ΣΚΛΗΡΟΑΤΡΟΦΙΚΟΣ ΛΕΙΧΗΝΑΣ ΠΕΟΥΣ ΘΕΡΑΠΕΙΑ
με Απώλεια Βάρους
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genital lichen sclerosus (GLSc) a small body of observational evidence suggests obesity predisposes men to developing GLSc A recent case–control study found that men with genital lichen sclerosus had a significantly higher mean body mass index when compared with controls. 8 In a recent review of adult concealed (buried or trapped) penis, Higuchi et al.10 highlight the role obesity plays in the formation of a prominent escutcheon that can descend and encroach on the penis, creating conditions that predispose to infection, irritation and scarring and genital lichen sclerosus. Similarly, recurrent GLSc has been described in men previously circumcised for LSc when residual skin folds remain secondary to obesity; in these patients, the skin on the shaft of the penis can move forward and cause a pseudoforeskin as the penis becomes ‘buried’ in the suprapubic fat pad. In our specialty clinics, men who have been circumcised and subsequently develop GLSc are a minority. However, of those men, almost all are overweight or obese. Subjective notation regarding increased body habitus, increased body mass index or presence of pannus/abdominal/suprapubic fat pad was present for all patients. A concealed penis was present in sixteen (84%) of patients. Πρόσφατα, ένας κύριος με σκληροατροφικός λειχήνα πέους μου ανέφερε ότι όταν ήταν στο φυσιολογικό του βάρος, δεν υπήρχε η εκδήλωση της νόσου. Θυμόμουν ότι υπήρχε κάποια συσχέτιση ανάμεσα στο περιττό βάρος και την ανάτπυξη - επιδείνωση της νόσου, αλλά αποφάσισα να κοιτάξω διεξοδικά την επιστημονική βιβλιογραφία. Πράγματι, τα ευρήματα έδειξαν ότι το περιττό βάρος, πόσο μάλλον η παχυσαρκία, αποτελούν προδιαθεσικό παράγοντα για την εκδήλωση του σκληροατροφικού λειχήνα πέους. Ως εκ τούτου, η απώλεια βάρους αξίζει να συστήνεται σε όλους τους άνδρες με σκληροατροφικό λειχήνα πέους, ως συμπληρωματική προσέγγιση για την θεραπεία τους. 16 patients (84%) acknowledged ‘dribbling’ of urine post-micturition. This case series illustrates the increasing clinical problem of obesity-related MGLSc. It adds to the compelling body of evidence that occlusive irritation of a susceptible epithelium by urine is the sine qua non in the pathogenesis of MGLSc Uncircumcised men of any body habitus are at risk of developing GLSc, but growing evidence indicates obesity may predispose men to developing GLSc at higher rates and may also complicate management. Longstanding obesity, or weight gain occurring de novo post-circumcision, can result in the generation of a pseudofore- skin and recreation of the occlusive conditions that sustain dis- ease. Management can be very challenging and centres around the prevention of urinary exposure (barrier emollients), mitigation of inflammation (curative ultrapotent topical steroids under clinical supervision and longer term maintenance low potency topical steroids), specialized urological surgery (e.g. ‘redo’ circumcision), the management of PeIN and the prevention of frank SCC. Early recognition and management must be the goals in order to minimize disease morbidity and mortality. Hide this page from search engines. Doiron PR, Bunker CB. Obesity-related male genital lichen sclerosus. J Eur Acad Dermatol Venereol. 2017 May;31(5):876-879. doi: 10.1111/jdv.14035. Epub 2016 Nov 28. PMID: 27891728. https://pubmed.ncbi.nlm.nih.gov/27891728/ https://sci-hub.st/10.1111/jdv.14035 https://www.google.com/search?client=firefox-b-d&q=lichen+obesity https://pubmed.ncbi.nlm.nih.gov/?term=lichen+obesity&size=200 |
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Μελέτη σε 70 ανθρώπους με ομαλό λειχήνα έδειξε υψηλή συχνότητα κεντρικής παχυσαρκίας (γυναίκες: 86,5% + άνδρες: 27,3%)
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