Real-life experience of managing vulval erosive lichen planus: a case-based review and UK multicentre case note audit

被引：39

作者：

Simpson, R. C. ^{[1
]}

Littlewood, S. M. ^{[2
]}

Cooper, S. M. ^{[3
]}

Cruickshank, M. E. ^{[4
]}

Green, C. M. ^{[5
]}

Derrick, E. ^{[6
]}

Yell, J. ^{[7
]}

Chiang, N. ^{[7
]}

Bell, H. ^{[8
,9
]}

Owen, C. ^{[10
]}

Javed, A. ^{[10
]}

Wilson, C. L. ^{[11
]}

McLelland, J. ^{[12
]}

Murphy, R. ^{[2
]}

机构：

[1] Univ Nottingham, Ctr Evidence Based Dermatol, Nottingham NG7 2NR, England

[2] Univ Nottingham Hosp, Dept Dermatol, Nottingham NG7 2UH, England

[3] Oxford Univ Hosp NHS Trust, Churchill Hosp, Dept Dermatol, Oxford, England

[4] Univ Aberdeen, Dept Obstet & Gynaecol, Aberdeen, Scotland

[5] NHS Tayside, Ninewells Hosp, Dept Dermatol, Dundee, Scotland

[6] Brighton & Sussex Univ Hosp, Dept Dermatol, Brighton, E Sussex, England

[7] Salford Royal NHS Fdn Trust, Dept Dermatol, Manchester, Lancs, England

[8] Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Dermatol, Liverpool, Merseyside, England

[9] Liverpool Womens NHS Fdn Trust, Liverpool, Merseyside, England

[10] E Lancashire Hosp NHS Trust, Royal Blackburn Hosp, Dept Dermatol, Blackburn, Lancs, England

[11] Leeds Teaching Hosp NHS Trust, Dept Dermatol, Leeds, W Yorkshire, England

[12] Newcastle upon Tyne Hosp NHS Trust, Royal Victoria Infirm, Dept Dermatol, Newcastle Upon Tyne, Tyne & Wear, England

来源：

BRITISH JOURNAL OF DERMATOLOGY | 2012年 / 167卷 / 01期

基金：

美国国家卫生研究院;

关键词：

QUALITY-OF-LIFE; INVOLVEMENT; CARCINOMA;

D O I：

10.1111/j.1365-2133.2012.10919.x

中图分类号：

R75 [皮肤病学与性病学];

学科分类号：

100206 ;

摘要：

Background There is a lack of published evidence for treatment and outcome measures for vulval erosive lichen planus (ELPV). Objectives To conduct a multicentre case note review to examine real-life management of ELPV comparing current U. K. practice against an agreed audit standard. Methods Criteria for standards of care for which to evaluate current service provision were set following communication with experts from the British Society for the Study of Vulval Disease. Participants from 10 U. K. centres included nine dermatologists and one gynaecologist who run specialist vulval clinics. Standards examined the documentation of disease severity/impact measures, the use of diagnostic biopsies, treatments used and assessment of treatment response. Results Audit data were collected from 172 patients. Documentation of symptoms/clinical findings was excellent (99%, 170/172). A schematic diagram was present in the notes of 87% (150/172). Patient-related disease impact measures including Dermatology Life Quality Index (3%, 6/172) or visual analogue scales (1%, 2/172) were less well documented. Biopsies were performed in 78% (135/172); 71% (96/135) showed histological features consistent with erosive lichen planus. Squamous cell carcinoma developed in four patients (two vulval, two oral) and vulval intraepithelial neoplasia in two further patients. Recommended first-line treatment with a very potent topical steroid was used in 75% (129/172) with improvement in 66% (85/129). Significant variation in second-line therapy was seen. Conclusions Wide variation in U. K. practice demonstrates the absence of standardized guidance for treating ELPV and the need for vulval-specific outcomes. This audit should act as a framework towards improving ELPV management and to plan future research in this area.

引用

页码：85 / 91

页数：7