129例女阴硬化性苔藓临床特征分析

Clinical analysis of 129 cases of vulvar lichen sclerosus

目的 分析女阴硬化性苔藓（VLS）的临床特点。方法 收集在北京医院皮肤科就诊的VLS患者临床资料，分析其发病年龄、病程、既往诊治情况、临床合并症、症状、皮损特点等。结果 2016年3月至2017年2月，共收集129例VLS患者。总体发病年龄呈正态分布，峰值为25 ~ 30岁，绝经后发病仅占14.0%（18例）。9.3%（12例）合并自身免疫性疾病，以甲状腺疾病为主。瘙痒为主要症状（122例，94.6%），60%（51例）的VLS患者性生活受影响。最常受累部位为小阴唇（92例，71.3%），极少见单侧大阴唇受累。最常见的皮损改变依次为色素减退（119例，92.2%）、苔藓化（71例，55.0%）和萎缩（52例，40.3%）。有萎缩表现的患者较无萎缩表现的患者病程更长（Z = 3.124，P = 0.002），曾外用过糖皮质激素或钙调神经磷酸酶抑制剂治疗的患者出现萎缩的比例低于未外用者（χ2 = 5.074，P = 0.024）。结论 VLS好发于育龄期女性，而非绝经后女性，以瘙痒和色素减退为基本临床特点，常累及双侧小阴唇，多数影响性生活。

Objective To investigate clinical features of vulvar lichen sclerosus （VLS）. Methods Clinical data were collected from patients with VLS in Department of Dermatology of Beijing Hospital, and analyzed retrospectively with respect to age, duration of disease, medical history, complications, clinical symptoms and signs, and features of skin lesions. Results A total of 129 patients with VLS were enrolled into this study from March 2016 to February 2017. The age of onset in these patients presented a normal distribution, with the highest frequency at the age range of 25 - 30 years. Of the 129 patients, only 18 （14%） developed VLS after menopause, and 12 （9.3%） were complicated by autoimmune diseases, especially thyroid diseases. Pruritus was reported as the main symptom in 122 （94.6%） of the 129 patients, and 51 （60%） reported that their sexual life had been affected. Labia minora was the most commonly involved site in 92 （71.3%）patients, but unilateral labia majus was rarely involved. The most common skin lesion was hypopigmentation （92.2%, 119/129）, followed by lichenification （55.0%, 71/129） and skin atrophy （40.3%, 52/129）. Patients with skin atrophy had significantly longer duration of disease than those without skin atrophy （Z = 3.124, P = 0.002）, and the incidence of skin atrophy was lower in the patients who had been treated with topical glucocorticoids or calcineurin inhibitors than those who had not received these treatment （χ2 = 5.074, P = 0.024）. Conclusions VLS is more common in women of childbearing age than in postmenopausal women, and basically characterized by pruritus and hypopigmentation. VLS commonly involves bilateral labia minora, and usually affects sexual life.