ResearchPad - Dermatology https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients]]> https://www.researchpad.co/article/elastic_article_12540 Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients’ perception of skin disease.MethodsA mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome.ResultsOut of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days’ wages of a labourer).ConclusionSteroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek ‘quick fixes’ from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and prescription of irrational TS combinations. ]]> <![CDATA[Lamotrigine-induced DRESS Syndrome Manifesting as ‘Eosinophilic Colitis’: An Uncommon Presentation of a Very Uncommon Condition]]> https://www.researchpad.co/article/elastic_article_11584 Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug-induced hypersensitivity reaction that manifests with a variety of signs and symptoms. It is an important condition that must be recognized by all physicians because if untreated, it can be fatal. There are a variety of medications that are responsible for this condition. The liver, lungs, and kidneys are commonly affected, with the involvement of the gastrointestinal tract being very rare; only a few cases are reported worldwide. We are presenting a case of lamotrigine-induced DRESS syndrome manifesting as colitis. A 32-year-old female presented with diarrhea, two weeks after the initiation of lamotrigine. Her condition worsened with the development of a generalized rash and bloody diarrhea. Further investigations revealed that she likely had a drug reaction secondary to lamotrigine. Fortunately, prompt initiation of systemic steroids led to the resolution of her symptoms.

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<![CDATA[Interdigital Tinea Nigra]]> https://www.researchpad.co/article/elastic_article_11580 Tinea nigra is an uncommon superficial dermatomycosis precipitated by Hortaea werneckii, a halophilic and halothermic yeast-like fungus capable of producing a melanin-like substance. This pathogen infiltrates the stratum corneum in the setting of microtrauma and produces an asymptomatic brown to black macule or patch that appears similarly to melanocytic nevi or melanoma. We present a case of a 52-year-old woman who presented to clinic several months after developing a painless, nonpruritic dark brown patch in her left foot inside the fourth toe web. The coloration and location of this lesion would typically prompt biopsy; however, Wood’s lamp examination and potassium hydroxide (KOH) preparation were pursued first and demonstrated evidence of infection by H. werneckii. The patient was treated with topical clotrimazole cream and miconazole powder for one month, and her lesions cleared completely. Her lesions did not recur at her three-month follow-up appointment.

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<![CDATA[Tinea Corporis-associated Erythroderma: Case Report and Review of Erythrodermic Patients with Chronic Dermatophyte Infection]]> https://www.researchpad.co/article/elastic_article_11572 Erythroderma presents as generalized skin redness. The features of a 39-year-old man who presented with erythroderma are described. His skin biopsy revealed hyphae in the stratum corneum, which established the diagnosis of tinea corporis. His erythroderma resolved following treatment with an oral antifungal agent. Several conditions can be associated with erythroderma. Common etiologies for erythroderma include medications, neoplasms, and papulosquamous disorders. Superficial dermatophyte-associated erythroderma is rare. However, although erythroderma caused by generalized superficial mycosis is infrequently encountered, tinea corporis should be included in the new-onset or chronic erythroderma. The detection of fungal hyphae in the stratum corneum of a biopsy of the erythrodermic skin can not only establish dermatophyte infection as the underlying cause of the individual’s erythroderma but also an alternative cause of erythroderma. 

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<![CDATA[A Rare Clinical Presentation of Metastatic Crohn’s Disease]]> https://www.researchpad.co/article/elastic_article_10693 A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn’s disease. Metastatic Crohn’s disease is a rare cutaneous manifestation of Crohn’s disease characterized by non-caseating granulomas in regions non-contiguous with the gastrointestinal tract. At the time of diagnosis, our patient reported no gastrointestinal symptoms aside from occasional blood-streaked stools from hemorrhoids. This case demonstrates the importance of considering the disease when a patient presents with intertriginous or genital lesions, even in the absence of systemic manifestations.

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<![CDATA[Clinical Psoriasiform Dermatitis Following Dupilumab Use for Autoeczematization Secondary to Chronic Stasis Dermatitis]]> https://www.researchpad.co/article/elastic_article_10510 T helper 2 (Th2) and T helper 1 (Th1) mediated immune processes lie on a spectrum. Autoeczematization secondary to chronic stasis dermatitis may fall on the Th2 side of the spectrum due to skin stretch and chronic barrier dysfunction, supporting a primary Th2 response to self-antigen. In our patient, we posited that dupilumab would benefit autoeczematization secondary to chronic stasis dermatitis given its efficacy in atopic dermatitis, a Th2-mediated immune process. We report a case of clinical psoriasiform dermatitis, suggesting a shift toward a Th1-mediated immune process developing during dupilumab treatment for autoeczematization secondary to chronic stasis dermatitis.

