Medication-Induced Lichen Sclerosus: A Systematic Review

Samar Alyousef, Lama Alqahtani, Asem Shadid, Mohammed Almashali
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Abstract

Background

Lichen sclerosus (LS) is an inflammatory skin disease that predominantly affects the anogenital region, although it can occasionally present in extragenital areas. The precise etiology of LS remains uncertain; however, recent studies suggest that certain medications may contribute to its onset or exacerbate its progression. This systematic review and meta-analysis aims to evaluate the association between specific medications and the development of LS.

Methods

A comprehensive search of multiple databases identified 16 publications that met the inclusion criteria. These studies, primarily comprising case reports and case series, revealed a significant correlation between LS and immune checkpoint inhibitors (ICIs), such as nivolumab and pembrolizumab, as well as hormonal therapies, including anti-androgenic oral contraceptives and aromatase inhibitors.

Results

The findings suggest that these medications may disrupt immune tolerance or hormonal homeostasis, thereby contributing to the pathogenesis of LS. The analysis highlights the challenges in managing medication-induced LS, particularly in patients who cannot discontinue the implicated drug due to underlying conditions such as cancer or chronic illnesses.

Conclusion

Despite offering valuable insights into the potential risks of specific medications, the study's limitations—including reliance on small case studies and data heterogeneity—underscore the need for further research. Larger observational studies and randomized controlled trials are essential to validate these associations and inform targeted prevention and treatment strategies. Clinicians should remain vigilant for signs of LS in patients undergoing treatment with these medications to facilitate early diagnosis and intervention.

药物性地衣硬化:系统综述
背景:硬化地衣(LS)是一种炎症性皮肤病,主要影响肛门生殖器区域,尽管它偶尔会出现在生殖器外区域。LS的确切病因尚不清楚;然而,最近的研究表明,某些药物可能有助于其发病或加剧其进展。本系统综述和荟萃分析旨在评估特定药物与LS发展之间的关系。方法对多个数据库进行综合检索,筛选出符合纳入标准的文献16篇。这些研究主要包括病例报告和病例系列,揭示了LS与免疫检查点抑制剂(ICIs)之间的显著相关性,如纳沃单抗和派姆单抗,以及激素疗法,包括抗雄激素口服避孕药和芳香酶抑制剂。结果这些药物可能破坏免疫耐受或激素稳态,从而参与了LS的发病机制。该分析强调了管理药物引起的LS的挑战,特别是对于由于癌症或慢性疾病等潜在疾病而无法停止相关药物的患者。尽管对特定药物的潜在风险提供了有价值的见解,但该研究的局限性——包括依赖于小案例研究和数据异质性——强调了进一步研究的必要性。更大规模的观察性研究和随机对照试验对于验证这些关联并为有针对性的预防和治疗策略提供信息至关重要。临床医生应该对接受这些药物治疗的患者的LS症状保持警惕,以促进早期诊断和干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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