Effectiveness of photodynamic therapy in the treatment of lichen sclerosus: cell changes in immunohistochemistry.
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.
Olejek
Anita
A
Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland. bytomobstgyn@sum.edu.pl
Kozak-Darmas
Iwona
I
Kellas-Sleczka
Sylwia
S
Steplewska
Katarzyna
K
Biniszkiewicz
Tomasz
T
Birkner
Beata
B
Jarek
Anna
A
Nowak
Leszek
L
Stencel-Gabriel
Krystyna
K
Sieron
Aleksander
A
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
D018952:Antigens, CD34; D017252:CD3 Complex; C497483:CD44 protein, human; D018960:Hyaluronan Receptors; D019394:Ki-67 Antigen; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid