard protocol of class I topical corticosteroid and topical calcineurin inhibitor［J］. J Dermatolog Treat, 2016,27（1）:64⁃66. doi: 10.3109/09546634.2015.1054777.
［28］	Mazzilli S, Diluvio L, Di Prete M, et al. Tacrolimus 0.03% ointment for treatment of paediatric lichen sclerosus: a case series and literature review［J］. J Int Med Res, 2018,46（9）:3724⁃3728. doi: 10.1177/0300060518778219.
［29］	Funaro D, Lovett A, Leroux N, et al. A double⁃blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus［J］. J Am Acad Dermatol, 2014,71（1）:84⁃91. doi: 10.1016/j.jaad.2014.02.019.
［30］	Prodromidou A, Chatziioannou E, Daskalakis G, et al. Photodynamic therapy for vulvar lichen sclerosus⁃a systematic review［J］. J Low Genit Tract Dis, 2018,22（1）:58⁃65. doi: 10.1097/LGT.0000000000000362.
［31］	Shi L, Miao F, Zhang LL, et al. Comparison of 5⁃aminolevulinic acid photodynamic therapy and clobetasol propionate in treatment of vulvar lichen sclerosus［J］. Acta Derm Venereol, 2016,96（5）:684⁃688. doi: 10.2340/00015555⁃2341.
［32］	陈静, 李振鲁, 朱雪峰, 等. 氨基酮戊酸光动力疗法治疗硬化萎缩性苔藓的疗效观察［J］. 中华皮肤科杂志, 2014,47（6）:433⁃434. doi: 10.3760/cma.j.issn.0412⁃4030.2014.06.020.
［33］	赵慧霞, 贾振宇, 张嘉, 等. 盐酸氨酮戊酸光动力治疗外阴硬化性苔藓的疗效观察［J］. 中国现代医学杂志, 2018,28（28）:113⁃116. doi: 10.3969/j.issn.1005⁃8982.2018.28.020.
［34］	Mallidi S, Anbil S, Bulin AL, et al. Beyond the barriers of light penetration: strategies, perspectives and possibilities for photodynamic therapy［J］. Theranostics, 2016,6（13）:2458⁃2487. doi: 10.7150/thno.16183.
［35］	Declercq A, Güvenç C, De Haes P. Proposition of standardized protocol for photodynamic therapy for vulvar lichen sclerosus［J］. J Dermatolog Treat, 2020. doi: 10.1080/09546634.2020. 1771260.［published online ahead of print 2020⁃07⁃01］.
［36］	Krapf JM, Mitchell L, Holton MA, et al. Vulvar lichen sclerosus: current perspectives［J］. Int J Womens Health, 2020,12:11⁃20. doi: 10.2147/IJWH.S191200.
［37］	Pérez⁃López FR, Vieira⁃Baptista P. Lichen sclerosus in women: a review［J］. Climacteric, 2017,20（4）:339⁃347. doi: 10.1080/13697137.2017.1343295.
［38］	Nguyen Y, Bradford J, Fischer G. Lichen sclerosus in pregnancy: a review of 33 cases［J］. Aust N Z J Obstet Gynaecol, 2018,58（6）:686⁃689. doi: 10.1111/ajo.12812.
［39］	李静然, 魏丽惠. 外阴苔藓类疾病的局部糖皮质激素治疗［J］. 中华妇产科杂志, 2018,53（9）:651⁃653. doi: 10.3760/cma.j.issn.0529⁃567x.2018.09.016.

[1]	侯晓媛吴南辉徐明圆刘业强. JAK抑制剂巴瑞替尼治疗环状肉芽肿1例[J]. 中华皮肤科杂志, 2024, 57(5): 461-462.
[2]	中华医学会皮肤性病学分会中国医师协会皮肤科医师分会中国中西医结合学会皮肤性病专业委员会 . [开放获取] 中国化学剥脱术临床应用专家共识（公众版2024版）[J]. 中华皮肤科杂志, 2024, 0(5): 20230620-e20230620.
[3]	《乳房外Paget病诊治专家共识（版）》编写委员会专家组. [开放获取] 乳房外Paget病诊治专家共识（2024版）[J]. 中华皮肤科杂志, 2024, 57(5): 400-408.
[4]	中国医师协会皮肤科医师分会. [开放获取] 慢性瘙痒管理指南（2024版）[J]. 中华皮肤科杂志, 2024, 57(5): 387-399.
[5]	中国“一带一路”皮肤病专病联盟分枝杆菌病研究联盟中国麻风防治协会皮肤性病检验与诊断分会. [开放获取] 中国皮肤结核临床诊疗专家共识（2024版）[J]. 中华皮肤科杂志, 2024, 57(5): 426-434.
[6]	中国医师协会皮肤科医师分会中国中西医结合学会皮肤性病学分会. 红皮病型银屑病诊疗中国专家共识（2024版）[J]. 中华皮肤科杂志, 2024, 57(5): 409-417.
[7]	中国中西医结合学会皮肤性病学分会真菌学组中国耐药皮肤癣菌病诊治与防控工作组. [开放获取] 中国耐药皮肤癣菌感染诊治与防控专家共识（2024版）[J]. 中华皮肤科杂志, 2024, 57(5): 418-425.
[8]	岳淑珍树叶罗鸯鸯李珂瑶张圆圆汤建萍韦祝. 奥马珠单抗治疗儿童慢性荨麻疹的疗效和安全性回顾研究[J]. 中华皮肤科杂志, 2024, 57(4): 354-358.
[9]	宋雨晴杨楠刘琳琳冯子仪韩世新周梅娟. [开放获取] 皮肤磨削术治疗家族性良性慢性天疱疮6例临床观察[J]. 中华皮肤科杂志, 2024, 0(4): 20220278-e20220278.
[10]	刘祎曲莹雷文知刘晓刚潘炜华张超. 食盐封包法治疗化脓性肉芽肿25例临床观察[J]. 中华皮肤科杂志, 2024, 0(4): 20230553-e20230553.
[11]	鞠强李嘉祺. [开放获取] 寻常痤疮再认识：从发病机制到治疗策略[J]. 中华皮肤科杂志, 2024, 57(4): 289-294.
[12]	张迪敏曹成周妙妮盛安琪林福全许爱娥. 复方倍他米松注射液联合治疗后进展期非节段型白癜风稳定率及影响因素分析[J]. 中华皮肤科杂志, 2024, 57(4): 350-354.
[13]	田静邓思思宋志强. 特应性与非特应性结节性痒疹患者临床特征比较[J]. 中华皮肤科杂志, 2024, 57(4): 331-337.
[14]	葛新红马迎东焦亚宁刘玲玲周镁紫薇李博文. 532 nm皮秒激光治疗面部早期脂溢性角化病的疗效和安全性分析[J]. 中华皮肤科杂志, 2024, 57(4): 359-362.
[15]	严汝帆廖洁月郭子瑜姚南周文玉罗帅寒天张桂英赵明. 天疱疮发病机制和靶向治疗的研究进展[J]. 中华皮肤科杂志, 2024, 57(4): 374-378.

[开放获取] 女阴硬化性苔藓诊疗专家共识

Expert consensus on the diagnosis and treatment of vulvar lichen sclerosus

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 39

相关文章 15

Metrics

本文评价

推荐阅读 10