Clinical and psychological features of children with anogenital lichen sclerosus. approaches to the choice of therapy
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Clinical and psychological features of children with anogenital lichen sclerosus. approaches to the choice of therapy Maria Osminina
Lichen sclerosus (scleroatrophic lichen) is a chronic inflammatory dermatosis of the dermal papilla, manifested by ivory white or rose-colored papules and plaques, with atrophy in the center. Lichen sclerosus morphological changes are characterized by a thin flat epidermis, a subepidermal zone of oedematous and hyalinized collagen. It is still not established, but more and more clinicians state lichen sclerosus is associated to localized scleroderma. Lichen sclerosus can affect any parts of the body, but genital involvement is the most common. Extragenital lichen sclerosus occurs in 6-20% of the population.
We carried out a retrospective analysis of clinical presentations and treatment response of 12 patients with anogenital lichen sclerosus in children aged 3-14 years. We presented the clinical features and identified a combination of lichen sclerosus with localized scleroderma in 41% of the examined patients, revealed psychoemotional disorders in the patients. The treatment of the disease varied greatly in the group of these patients. The anogenital lischen sclerosus therapy was stepwise. It started with local treatment using topical corticosteroids and calcineurin inhibitors. If such treatment was ineffective, it was enhanced by using of oral immunosuppressants, which significantly improved the prognosis and outcome of the disease. The assessment of the effectiveness of the treatment was implemented using the visual scales of activity, skin fibrosis and the scale of local pain. The psycho-emotional status of children was assessed using the Luscher test and the Childrens Manifest Anxiety Scale. Dynamic follow-up of our patients verified significant problems of emotional-volitional and motivational spheres, as well as severe anxiety, which correlated with the activity of the skin processes. Also we report uneven reverse reduction of clinical and psychological manifestations, such as normalization of psychoemotional disorders previously to somatic improvement. Deep psychoemotional impairment status revealed that children with anogenital lischen sclerosus require psychological adjustment and, if necessary, medical treatment provided by a neuropsychiatrist.
DOI: https://ysmu.am/v2/wp-content/uploads/2023/05/3855ea63-1.pdf The New Armenian Medical Journal Vol.14 (2020), Nо 3 88-99
