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Italian Journal of Dermatology and Venereology 2021 October;156(5):519-33

DOI: 10.23736/S2784-8671.21.06764-X


lingua: Inglese

Diagnosis and management of cutaneous and anogenital lichen sclerosus: recommendations from the Italian Society of Dermatology (SIDeMaST)

Manuela PAPINI 1, Ada RUSSO 1, Oriana SIMONETTI 2, Alessandro BORGHI 3, Monica CORAZZA 3, Stefano PIASERICO 4, Claudio FELICIANI 5 , Piergiacomo CALZAVARA-PINTON 6, on behalf of the Mucous Membrane Disorders Research Group of SIDeMaST 

1 Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; 2 Section of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy; 3 Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; 4 Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy; 5 Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; 6 Department of Dermatology, University of Brescia, Brescia, Italy

Lichen sclerosus (LS) is a disabling chronic inflammatory disease of skin and genital mucous membrane causing itch, pain, dysuria and restriction of micturition, and significant sexual dysfunction and dyspareunia both in women and men. If left untreated, LS is associated with a high degree of sclerosis and scarring, as well as with an elevated risk of cancer in the genital area. Although a central role of autoimmunity is suggested, the pathogenesis of LS is still not clearly understood and the disease remains difficult to treat. The goals of treatment of LS are to alleviate symptoms and discomfort, prevent anatomical changes and prevent malignant transformation. This guideline has been developed by an Italian group of experts. It summarizes evidence-based and expert- based recommendations. The highest level of evidence favors the use of topical high potency corticosteroids; second- and third-line treatments include topical calcineurin inhibitors and topical retinoids, respectively. Surgical treatment has become the treatment of choice in male genital LS with persistent phimosis not responsive to medical treatment. The aim of this paper is to offer evidence-based and easily applicable recommendations for the management of LS.

KEY WORDS: Lichen sclerosus et atrophicus; Vulvar lichen sclerosus; Rare diseases; Guideline; Drug therapy; Operative surgical procedures

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