A Guide to Screening for Autoimmune Diseases in Patients With Vulvar Lichen Sclerosus

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology Pub Date : 2025-02-14 DOI:10.1111/ajd.14434

Annabel Guttentag, Marlene Wijaya, Gayle O. Fischer, Angela Lee, Ken Liu, Rebecca Bronwyn Saunderson

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Abstract

Background

The aetiology of vulvar lichen sclerosus (VLS) remains unknown. However, there is evidence that in addition to a genetic predisposition, autoimmunity contributes to the pathogenesis.

Objectives

The objective of this study was to determine the prevalence of autoimmune disease and positive autoantibody serology in patients with VLS.

Methods

A VLS database in Sydney, Australia, was retrospectively reviewed. A diagnosis of VLS was required for inclusion in the study. Data collected included demographics, comorbidities including any personal history of autoimmune disease, family history of autoimmune disease, and the results from autoantibody testing. A total of 2243 females with VLS were included in this study.

Results

Autoimmune disease was found in 24.5% and 34.6% of children and adults with VLS, respectively. The most prevalent autoimmune conditions were psoriasis, Hashimoto's thyroiditis, lichen planus, and vitiligo. Antinuclear antibodies were common and found in 31.0% of patients. Thyroid peroxidase and thyroglobulin antibodies were present in 16.1% and 18.9% of cases, respectively. Thyroid function, determined by thyroid stimulating hormone, was abnormal in 8.2% of patients. 5.3% of patients had positive parietal cell antibodies, and 5.9% had low vitamin B12 levels.

Conclusions

This work provides support that VLS is of an autoimmune aetiology, and that there is an association between VLS and autoimmune diseases. The high proportion of patients with an abnormal thyroid test, positive thyroid antibodies, and intrinsic factor and gastric parietal cell antibodies with low vitamin B12 levels, warrants screening for thyroid disease and pernicious anaemia in patients with VLS. Initial autoimmune screening in VLS can be rationalised to TSH, vitamin B12 levels, intrinsic factor and parietal cell antibodies. Thyroid antibodiy testing shouls be performed in hypothyroid patients.

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外阴硬化性地衣患者自身免疫性疾病筛查指南

背景：外阴硬化苔藓（VLS）的病因尚不清楚。然而，有证据表明，除了遗传易感性外，自身免疫也有助于发病。目的：本研究的目的是确定VLS患者自身免疫性疾病的患病率和自身抗体阳性血清学。方法：回顾性分析澳大利亚悉尼的VLS数据库。诊断为VLS是纳入研究的必要条件。收集的数据包括人口统计学、合并症（包括任何自身免疫性疾病的个人病史、自身免疫性疾病的家族史）和自身抗体检测的结果。本研究共纳入2243例女性VLS患者。结果：自身免疫性疾病在儿童和成人VLS患者中分别占24.5%和34.6%。最常见的自身免疫性疾病是牛皮癣、桥本甲状腺炎、扁平苔藓和白癜风。抗核抗体是常见的，在31.0%的患者中发现。甲状腺过氧化物酶和甲状腺球蛋白抗体分别占16.1%和18.9%。8.2%的患者甲状腺功能异常，以促甲状腺激素测定。5.3%的患者壁细胞抗体阳性，5.9%的患者维生素B12水平低。结论：本研究支持VLS是自身免疫性病因，并且VLS与自身免疫性疾病之间存在关联。甲状腺检查异常、甲状腺抗体阳性、维生素B12水平低的内在因子和胃壁细胞抗体患者比例高，值得对VLS患者进行甲状腺疾病和恶性贫血筛查。VLS的初始自身免疫筛查可以合理地考虑TSH、维生素B12水平、内在因子和壁细胞抗体。甲状腺功能减退患者应进行甲状腺抗体检测。

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来源期刊

Australasian Journal of Dermatology 医学-皮肤病学

CiteScore

3.20

自引率

5.00%

发文量

186

审稿时长

6-12 weeks

期刊介绍： Australasian Journal of Dermatology is the official journal of the Australasian College of Dermatologists and the New Zealand Dermatological Society, publishing peer-reviewed, original research articles, reviews and case reports dealing with all aspects of clinical practice and research in dermatology. Clinical presentations, medical and physical therapies and investigations, including dermatopathology and mycology, are covered. Short articles may be published under the headings ‘Signs, Syndromes and Diagnoses’, ‘Dermatopathology Presentation’, ‘Vignettes in Contact Dermatology’, ‘Surgery Corner’ or ‘Letters to the Editor’.