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<![CDATA[Out of the Blue: A Case of Blue Subungual Discoloration Associated with Prolonged Tetracycline Use]]> https://www.researchpad.co/article/elastic_article_10504 Tetracycline derivatives are antibiotics such as minocycline and doxycycline that have been commonly utilized for inflammatory dermatological conditions such as acne and rosacea. Hyperpigmentation of the skin, nails, thyroid, oral mucosa, teeth, and bones is a known but rare side effect of prolonged tetracycline use. The hyperpigmentation typically takes months to years to develop. There may also be residual changes to the skin after discontinuation of the medication. For this reason, the time tetracyclines are used should be minimized and patients should be monitored for the skin findings. Subungual discoloration carries a broad differential including infectious, inflammatory, metabolic, malignant or systemic diseases. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration. We report on a case of a patient who has been on long-term minocycline use for adult acne management. He was initially on minocycline for six years, but due to minocycline-induced hyperpigmentation of his ears and fingernails, he had switched to doxycycline. One year later, the skin hyperpigmentation of the ears regressed; however, the blue subungual hyperpigmentation of his hands progressively become more prominent without any other significant symptoms. 

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<![CDATA[Discoid Lupus Erythematosus Lesions Associated with Systemic Fluorouracil Agents: A Case Report and Review]]> https://www.researchpad.co/article/elastic_article_10497 Systemic fluorouracil agents include not only 5-fluorouracil (5FU), but also capecitabine, tegafur, and uracil/tegafur (UFT). Systemic lupus erythematosus (SLE), subacute cutaneous lupus erythematosus (SCLE), and discoid lupus erythematosus (DLE) are subtypes of lupus erythematosus; drug-induced lupus erythematosus can also present in each of these subtypes. This report describes the case of a 65-year-old woman with systemic 5FU-induced DLE. Fluorouracil agent-induced DLE lesions occurring after initiating treatment with either systemic 5FU or its prodrugs have been described in 19 individuals (Including the woman in this report) in the literature: tegafur (10 patients), UFT (six patients), systemic 5FU (two patients), and capecitabine (one patient). The mean duration before the appearance of the DLE lesions on sun-exposed areas was 232 days after beginning the fluorouracil agent; however, the much earlier (three weeks) appearance of the DLE lesions after starting systemic 5FU in the women described in this report may have occurred since there was no delay associated with the conversion of a precursor drug to 5FU. Within two months (mean: 36 days) after stopping the fluorouracil agent, the DLE lesions resolved in 95% of the patients. Laboratory studies were only performed on some of the patients. None of the patients tested had antibodies to Ro/Sjogren’s syndrome A (Ro/SSA) and La/Sjogren’s syndrome B (La/SSB). The antinuclear antibody (ANA) titer was elevated in 71% of the tested individuals and decreased in all of the patients who were evaluated after the causative drug was discontinued. The pathogenesis for fluorouracil agent drug-induced DLE remains to be definitively established.

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<![CDATA[Readmission Risk Factors and Complications in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis]]> https://www.researchpad.co/article/elastic_article_9460 Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous hypersensitivity reactions that cause necrosis of the epidermis, often at multiple sites. This process is frequently caused by medications and is associated with significant complications and mortality during hospitalization. However, increasing attention has been drawn to the less studied area of post-hospitalization complications leading to multiple readmissions. We present a patient diagnosed with trimethoprim-sulfamethoxazole induced SJS/TEN, who was readmitted within one week with sepsis. We also discuss the readmission risk factors and post-hospitalization features and complications of SJS/TEN.

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<![CDATA[Elevated C-reactive Protein and Role of Steroids in Cocaine-associated Levamisole-induced Vasculitis]]> https://www.researchpad.co/article/elastic_article_9459 Levamisole is a common contaminant in cocaine and has led to the emergence of an entity known as levamisole-induced vasculitis (LIV). There is no consensus on the management of this condition. We describe a patient who presented with acute on chronic LIV who was treated with pulse dose steroids. We aim to discuss the diagnosis and current management options for LIV. We have compared seven case reports that have measured C-reactive protein (CRP) and compared the CRP levels, site involved, dose, and mode of steroid administration. We postulate that elevated CRP may warrant steroid therapy over conservative management and could lead to a possible decreased hospital stay.

