Sun Zhongwen,Xu Qingyu,Ma Zhi.Recent advances in treatment of genitourinary lichen sclerosus in boys[J].Journal of Clinical Pediatric Surgery,2022,21(11):1086-1089.[doi:10.3760/cma.j.cn101785-202104003-016]
男童外生殖器萎缩性硬化性苔藓的治疗进展
- Title:
- Recent advances in treatment of genitourinary lichen sclerosus in boys
- 摘要:
- 萎缩性硬化性苔藓（lichen sclerosus，LS）是一种容易被忽视的皮肤苔藓样变，该病往往于儿童期发病且容易忽视，在青春期和中年期之间存在很长的潜伏期，中年期后存在再次发病的可能。LS可以导致阴茎头包皮僵硬狭窄、阴茎头上皮萎缩、包皮内板上皮剥脱，严重情况下可以导致包皮与阴茎头完全融合粘连或尿道口狭窄，增加阴茎癌患病风险。男童LS的治疗困难，目前治疗的主要目的在于消除高风险因素、延缓病情进展和预防性早期干预，治疗方式存在很大的主观性。本文就男童外生殖器LS的治疗现状进行综述，旨在为今后男童LS的临床干预提供参考。
- Abstract:
- Lichen sclerosus (LS) is an easily overlooked dermal lichenification in childhood with a long incubation period during adolescence and middle age and a possibility of recurrence after middle age.LS leads to stiffness and stenosis of glans penis prepuce, atrophy of glans penile epithelium and epithelial exfoliation of inner prepuce plate.In severe cases, complete fusion and adhesion of prepuce and glans penis or stenosis of urethral meatus may elevate the risk of penile cancer.LS is difficult to treat in boys and the main objective of current treatment is to eliminate high-risk factors, delay disease development and implement early interventions.Its treatment modalities are quite subjective.This reviews summarized current status of managing LS of external genitalia in boys to provide references for proper clinical interventions.
参考文献/References:
[1] Russo T, Currò M, Ferlazzo N, et al.Stable ozonides with vitamin E acetate versus corticosteroid in the treatment of lichen sclerosus in foreskin:evaluation of effects on inflammation[J].Urol Int, 2019, 103(4):459-465.DOI:10.1159/000499846.
[2] Charlton OA, Smith SD.Balanitis xerotica obliterans:a review of diagnosis and management[J].Int J Dermatol, 2019, 58(7):777-781.DOI:10.1111/ijd.14236.
[3] 赵冬艳, 唐达星, 徐珊, 等.干燥性闭塞性龟头炎儿童时期发病特点分析[J].临床小儿外科杂志, 2018, 17(1):34-37.DOI:10.3969/j.issn.1671-6353.2018.01.009. Zhao DY, Tang DX, Xu S, et al.Onset features of balanitis xerotica obliterans in children[J].J Clin Ped Sur, 2018, 17(1):34-37.DOI:10.3969/j.issn.1671-6353.2018.01.009.
[4] 张镟, 邓涛, 张九鸿, 等.儿童干燥闭塞性阴茎头炎8例及文献复习[J].临床小儿外科杂志, 2018, 17(7):514-518.DOI:10.3969/j.issn.1671-6353.2018.07.009. Zhang X, Deng T, Zhang JH, et al.Balanitis xerotica obliterans in boys:a report of 8 cases with a literature review[J].J Clin Ped Sur, 2018, 17(7):514-518.DOI:10.3969/j.issn.1671-6353.2018.07.009.
[5] Morrel B, Van Eersel R, Burger CW, et al.The long-term clinical consequences of juvenile vulvar lichen sclerosus:a systematic review[J].J Am Acad Dermatol, 2020, 82(2):469-477.DOI:10.1016/j.jaad.2019.08.030.
[6] Kwok R, Shah TT, Minhas S.Recent advances in understanding and managing Lichen Sclerosus[J].F1000Res, 2020, 9:F1000.DOI:10.12688/f1000research.21529.1.
[7] Kravvas G, Shim TN, Doiron PR, et al.The diagnosis and management of male genital lichen sclerosus:a retrospective review of 301 patients[J].J Eur Acad Dermatol Venereol, 2018, 32(1):91-95.DOI:10.1111/jdv.14488.
