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Why is it important to publish cases with unusual findings?


Dr. Mona Abdel-Halim

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We all know that LSEA commonly affects the vulva but we have been taught that it does not affect the vagina. I came across an interesting article in The JAMA Dermatol* issue of October 2013 about two cases of vulvar LSEA involving the vagina and this was confirmed by finding typical features of LSEA in vaginal biopsies.

It appears that may be we are underestimating vaginal involvement in LSEA, maybe it is present while we do not know as we have been taught that it does not affect the vagina? Maybe we have neglected vaginal symptoms in such ladies and attributed it to age related atrophy when it was actually due to LSEA?? Does it have increased risk of carcinoma??

This raised my attention to the great importance of publishing any new findings, new associations or atypical presentations of skin diseases. It is through these publications that knowledge expands and changes over years as well as our understanding of the pathogenesis of various skin diseases. I think this is one of doctors' missions to contribute to the progress of medical knowledge by documenting and reporting all what they see that is not written in text books.. It will be written in newer editions!!!!!


[center]*Lichen sclerosus with vaginal involvement: Report of two cases and review of the literature.[/center]
[center]Kate Zendell and Libby Edwards[/center]
[center]JAMA Dermatol, 2013; 149(10): 1199-1202.[/center]
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I think this is a misconception that LS does not affect the vagina. [url="http://www.ncbi.nlm.nih.gov/pubmed/20534086"]We have recently reported involvement of the lips and oral mucosa[/url]. LP effects the oral mucosa and vagina. So see no reason why LS cannot. I did not realise that it is 'taught' that LS does not involve the vagina. I was certainly not taught that and I always presumed that vaginal involvement is part of the spectrum.

Glad that folk are trying to quash this misconception!
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Mark A. Hurt MD

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The observations of individual cases have [i][u]enormous[/u][/i] impact on the thinking about the natural history of diseases. They, in essence, fill in the blanks of the suspected spectrum of findings, and sometimes they surprise all of us.
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