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<![CDATA[White Fibrous Papulosis of the Axillae and Neck]]> https://www.researchpad.co/article/elastic_article_9449 Fibroelastolytic papulosis of the neck (FEPN) consists of two disorders: white fibrous papulosis of the neck (WFPN) and pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE). The neck and supraclavicular areas are frequently involved; however, axillary involvement is significantly more rare, especially for white fibrous papulosis. Herein, we present an unusual case of white fibrous papulosis of the axillae, in addition to the neck, in a Caucasian woman.

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<![CDATA[Protocol for a prospective, observational, longitudinal study in paediatric patients with moderate-to-severe atopic dermatitis (PEDISTAD): study objectives, design and methodology]]> https://www.researchpad.co/article/elastic_article_9145 Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with atopic comorbidities and has significant impact on children and their families. There is a lack of robust and longitudinal long-term data on disease characteristics and typical clinical practice with currently available treatments in children with moderate-to-severe AD. Hence, an observational study is needed to evaluate AD characteristics and progression in paediatric patients with moderate-to-severe AD.Methods and analysisPediatric Study in Atopic Dermatitis (PEDISTAD) is a prospective, observational, longitudinal study in paediatric patients with moderate-to-severe AD who are currently receiving systemic or topical treatment and whose disease is not adequately controlled by topical prescription therapies or for whom those therapies are not medically advisable. 1300 children at 100–150 sites in approximately 20 countries worldwide will be enrolled and followed for 5 years. AD therapy is at the discretion of the investigator. Data collected will include: AD disease characteristics and comorbidities; current therapy for AD and initiation of new treatments/changes in current treatment; patient-reported/caregiver-reported outcomes; days missed from school/work for the patient/caregiver; healthcare professional visits; safety and biomarkers.Ethics and disseminationThis study is conducted in accordance with the principles established by the 18th World Medical Assembly and all subsequent amendments and the guidelines for Good Epidemiology Practice. Each individual country assures that ethics approval has been received and local regulatory requirements are met. Ethics approval has been obtained in all countries currently participating in PEDISTAD. Study data will be disseminated in manuscripts submitted to peer-reviewed medical journals as well as in abstracts submitted to congresses and in the resulting posters and presentations.Trial registration number NCT03687359; pre-results. ]]> <![CDATA[Depigmenting potential of lichen extracts evaluated by in vitro and in vivo tests]]> https://www.researchpad.co/article/elastic_article_8410 Melanin is the main pigment of human skin, playing the primary role of protection from ultraviolet radiation. Alteration of the melanin production may lead to hyperpigmentation diseases, with both aesthetic and health consequences. Thus, suppressors of melanogenesis are considered useful tools for medical and cosmetic treatments. A great interest is focused on natural sources, aimed at finding safe and quantitatively available depigmenting substances. Lichens are thought to be possible sources of this kind of compounds, as the occurrence of many phenolic molecules suggests possible effects on phenolase enzymes involved in melanin synthesis, like tyrosinase. In this work, we used four lichen species, Cetraria islandica Ach., Flavoparmelia caperata Hale, Letharia vulpina (L.) Hue, and Parmotrema perlatum (Hudson) M. Choisy, to obtain extracts in solvents of increasing polarity, viz. chloroform, chloroform-methanol, methanol, and water. Cell-free, tyrosinase inhibition experiments showed highest inhibition for L. vulpina methanol extract, followed by C. islandica chloroform-methanol one. Comparable results for depigmenting activities were observed by means of in vitro and in vivo systems, such as MeWo melanoma cells and zebrafish larvae. Our study provides first evidence of depigmenting effects of lichen extracts, from tyrosinase inhibition to cell and in vivo models, suggesting that L. vulpina and C. islandica extracts deserve to be further studied for developing skin-whitening products.