[8] Folaranmi SE, Corbett HJ, Losty PD.Does application of topical steroids for lichen sclerosus (balanitis xerotica obliterans) affect the rate of circumcision? A systematic review[J].J Pediatr Surg, 2018, 53(11):2225-2227.DOI:10.1016/j.jpedsurg.2017.12.021.
[9] Hasegawa M, Ishikawa O, Asano Y, et al.Diagnostic criteria, severity classification and guidelines of lichen sclerosus et atrophicus[J].J Dermatol, 2018, 45(8):891-897.DOI:10.1111/1346-8138.14171.
[10] Leganés Villanueva C, Gander R, Royo Gomes G, et al.Treatment of balanitis xerotica obliterans in pediatric patients[J].Cir Pediatr, 2020, 33(2):79-83.
[11] 高瑞雪, 柏冰雪.硬化萎缩性苔藓的治疗进展[J].实用医学杂志, 2015, 31(23):3817-3819.DOI:10.3969/j.issn.1006-5725.2015.23.001. Gao RX, Bai BX.Advances in the treatment of lichen sclerosus[J].J Pract Med, 2015, 31(23):3817-3819.DOI:10.3969/j.issn.1006-5725.2015.23.001.
[12] Chung ASJ, Suarez OA.Current treatment of lichen sclerosus and stricture[J].World J Urol, 2020, 38(12):3061-3067.DOI:10.1007/s00345-019-03030-z.
[13] 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.
[14] Sultan M, El-Shazly M, Elsherif E, et al.Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair[J].Arab J Urol, 2017, 15(4):326-330.DOI:10.1016/j.aju.2017.08.002.
[15] Promm M, R sch WH, Kirtschig G.Lichen sclerosus in children[J].Urologe A, 2020, 59(3):271-277.DOI:10.1007/s00120-020-01140-w.
[16] 董妍, 曾维惠, 李文彬, 等.他克莫司软膏治疗儿童特应性皮炎疗效和安全性的meta分析[J].临床皮肤科杂志, 2017, 46(4):239-242.DOI:10.16761/j.cnki.1000-4963.2017.04.006. Dong Y, Zeng WH, Li WB, et al.Efficacy and safety of topical tacrolimus for childhood atopic dermatitis:a Meta-analysis[J].J Clin Dermatol, 2017, 46(4):239-242.DOI:10.16761/j.cnki.1000-4963.2017.04.006.
[17] Kirtschig G.Lichen sclerosus:symptoms, diagnosis, therapeutic procedures[J].Hautarzt, 2018, 69(2):127-133.DOI:10.1007/s00105-017-4121-2.
[18] Cury Martins J, Martins C, Aoki V, et al.Topical tacrolimus for atopic dermatitis[J].Cochrane Database Syst Rev, 2015, 2015(7):CD009864.DOI:10.1002/14651858.CD009864.pub2.
[19] Nguyen ATM, Holland AJA.Balanitis xerotica obliterans:an update for clinicians[J].Eur J Pediatr, 2020, 179(1):9-16.DOI:10.1007/s00431-019-03516-3.
[20] Olejek A, Gabriel I, Bilska-Janosik A, et al.ALA-photodynamic treatment in lichen sclerosus-clinical and immunological outcome focusing on the assesment of antinuclear antibodies[J].Photodiagnosis Photodyn Ther, 2017, 18:128-132.DOI:10.1016/j.pdpdt.2017.02.006.
[21] Hao JC, Liu J.Feasibility of 5-aminolevulinic acid mediated photodynamic therapy for male genital lichen sclerosus[J].Photodiagnosis Photodyn Ther, 2020, 29:101666.DOI:10.1016/j.pdpdt.2020.101666.
[22] Zucchi A, Cai T, Cavallini G, et al.Genital lichen sclerosus in male patients:a new treatment with polydeoxyribonucleotide[J].Urol Int, 2016, 97(1):98-103.DOI:10.1159/000443184.
[23] Currò M, Russo T, Ferlazzo N, et al.Anti-inflammatory and tissue regenerative effects of topical treatment with ozonated olive oil/vitamin E acetate in balanitis xerotica obliterans[J].Molecules, 2018, 23(3):645.DOI:10.3390/molecules23030645.
