Peripheral xerotica Balance

Peripheral xerotica Balance Lichen sclera is a chronic inflammatory dermatosis, sclerosing, progressive, etiology unclear. Most cases of lichen scleral involve the genitals. In men, genital damage is known as the balance xerotica Peripheral or penile lichen sclera.
Penis changes are insignificant debut. While these include changes in color and texture. These include itching, dysuria, painful erections, with or without urethritis debacluri. The penis shows phimosis and paraphimosis. The etiology of the disease is unknown but believed to be multifactorial. The following factors are incriminated: circumcision after 13 years, hormonal factors, autoimmune diseases, genetic factors and human papilloma virus present.
Effective treatment has not been discovered yet. Some therapies with varying degrees of success have been tested: topical or intralesional steroids, tacrolimus, testosterone topical etretinat, carbon dioxide laser. And surgical methods are used for signs and symptoms of urethral stenosis or malignant change. As the disease progresses retrograde retention of urine occurs with impaired renal parenchyma. Erectile painful intercourse life limiting. Neoplasms have been reported and lesions that develop in the penis. Lichen sclera of the penis is chronic and progressive regression or improvement of the affected areas is unusual.
Pathogenesis and causes
The etiology of penile lichen sclera is unknown but is believed to be multifactorial. The occurrence of several factors contributing balanitei xerotice obstructive disease:
Circumcision after 13 years / uncircumcised status. The involvement of this factor may be due to the effect known as the Koebner or isomorphic phenomenon. What ami large majority of male genitalia inflammatory dermatoses, including lichen sclera occur in uncircumcised men, or belated circumscribed. The foreskin may promote chronic irritation or serves to maintain a favorable environment for infectious agents. Such chronic infection may initiate changes seen in lichen sclera.
Hormonal factors. Hormonal influences in the development of lichen have been incriminated much sclera, especially in the form of vulvar female. Most studies have focused on the role of testosterone in the pathogenesis of penile lesions. Vulvar lichen sclera in children resolves pubertal onset of menarche and increasing testosterone in genital skin. In addition, adults were evaluated for low levels of testosterone, androstenedione and dihidrostestosteron comparable to control subjects. Defect can be the altered function of 5-alpha reductase.
Autoimmune diseases. Many autoantibodies, including antinuclear, antimicrosomali thyroid, gastric parietal anticelule, anticortex adrenal, smooth and antimitochondrial antimuschi were detected in patients with lichen sclera. Vitiligo, thyroid disease, diabetes and alopecia areata have been reported frequently with lichen sclera.
Genetics. Lichen sclera has been reported in families, including twins, siblings, mothers and daughters and brother and sister. However it has not been identified yet heredity.
The human papilloma virus. This virus has been reported it in some cases of penile lichen sclera. If lichen is secondary infection, or it promotes the appearance is still a fact not disputed.
Signs and symptoms
Peripheral xerotica Balance is more common in middle-aged men. Early in the disease, penile lichen sclera is relatively asymptomatic with only a few noticeable changes. Later symptoms are more obvious with the passage of years, equipment and changes color and texture. Early symptoms are more prevalent in uncircumcised patients.
The clinical picture includes: -Itching, burning, dysuria Glans penis, hypoesthesia Painful erections, impaired sexual function Strength-reducing urinary bladder and jet size Debacluri-with or without urethritis.
Symptoms of late stage Peripheral xerotica balanitei include: Phimosis-unable-to decalota glans Paraphimosis-unable-to recalota glans. Development of squamous cell carcinoma in individuals with multifocal scleral and atrophic lichen of the penis and infection with hepatitis C were reported.
Physical examination. Lichen sclera shows only subtle physical changes in the initial phase, nonspecific erythema, mild hypopigmentation. As the condition progresses, multiple erythematous papules appear discreet or patches that merge intro or splash plate or purple-white ivories. The lesions affect mainly the glans and foreskin. Frenulum, urethral meatus, fossa naviculara, sheath of penis and perianal area may be involved. A sclerotic white ring in place at this stage the foreskin is diagnostic. Erosion, cracks, spots, bubbles and sero-haemorrhagic teleangiectaziile gland are reported, although unusual.
With progression of the disease may become adherent to the glans foreskin. Coronary groove and sclerotic frenulum may be destroyed. Urinary meatus may be al until urinary retention. Urinary retention can be severe to cause retrograde ureterohidronefroza. Significant collapse of the urinary meatus may lead to retrograde urethral blockage. Phimosis and paraphimosis in uncircumcised patients may occur in the late stage.
Diagnosis
Histological examination. Sclera genital lichen histological elements are similar to those of nongenitale form. These include ortokeratoza, hyperkeratosis with follicular plugs, stoppers without hyperkeratosis, atrophy of the malpighian layer, hydropic degeneration of basal and splicing dermoepidermica dressed. Follicular plugs are not apparent in affected mucosa. Note the significant edema and homogenization of dermal collagen in the upper dermis with dilated blood and lymph vessels and loss of elastic fibers. The inflammatory infiltrate includes lymphocytes, plasma cells, histiocite in the middle dermis, it is less pronounced in advanced lesions. The differential diagnosis is made with the following conditions: Balan circumscribed plasmacytoma, mucosal candidiasis,'s eritroplazia Queyrat, lichen planus, psoriasis boards, phimosis, Balan.
Treatment
There is no specific treatment to deliver on all patients. Mode with intramuscular penicillin has proven benefits meet studio, improved sensitivity, itching and inflammatory changes in three weeks. Therapy for patients is more aggressive circumscribed. The following regimens have shown benefit in varying degrees: intrelezionali and topical steroids, tacrolimus, testosterone topical etretinat and carbon dioxide laser.
Surgical therapy. Therapeutic benefits of circumcision uncircumcised patients. The surgical intervention for urinary obstruction. The practice of oral mucous membrane uretroplastia.
Prognosis As the disease progresses, urinary retention occurs with retrograde kidney disease. Erectile are painful and can affect sex. Neoplasms may arise from penile lesions, rarely. Signs and symptoms include the appearance of a nodule malignant transformation, proliferation, ulceration, veziculizare, hematuria, erythema, pain, debacluri purulent lymphadenopathy. Peripheral xerotica Balance is a chronic and progressive. Regression or improvement of atrophic areas is unusual.