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<![CDATA[Novel interpenetrating polymer network provides significant and long‐lasting improvements in hydration to the skin from different body areas]]> https://www.researchpad.co/article/elastic_article_6912 Hydration and moisturization both impact skin quality, directly reflecting its appearance. Signs and onset of dehydration‐related skin aging are region‐specific and require tailored treatment to be effective.AimsTo test the hydrating effects of formulas containing a novel 3‐dimensional 3‐polymer interpenetrating network (3D3P‐IPN) to deliver humectants and actives to specific body sites.MethodsTwo clinical studies were conducted focused on the skin under eyes and body (arms/legs). Healthy women ages 25‐65 (eyes) or 35‐65 (body) with mild to moderate dry and aged skin were enrolled. Study product containing the 3D3P‐IPN and tailored actives was applied twice daily for 8 weeks on the periorbital area and for 4 weeks on the body. Changes in skin attributes were measured by biophysical instrumentation for hydration, dark circles, skin color, elasticity and transepidermal water loss, and by clinical grading and subject self‐assessment.ResultsSignificant improvements in hydration and skin smoothing were demonstrated in both studies. In the periorbital region, actives and humectants delivered by the 3D3P‐IPN also led to significant improvements in dark circles, fine lines/crow's feet, puffiness, restoring radiance, and overall younger‐looking appearance. On the arms and legs, there were significant reductions in crepiness and dullness. The arms and legs also had improvements in tactile and visual skin texture, radiance, and general healthy look. Improvements were immediate and persisted through the end of both studies.ConclusionThe 3D3P‐IPN provides immediate and long‐lasting improvements in skin hydration and overall healthy appearance regardless of the targeted application site. ]]> <![CDATA[Cutaneous Pseudolymphoma As a Rare Adverse Effect of Medicinal Leech Therapy: A Case Report and Review of the Literature]]> https://www.researchpad.co/article/N299a5340-b7cd-494b-b5fd-4f5f0b095fc4 Hirudotherapy (leech therapy) is one of the oldest practices in medical history, and nowadays it is used for several purposes in medicine. Salvage of flaps, wound healing, pain management, and treatment of varicose veins are among the common therapeutic applications of leeches. Complications associated with leech therapy include infections, bleeding, anemia, and allergic reaction. Cutaneous pseudolymphoma (benign proliferation of lymphoid cells in the skin) follows several underlying conditions. Although persistent arthropod bite reaction is one of the conditions associated with cutaneous pseudolymphoma, it has been rarely reported after medicinal leech therapy. Here we describe the case of a patient who presented with cutaneous pseudolymphoma after leech therapy as a rare cutaneous complication of hirudotherapy.

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<![CDATA[Tumid Lupus Erythematosus and Systemic Lupus Erythematosus: A Report on Their Rare Coexistence]]> https://www.researchpad.co/article/Nd4eda7bd-9eaa-460e-a826-5fd6fe3e6c97 Tumid lupus erythematosus (TLE) is a rare variant of cutaneous lupus erythematosus. Clinically, it lacks typical changes found in discoid lupus and antinuclear antibodies (ANA) levels are elevated in only 10% of the patients. Coexistent systemic lupus erythematosus (SLE) has been reported to be rare, and literature shows only a few case reports. We present a case of coexistent tumid lupus and SLE. We present a case of a 48-year-old Caucasian female who presented with chronic facial rash, photosensitivity, intermittent oral ulcers, joint pain with morning stiffness, and unintentional weight loss. Laboratory studies showed positive ANA at 1:640, elevated erythrocyte sedimentation rate, positive anticardiolipin immunoglobulin (Ig) G, anticardiolipin IgM, and anti-beta-2 glycoprotein IgM. Skin biopsy of the rash showed a superficial and deep dense lymphocytic infiltrate with mucin deposition, histopathology favoring tumid lupus. The patient was diagnosed with TLE with SLE and was started on hydroxychloroquine with improvement in her rash. Ultraviolet light and certain medications have been proven to play a role in the pathogenesis of tumid lupus. It usually responds to photoprotection, topical treatment, or oral antimalarial therapy.

