Treatment-induced anogenital melanosis is a very frequent finding in patients with vulvar lichen sclerosus.

Autor:	Gambichler T; Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.; Department of Dermatology, Christian Hospital Unna, Unna, Germany.; Department of Dermatology, Dortmund Hospital, University Witten/Herdecke, Dortmund, Germany., Erdogan G; Department of Dermatology, Ruhr-University Bochum, Bochum, Germany., Weyer-Fahlbusch SS; Department of Dermatology, Dortmund Hospital, University Witten/Herdecke, Dortmund, Germany., Susok L; Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.; Department of Dermatology, Dortmund Hospital, University Witten/Herdecke, Dortmund, Germany.
Jazyk:	angličtina
Zdroj:	International journal of women's dermatology [Int J Womens Dermatol] 2024 Jul 16; Vol. 10 (3), pp. e169. Date of Electronic Publication: 2024 Jul 16 (Print Publication: 2024).
DOI:	10.1097/JW9.0000000000000169
Abstrakt:	Background: Pigmented lesions such as melanosis have rarely been reported in patients with vulvar lichen sclerosus (VLS) that is typically characterized by hypopigmented lesions. Objective: We aimed to analyze systematically anogenital melanosis in a large cohort of VLS patients. Methods: 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. Results: 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 ( P = .0018) and negatively correlated with the use of pulsed high-dose corticosteroids plus low-dose methotrexate (PHDC-LDM, P = .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, P = .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, P = .018). Limitations: The study includes the retrospective monocentric design. Conclusion: 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. Competing Interests: None. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.)
Databáze:	MEDLINE
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