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Efficacy of Photodynamic Therapy in Vulvar Lichen Sclerosus Treatment Based on Immunohistochemical Analysis of CD34, CD44, Myelin Basic Protein, and Ki67 Antibodies
  1. Anita Olejek, MD, PhD*,
  2. Katarzyna Stęplewska, MD, PhD,
  3. Andrzej Gabriel, MD, PhD,
  4. Iwona Kozak-Darmas, MD, PhD*,
  5. Anna Jarek, MD*,
  6. Sylwia Kellas-Ślęczka, MD, PhD,
  7. Filip Bydliński, MD*,
  8. Karolina Sieroń-Stołtny, MD§,
  9. Stanisław Horak, MD, PhD*,
  10. Artur Chełmicki, MD, PhD, and
  11. Aleksander Sieroń, MD, PhD§
  1. * Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom;
  2. Department of Histopathology, Medical University of Silesia, Zabrze;
  3. Department of Brachytherapy, Maria Skłodowska-Curie Memorial Cancer Centre-Institute of Oncology, Gliwice;
  4. § Department of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, Bytom;
  5. Women's Health, and
  6. Health Education Faculty, Medical University of Silesia, Katowice, Silesia, Poland.
  1. Address correspondence and reprint requests to Anita Olejek, MD, PhD, Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, ul. Batorego 15, 41-902 Bytom, Silesia, Poland. E-mail: bytomobstgyn{at}slam.katowice.pl.

Abstract

Introduction: Lichen sclerosus (LS) is a chronic skin and mucosa inflammatory disease. It affects mainly the female anogenital area especially in postmenopausal period. The main symptoms include pruritus, burning, pain, sometimes urinary problems, or difficulties in defecation. Usually, porcelain-white plaques are seen in the skin and mucosa. The etiology and pathogenesis of LS are still uncertain. There are some research studies on possible genetic predisposition, yet autoimmune, hormonal, or infectious factors are not excluded. The typical treatment of LS is mainly pharmacological, although the alternative treatment method used in LS is photodynamic therapy (PDT), which is noninvasive technique based on selective destruction of lesions. Our study is focused on molecule markers of vascularisation (CD34), nervous cell function (myelin basic protein [MBP]), keratinocyte function (CD44), and proliferation index (Ki67) in cases treated with photodynamic method.

Materials and Methods: A group of 100 patients treated in our department was included in the study. All 100 women had LS on the basis of clinical and histological criteria. All the subjects underwent PDT. In all cases, skin biopsies were taken before and after treatment, and samples were analyzed with CD34, CD44, MBP, and Ki67 antibodies using immunohistochemical staining.

Results: The study shows the high efficacy of PDT in LS treatment including beneficial changes to CD34, CD44, and MBP immunostained molecules. The Ki67 proliferation index did not change significantly. A significant increase of CD34 (microvessel density), MBP, and CD44 expression was confirmed in the histological images and in the partial or full remission of clinical objective and subjective symptoms.

Conclusions: The PDT is a very effective therapeutic method in LS treatment.

  • Lichen sclerosus
  • Vulva
  • Photodynamic therapy
  • Immunohistochemistry

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