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<![CDATA[Linear crusted papules in an infant]]> https://www.researchpad.co/article/Nda17bc4a-2f7f-4d3a-bfd9-bf9b997cef77 <![CDATA[Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: Management Tips]]> https://www.researchpad.co/article/N2f939939-8cff-4d8a-a82d-4a7d57746646 Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the capacity and resources of health systems worldwide. A therapeutic vaccine is not yet on the rise, and preventive measures are the current approach to restraint the transmission of cases. As the virus is highly contagious via respiratory route (droplets from infected persons, widely spread by coughing or sneezing) and via contact with contaminated surfaces, community transmission and spread can be decreased through the practice of regular and diligent hand hygiene. Frequent hand washing implies a prolonged exposure to water and other chemical or physical agents and may induce several pathophysiologic changes, such as epidermal barrier disruption, impairment of keratinocytes, the subsequent release of proinflammatory cytokines, activation of the skin immune system, and delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as excessive skin dryness or even contact dermatitis (particularly the irritant subtype and, to a lesser extent, the allergic subtype), can occur, especially in individuals with a history of atopic dermatitis. These skin conditions are perfectly manageable, and applying a moisturizer immediately after washing hands or after using a portable hand sanitizer is the cornerstone in preventing the development of eczematous changes in the hands. In the current global context, the potential occurrence of these dermatological adverse events should in no way cause people to deviate from strict hand hygiene rules.

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<![CDATA[Epidermolysis Bullosa: A Case of Successful Total Hip Arthroplasty]]> https://www.researchpad.co/article/Nc11e9593-799f-4a09-8244-ccded50b38e9 Epidermolysis bullosa (EB) is a rare dermatological disease in which patients suffer from skin fragility and blisters. One of the major complications is the development of skin infections, which may preclude surgical intervention. We present a case of a 49-year-old female with a past medical history of EB, who presented to the emergency department (ED) with right groin pain of one-hour duration after falling on her right side. The patient underwent a successful open reduction and internal fixation for her right hip without complications. Over the course of three months after the procedure, she experienced worsening of the pain accompanied by skin necrosis and total collapse of the femoral head. Subsequent total hip replacement surgery was performed using a cementless (Zimmer, Warsaw, IN) prosthesis and fixated via cannulated screws. To decrease the risk of infection, IV cefazolin was given as a prophylactic antibiotic preoperatively. Vancomycin IV and imipenem/cilastatin IV were given for four days postoperatively. We made sure that our patient is experiencing the least possible pain by giving sufficient analgesics after the surgery. We used morphine, paracetamol, and gabapentin for pain control. For 25 days after the surgery, the patient did not complain of any pain. Upon follow-up, sutures were removed, and no surgical wound infection, rashes, or lacerations were noted. We encourage orthopedic surgeons dealing with patients suffering from dermatological conditions with fragile skin such as EB and decreased level of activity that requires total hip arthroplasty to proceed with the surgical intervention after considering adequate infection control to improve quality of life. 

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<![CDATA[Safety and Efficacy of Stromal Vascular Fraction Enriched Fat Grafting Therapy for Vulvar Lichen Sclerosus]]> https://www.researchpad.co/article/N3d37d58f-efae-4113-8d9a-1597bb6fb83c

Background

Lichen sclerosus is an inflammatory dermatosis of unknown etiology which currently has no cure. Most treatment guidelines recommend the use of ultrapotent topical corticosteroids. However, the relapse rate is usually high. Through a retrospective study we evaluated the efficacy and safety of stromal vascular fraction of adipose tissue as therapy for lichen sclerosus.

Material and methods 

For this retrospective review, we obtained data on patients with vulvar lichen sclerosus treated with autologous fat grafting enriched with adipose derived stromal vascular fraction cells. Data collected through a modified vulvo-vaginal symptoms questionnaire were analyzed before treatment, six months and 24 months after treatment. The 19 items questionnaire was subdivided in four categories: symptoms, signs, social functioning and sexual functioning. Global scores and partial scores for each category were analyzed using paired t-test. For all statistical analyses, a value of p ≤ 0.05 was considered statistically significant. All data are presented as mean ± SD.

Results

Thirty nine patients were included in the study. Thirty seven patients (94.87%) experienced a significant decrease in global score at six months and 24 months after treatment (p < 0.05). Decrease in scores were also statistically significant between pretreatment and 24 months after treatment for each of the four questionnaire categories - symptoms, signs, social functioning and sexual functioning (p < 0.05).

Conclusions

This retrospective study showed that the use of autologous fat grafting enriched with adipose derived stromal vascular fraction is safe and leads to significant and long lasting improvement in patients with vulvar lichen sclerosus.

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