title: Effectiveness of photodynamic therapy in the treatment of lichen sclerosus: cell changes in immunohistochemistry.
abstract: BACKGROUND
  Vulvar lichen sclerosus (LS) affects primarily women at postmenopausal age and its background remains unknown. One of the treatment modalities is photodynamic therapy (PDT). The aim was to investigate the efficacy of PDT in women with LS and the analysis of protein expression before and after PDT.
  
  
  METHODS
  From 04.2006-01.2008 28 women, with LS underwent photodynamic diagnosis and next PDT: six-courses every second week with using 5-aminolevulinic acid (ALA) as a photosensitizer. Punch biopsies were taken before and after treatment and immunohistochemistry was done with Ki67,CD44,CD34 and CD3.
  
  
  RESULTS
  Before PDT all patients suffered from pruritus and after in 89.3% the relief was noted. The histological examination showed that 35.7% patients hadn't LS after therapy completion. Anti-CD44 staining intensities was scored qualitatively - there were no statistical difference at the expression of protein CD44 in the epidermis (p>0.05) before and after therapy. Microvessel density was assessed at the hot spots, marked with anti-CD34. Statistical difference in AVD before and after therapy: (p<0.05). The staining intensity of Ki-67 didn't differ before and after PDT (p>0.05). The expression of CD3 on T lymphocytes showed statistical difference of the lymphocytic infiltration before and after PDT ( p<0.05).
  
  
  CONCLUSIONS
  The immunohistochemical staining in vulvar LS showed increasing microvessel density and decreasing lymphocytic infiltration. There were a clinical, and less histological improvement in patients with LS. We suggest that the photodynamic therapy is an effective, alternative treatment in some but not all patients with LS. Therefore, further studies are needed.
authors.affiliation: Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland. bytomobstgyn@sum.edu.pl
authors.forename: Anita
authors.initials: A
authors.lastname: Olejek
authors.forename: Iwona
authors.initials: I
authors.lastname: Kozak-Darmas
authors.forename: Sylwia
authors.initials: S
authors.lastname: Kellas-Sleczka
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Steplewska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Biniszkiewicz
authors.forename: Beata
authors.initials: B
authors.lastname: Birkner
authors.forename: Anna
authors.initials: A
authors.lastname: Jarek
authors.forename: Leszek
authors.initials: L
authors.lastname: Nowak
authors.forename: Krystyna
authors.initials: K
authors.lastname: Stencel-Gabriel
authors.forename: Aleksander
authors.initials: A
authors.lastname: Sieron
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D018952:Antigens, CD34 / Q000378:metabolism; D001706:Biopsy; D017252:CD3 Complex / Q000378:metabolism; D020405:Dermis / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D004817:Epidermis / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D013601:T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D014844:Vulva / Q000378:metabolism / Q000473:pathology; D014845:Vulvar Diseases / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology
chemical_list: D018952:Antigens, CD34; D017252:CD3 Complex; C497483:CD44 protein, human; D018960:Hyaluronan Receptors; D019394:Ki-67 Antigen; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid