Santina Conte

Zusammenfassung: Der Lichen sclerosus (LS) ist eine chronisch verlaufende entzündliche Dermatose, die in erster Linie durch Veränderungen der Hautpigmentierung, der Genitalarchitektur sowie durch Pruritus mit begleitender Dyspareunie gekennzeichnet ist. Es gibt eine Vielzahl von Komplikationen im Zusammenhang mit LS, die die gesundheitsbezogene Lebensqualität der Patienten darüber hinaus verschlechtern können. Eine systematische Übersichtsarbeit wurde durchgeführt, um die Literatur zu den klinischen Merkmalen von LS und LS‐assoziierten Komplikationen zusammenzufassen. Insgesamt wurden 900 Studien mit 17.011 klinischen Präsentationen und 2.795 Komplikationen von LS bei Frauen und 5.745 klinischen Präsentationen und 769 Komplikationen von LS bei Männern eingeschlossen. Bei beiden Geschlechtern war die Mehrzahl der gemeldeten Fälle (77% bei Frauen, 99% bei Männern) auf die Genitalien beschränkt. Bei Frauen verteilten sich die Symptome auf den Verlust der normalen Architektur (14%), Pigmentveränderungen (21%) und Juckreiz (18%), während bei Männern ein größerer Anteil der Fälle architektonische Veränderungen (34%), Pigmentveränderungen (15%) und urogenitale Symptome (15%) betraf. Des Weiteren wurden Texturveränderungen, Atrophien, Schmerzen, Brennen und unangenehme Empfindungen, Erosionen, Ulzerationen, Exkoriationen, Blutungen, Blutergüsse und Purpura sowie Defäkationsstörungen und Blasenbildungen als weitere Symptome im Zusammenhang mit LS beobachtet. Bei einem kleinen Teil der in der Literatur beschriebenen Fälle handelt es sich um asymptomatische LS. Zu den Komplikationen im Zusammenhang mit LS gehören Hautneoplasmen, urogenitale Probleme und sexuelle Funktionsstörungen, einschließlich einer Dyspareunie.

Summary: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis most commonly characterized by changes in skin pigmentation and pruritus, with associated dyspareunia and genital architectural changes. There are a variety of complications associated with LS, which further worsen a patient's health‐related quality of life. A systematic review was conducted to summarize the literature regarding clinical features of LS, as well as LS‐associated complications. In total, 900 studies were included, which represented 17,011 clinical presentations and 2,795 complications of LS in women, and 5,745 clinical presentations and 769 complications of LS in men. In both sexes, the majority of reported cases (77% in females, 99% in males) localized to the genitals. In women, presentations were spread amongst loss of normal architecture (14%), pigmentary changes (21%) and pruritus (18%), whereas in men a greater portion of cases presented with architectural alterations (34%), as well as pigmentary changes (15%) and urogenital symptoms (15%). Other classes of LS‐associated presentations included textural changes, atrophy, pain/burning/discomfort, erosions/ulcerations/excoriations, bleeding/bruising/purpura, defecatory symptoms and bullae. A small portion of cases found in the literature presented with asymptomatic LS. LS‐associated complications included skin neoplasms, urogenital issues and sexual dysfunction, including dyspareunia.

Background: Skin cancer prevention relies on effective sun safety practices. Previous studies have shown that LGBTQ+ individuals exhibit lower sunscreen use and higher tanning bed usage compared to their non-LGBTQ+ counterparts. This study is the first to assess skin cancer risk factors, sun-protective behaviors, and skin cancer concerns among LGBTQ+ individuals across Canada. Methods: A national survey study was conducted between July 2020 and March 2024 and included LGBTQ+ respondents aged ≥ 16 years who had completed the survey. Responses were summarized using frequency counts/percentages for categorical variables and means/standard deviations for continuous variables. Logistic regression models were used to calculate age- and gender-adjusted odds ratios for subgroup analyses. Results: Of the 700 LGBTQ+ participants included (59.3% women; median age 38 years), the majority had a Fitzpatrick skin phototype (FSP) I–III (76.4%). Concerningly, 60% reported >10 lifetime sunburns, 58% reported ≥1 blistering sunburn, 34% had used a tanning bed ≥1 time in their lifetime, and 69% reported having a tan in the last 12 months. Sunscreen was worn regularly by only half of the respondents, and half of the participants agreed or strongly agreed with “I look better and/or healthier with a tan”. Additional comparisons are presented based on gender, FSP, education, and income. Conclusion: The findings of this study highlight the need for public health campaigns tailored to the LGBTQ+ community, emphasizing culturally sensitive sun safety education, particularly for LGBTQ+ men, individuals with FSP IV–VI, and those with lower education levels, to help reduce future skin cancer risk.

