Harriet Kennedy

BACKGROUND: Erosive vulvovaginal lichen planus (EVLP) is a chronic, painful dermatosis affecting mucocutaneous sites. Clinicopathological diagnostic criteria have been described on the basis of expert consensus. The aim of this study was to review the presentation of EVLP, particularly assessing the frequency of suggested diagnostic criteria. METHODS: Clinical signs, symptoms and histological features of women with a clinical diagnosis of EVLP were identified from clinical records and photographs. RESULTS: In all, 72 women with an average age of 67 years were included. Pain or burning were documented in 66/72 cases (92%) and itch in 36 (50%). Clinical images showed well-demarcated red shiny areas or erosions at the vaginal introitus (96%), scarring with loss of normal architecture (88%) and hyperkeratotic border and Wickham striae (46%). A total of 27 women had mucosal disease at another site (38%) and 24 had vaginal involvement (33%). Vulval histology was available for 45/72 cases (63%). The most prevalent histological finding was a band of inflammation with predominant lymphocytes (35/72, 49%). Overall, 97% of cases had at least three of nine suggested diagnostic criteria. CONCLUSIONS: The most frequent findings in women with EVLP were symptoms of pain or burning, well-demarcated red shiny areas or erosions at the introitus and scarring with loss of architecture. Our findings support the recently described diagnostic criteria for EVLP.

Most states have established water quality standards for r creational waters based on the coliform index,1 even though there is no conclusive evidence of a correlation between coliform levels in recreational waters and the incidence of illness in populations bathing therein.2'3 The absence of conclusive evidence could be real in that there may be little if any hazard of enteric infection to bathers even when the recreational waters used are grossly polluted with fecal wastes. Moore et al^ concluded that, in the absence of gross contamination with visible fecal ma terial, there is a negligible health hazard associated with bathing in wastewater polluted marine waters. Stevenson5 did observe two instances that suggested a cor relation between gastrointestinal disease and coliform densities in freshwaters used for bathing. He noted that the evidence was far from conclusive, however. It is the present authors' view that there are measurable health hazards associated with swimming in waters polluted with fecal wastes but that limitations in the design of previous studies have precluded detection of these hazards. For example, in none of the previous studies, including those of Stevenson,5 was swimming or bath ing defined so that the incidence of illness was measured in the population actually, at risk, that is, individuals with significant exposure of their upper body orifices to the water. Furthermore, many workers have questioned the validity of total coliform densities as an index of fecal pollution.2'3> 6 Several states use fecal coliform standards; in fact, the proposed National Technical Advisory Council (ntac) standard is based on fecal coliform densities in water.7 There are, however, no data correlating fecal coliform densities to enteric disease

Cutaneous reactions to povidone (PVP)-iodine are widely reported; however, distinction between allergic and irritant reactions can be challenging. Free iodine is responsible for irritant reactions and is released when PVP-iodine is in a liquid state. The aim of this study was to review the clinical presentation and results of patch testing in patients with PVP-iodine contact dermatitis. A systematic review was conducted by searching Pubmed, MEDLINE, and Google Scholar databases for reports of contact dermatitis secondary to PVP-iodine. Data were collated including study design, patient age and gender identity, iodine exposure, skin biopsy findings, and patch test methodology and results. The search revealed 187 reports with 38 eligible studies; 30 case reports/case series and 8 retrospective cohort studies. Overall, there were 223 patients with PVP-iodine contact dermatitis. The commonest reaction was irritant contact dermatitis (51%), followed by allergic contact dermatitis (40%) and contact dermatitis not further specified (9%). Irritant reactions were characterised by burn-like morphology and, when due to surgical skin disinfectant, were often distant from the surgical incision site. Patch testing was most often performed with a 10% PVP-iodine aqueous solution; however, irritant reactions in controls occur. Various testing methods including iodine in petrolatum, ethanol, dried powder, and open application testing were described. Most reactions to PVP-iodine are irritant and patch testing using a closed-chamber method yields inconsistent results due to risk of irritation from free iodine release over the 2-day occlusion time. Surgeons should be aware of the risk of prolonged skin contact with wet iodine solution.

BACKGROUND: A potential link between isotretinoin and sexual dysfunction has been reported in various studies. However, such an association has not been explored within the context of a literature review until now. OBJECTIVES: To evaluate the methodology and quality of studies investigating this association, and to examine the definitions of sexual dysfunction used. METHODS: A scoping review approach was used to identify peer-reviewed research articles. The search terms used were 'isotretinoin', 'sexual dysfunction', 'erectile dysfunction', 'ejaculatory disorders', 'decreased libido', 'female sexual interest', 'female arousal disorder', 'libido', 'pelvic pain', 'dyspareunia', 'orgasmic disorder', 'impotence', 'ovaries', 'fertility' and 'menstrual irregularity'. RESULTS: In total, 55 peer-reviewed manuscripts were included, consisting of 8 animal studies and 46 human studies with 2420 patients. Of the studies in humans, there were 18 case reports or case series, 2 case-control studies, 4 cross-sectional studies, 6 longitudinal studies, 3 pharmacovigilance reports and 13 cohort studies. The most frequently observed dose range of isotretinoin was 0.5-1.0 mg kg-1 per day, usually for a duration of 1-6 months. More than half of the studies (54%, n = 25) reported a beneficial or neutral effect of isotretinoin on sexual function. The majority of studies (89%, n = 41) were categorized as Oxford Evidenced-Based Medicine level 4. CONCLUSIONS: This scoping review revealed very weak evidence supporting a link between isotretinoin and sexual dysfunction. Notably, the diverse definitions of sexual dysfunction pose a significant challenge for comparative analysis. The authors advocate for a standardized definition of sexual dysfunction and a framework for determining causality in order to contribute to a more comprehensive understanding of the relationship between isotretinoin and sexual dysfunction.