[24] Eshtiaghi P, Sadownik LA.Fact or fiction? Adipose-derived stem cells and platelet-rich plasma for the treatment of vulvar lichen sclerosus[J].J Low Genit Tract Dis, 2019, 23(1):65-70.DOI:10.1097/LGT.0000000000000440.
[25] Casabona F, Gambelli I, Casabona F, et al.Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus:the impact on tissue repair and patient quality of life[J].Int Urol Nephrol, 2017, 49(4):573-580.DOI:10.1007/s11255-017-1523-0.
[26] Green PA, Bethell GS, Wilkinson DJ, et al.Surgical management of genitourinary lichen sclerosus et atrophicus in boys in England:a 10-year review of practices and outcomes[J].J Pediatr Urol, 2019, 15(1):45.e1-45.e5.DOI:10.1016/j.jpurol.2018.02.027.
[27] Pradhan A, Patel R, Said AJ, et al.10 years’ experience in balanitis xerotica obliterans:a single-institution study[J].Eur J Pediatr Surg, 2019, 29(3):302-306.DOI:10.1055/s-0038-1668562.
[28] Prabhakaran S, Ljuhar D, Coleman R, et al.Circumcision in the paediatric patient:a review of indications, technique and complications[J].J Paediatr Child Health, 2018, 54(12):1299-1307.DOI:10.1111/jpc.14206.
[29] Kiss A, Király L, Kutasy B, et al.High incidence of balanitis xerotica obliterans in boys with phimosis:prospective 10-year study[J].Pediatr Dermatol, 2005, 22(4):305-308.DOI:10.1111/j.1525-1470.2005.22404.x.
[30] 战立龙, 宋兆录, 魏瑞雪, 等.曲安奈德联合尿道扩张术治疗尿道外口狭窄的临床报道[J].中国男科学杂志, 2019, 33(6):64, 66.DOI:10.3969/j.issn.1008-0848.2019.06.015. Zhan LL, Song ZL, Wei RX, et al.Clinical report of triamcinolone acetonide plus urethral dilatation for urethral stricture[J].Chin J Androl, 2019, 33(6):64, 66.DOI:10.3969/j.issn.1008-0848.2019.06.015.
[31] 朱小江, 董隽, 葛征, 等.分期包皮岛状皮瓣尿道板重建术式治疗重度尿道下裂的疗效评价[J].中华男科学杂志, 2021, 27(2):134-139.DOI:10.13236/j.cnki.nja.2021.02.006. Zhu XJ, Dong J, Ge Z, et al.Staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap for severe hypospadias[J].Natl J Androl, 2021, 27(2):134-139.DOI:10.13236/j.cnki.nja.2021.02.006.
[32] Arena S, Russo T, Impellizzeri P, et al.Utility of uroflowmetry during the follow-up of children affected by balanitis xerotica obliterans (BXO)[J].Arch Ital Urol Androl, 2018, 90(2):123-126.DOI:10.4081/aiua.2018.2.123.
[33] Hughes KE, Corbett HJ.Ultrasound evidence of bladder outlet obstruction secondary to lichen sclerosus et atrophicus in boys (balanitis xerotica obliterans)[J].J Pediatr Surg, 2020, 55(4):721-725.DOI:10.1016/j.jpedsurg.2019.07.020.
[34] Granieri MA, Peterson AC, Madden-Fuentes RJ.Effect of lichen sclerosis on success of urethroplasty[J].Urol Clin North Am, 2017, 44(1):77-86.DOI:10.1016/j.ucl.2016.08.004.
[35] 吕军, 黄晓东.男性生殖器硬化性苔藓样病的诊治现状[J].中华男科学杂志, 2014, 20(7):579-585.DOI:10.13263/j.cnki.nja.2014.07.001. Lyu J, Huang XD.Current diagnosis and treatment of male genital lichen sclerosus[J].Natl J Androl, 2014, 20(7):579-585.DOI:10.13263/j.cnki.nja.2014.07.001.
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备注/Memo
收稿日期:2021-04-02。
基金项目:黑龙江省省属高等学校基本科研业务费科研项目（2019—KYYWFMY—0041）
通讯作者:马志,Email:mz13945307895@163.com