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that affects both genital and extragenital sites. It is often difficult to treat and may lead to a variety of complications if not adequately treated. The mainstay of therapy involves topical corticosteroids, topical calcineurin inhibitors, and systemic immunomodulators. Although a variety of topical, oral, and procedural therapies are available, a review comparing relative efficacy is lacking. To this end, this systematic review aimed to summarize the literature regarding treatment modalities and their respective response rates in patients with genital LS. Methods: A literature search was conducted in accordance with PRISMA guidelines. Results: This review qualitatively summarizes information from 31 randomized controlled trials, encapsulating a total of 1507 patients with LS, the majority of which were female (n = 1374, 91%). Topical corticosteroids, the mainstay of therapy for LS, were discussed throughout the literature, and proved to be more efficient than topical calcineurin inhibitors, topical hormonal therapy, topical vitamin E oil and cold cream. However, other treatment modalities proved to be more efficient than topical corticosteroids, including CO₂ and Nd:YAG laser therapies, and the addition of polydeoxyribonucleotide intradermal injections, to steroid therapy. Finally, other modalities that proved to be efficient in the treatment of LS included silk undergarments, human fibroblast lysate cream, platelet-rich plasma, acitretin, and surgical intervention. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Limitations included the inclusion of only randomized controlled trials, moderate or high risk of bias, and heterogeneity in treatment regimens, among others. Conclusion: Although high-potency topical corticosteroids have validated efficacy in the management of LS, other treatment modalities, including steroid-sparing agents and/or procedural adjuncts, have been demonstrated to have a beneficial role in the treatment of LS.

The rapidly increasing skin cancer rates in Canada are alarming, with current data estimating that 1/3 of Canadians will be affected in their lifetime. Thus, deeper understanding of high-risk sun exposure behaviors is needed to help counter this trend. Only limited action has been taken by federal/provincial governments to reduce skin cancer incidence. A cross-sectional survey study was conducted in Manitoba, with frequency counts, means, and percentages used to encapsulate responses. Age- and gender-adjusted odds ratios were calculated using logistic regression analyses. Our study identified worrying inadequacies in sun protective behaviors and attitudes, with the threat of such high-risk behaviors amplified by a lack of skin cancer awareness. Alarming elements were noted in participants’ sun exposure history (>65% reported a history of sunburns, >50% previously used a tanning bed, and >75% recently tanned for pleasure), beliefs and attitudes (>50% believe that they look better/healthier with a tan, and >40% believe that having a base tan is protective against further sun damage), and sun protection efforts (sun protective clothing was used <60% of the time, sunscreen was used by <50%, and there was a lack of knowledge about sunscreen characteristics in ~30% of respondents), in addition to significant differences being established between demographic subgroups (based on gender, age, skin phototype, income, and education attained). This study provides worrisome insight onto the grim landscape of sun protective behaviors and attitudes in Manitoba, which will inevitably translate into higher skin cancer rates and should serve as a call to action to promote targeted public health messaging in this jurisdiction and beyond.

Introduction: Acantholytic squamous cell carcinoma (aSCC) is a rare clinicopathological subtype of cutaneous squamous cell carcinoma, accounting for approximately 4.9% of all SCC cases. However, there are currently no standardized criteria for the diagnosis of aSCC. This systematic review is the first to summarize the clinical and molecular features of aSCC. Methods: A systematic search of Medline, Embase, Scopus, and PubMed was performed. All articles in English or French were included, with no restriction of publication date. All articles with original data pertaining to clinical or molecular characteristics of aSCC were included. Two reviewers screened articles and resolved conflicts. Results: Our systematic review included 52 studies on the clinical and molecular features of aSCC, including a total of 482 patients (76% male, mean age at diagnosis 68.9 years): 430 cases assessed clinical features, while 149 cases assessed molecular features. The most common location of aSCC was the head and neck (n = 329/430; 76.5%). In terms of morphology, most lesions were described as nodules (n = 93/430, 21.6%), with common surface changes being hyperkeratosis (n = 6), erosion (n = 6), ulceration (n = 5), and crusting (n = 3). With regard to dermoscopy, only six cases were noted in the literature, including findings such as ulceration (n = 3), keratin clots (n = 2), and erosions (n = 2). Thirty-four studies discussed the molecular markers of aSCC, with the most prevalent markers being cytokeratins. CD15 negativity was noted in 23 cases, while common endothelial vascular markers such as CD34 (n = 16), CD31 (n = 15), factor VIII-related antigen (n = 10), and ERG (n = 1) were often not expressed. Finally, expression of intracellular adhesion molecules (i.e., E-cadherin, CD138) was markedly decreased compared to non-acantholytic invasive SCC. Conclusions: This systematic review summarizes the clinical characteristics and molecular features of aSCC. As clinical differentiation can be difficult, clinicopathological correlation with molecular markers may help ensure proper diagnosis.