LÍQUEN ESCLEROSO GENITAL : CONHEÇA ESTA PATOLOGIA
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LÍQUEN ESCLEROSO GENITAL ( LE ) É UMA DOENÇA DE ORIGEM MULTIFATORIAL QUE ENVOLVE EM SUA GÊNESE FATORES GENÉTICOS , AMBIENTAIS , HORMONAIS , INFECCIOSOS E IMUNOLÓGICOS . RELATIVAMENTE RARA , ATINGE AMBOS OS SEXOS , EM QUALQUER IDADE E EM QUALQUER ÁREA DO CORPO , SENDO MAIS COMUM NA RAÇA BRANCA. A PROPORÇÃO DE INCIDÊNCIA ENTRE MULHER-HOMEM VARIA DE 10:1 A CERCA DE 1:1.
O LE PODE AFETAR ÁREAS GENITAIS OU NÃO GENITAIS DO HOMEM OU DA MULHER SENDO QUE EM 85 % A 98 % SUA LOCALIZAÇÃO É ANO-GENITAL. ESTUDOS MÉDICOS COM GRANDES GRUPOS DE MULHERES COM LE MOSTRARAM QUE O RISCO DE CÂNCER DE VULVA É DE 4 A 5 % E A ASSOCIAÇÃO DE LE COM CÂNCER DE PÊNIS É INCERTA.
E PORQUE OCORRE A DOENÇA ?
SUA CAUSA AINDA NÃO ESTÁ BEM ESCLARECIDA E NÃO EXISTEM FATORES DE RISCO IDENTIFICADOS ATÉ O MOMENTO. MUITOS MECANISMOS TEM SIDO ESTUDADOS ATUALMENTE E SUGEREM UMA ORIGEM MULTIFATORIAL COMO UMA FORMAÇÃO GENÉTICA , AUTO-IMUNE , HORMONAL E INFECCIOSA. MUITAS TENTATIVAS TEM SIDO FEITAS PARA IDENTIFICAÇÃO DE UM ORGANISMO INFECCIOSO COM FATOR CAUSAL , MAS NADA FORA CONFIRMADO . ALTERAÇÕES HORMONAIS ( PRINCIPALMENTE ALTOS NÍVEIS DE TESTOSTERONA ) ACOMPANHADA DE ALTERAÇÕES ENZIMÁTICAS PODERIAM LEVAR À MUDANÇAS NA PELE DA REGIÃO GENITAL ; O ENVOLVIMENTO DO SISTEMA IMUNE DA PELE ASSOCIADO A DOENÇAS AUTO-IMUNES SUGEREM UM COMPONENTE IMUNOGENÉTICO E A ASSOCIAÇÃO DO LE COM DOENÇAS DA TIREÓIDE , ALOPÉCIA , ANEMIA PERNICIOSA E VITILIGO FORTALECEM A PATOGÊNESE AUTO-IMUNOLÓGICA.
E QUAIS OS SINTOMAS ?
OS SINTOMAS OCORREM EM MAIS DE 82 % DOS CASOS NA REGIÃO ANOGENITAL E EM TORNO DE 18% DOS PACIENTES , O LE É ASSINTOMÁTICO. O PRURIDO ( COCEIRA ) É O SINTOMA MAIS COMUM E COMO CONSEQUÊNCIA DO ATO DE COÇAR PODEM APARECER FISSURAS , RACHADURAS , SANGRAMENTOS , ULCERAÇÕES E INFECÇÕES LOCAIS. ALÉM DO PRURIDO INTENSO , HÁ DOR E IRRITAÇÃO ACOMPANHADO DE LESÕES GENITAIS COM ERITEMA ( VERMELHIDÃO ) , DESCAMAÇÃO E DESPIGMENTAÇÃO DA PELE . NO HOMEM O LE É UM PROCESSO CRÔNICO , ATRÓFICO E ESCLEROSANTE ENVOLVENDO A GLÂNDE DO PÊNIS , SULCO CORONAL , PREPÚCIO , MEATO URETRAL , PODENDO CAUSAR ESTENOSE DO MEATO URETRAL LEVANDO A PROBLEMAS URINÁRIOS ( DOR AO URINAR E / OU OBSTRUÇÃO URINÁRIA ) E SEXUAIS ( DOR DURANTE A EREÇÃO ) . AS LESÕES GERALMENTE APARECEM SEM QUALQUER FATOR PRECIPITANTE . NOS CASOS DE LONGA DURAÇÃO ENCOTRAREMOS ALTERAÇÕES DE COR NA ÁREA AFETADA QUE INCLUEM ASPECTO BRANCO , NACARADO , BRILHANTE E NAS MULHERES COM O PASSAR DO TEMPO, PODE HAVER O SEPULTAMENTO DO CLÍTORIS , RETRAÇÃO DO ORIFÍCIO VAGINAL E ESTENOSE ( FECHAMENTO ) DA ENTRADA VAGINAL .
COMO SABER SE TENHO LE ?
O DIAGNÓSTICO SERÁ FEITO BASEADO NOS SINTOMAS CLÍNICOS ( PRURIDO , ARDOR E DOR PRINCIPALMENTE ) E EXAME FÍSICO E COLPOSCÓPICO DE VULVA , ÂNUS E PÊNIS , PORÉM , FIRMAMOS O DIAGNÓSTICO ATRAVÉS DA BIÓPSIA DA ÁREA GENITAL COMPROMETIDA . A BIÓPSIA É MUITO IMPORTANTE, POIS NOS PERMITE AFASTAR A PRESENÇA DE NEOPLASIAS MALIGNAS E PERMITE O DIAGNÓSTICO CORRETO DO LE GARANTINDO UM TRATAMENTO EFICAZ E MELHOR MANUTENÇÃO DA ARQUITETURA GENITAL . DEVEMOS SEMPRE AFASTAR AS PATOLOGIAS PARECIDAS COM O LE QUE INCLUEM O VITILIGO , PÊNFIGO ( FOGO SELVAGEM ) , DERMATITE MICÓTICA , PSORÍASE E NEOPLASIAS.
E COMO TRATAR ?
O LE GENITAL É CONSIDERADO DOENÇA DE CURSO CRÔNICO CUJO TRATAMENTO É DIFÍCIL E DE RESPOSTA LENTA . A ACEITAÇÃO DO PACIENTE E A CONTINUIDADE DO TRATAMENTO É UM PILAR FUNDAMENTAL PARA O ÊXITO TERAPÊUTICO. DEVEMOS TRATAR PARA ALIVIAR OS SINTOMAS E DESCONFORTO , PREVENÇÃO DE MUDANÇAS ANATÔMICAS E DE MALIGNIZAÇÃO. OS CUIDADOS LOCAIS SÃO DE FUNDAMENTAL IMPORTÂNCIA DEVENDO-SE EVITAR HIGIENIZAÇÃO EXAUSTIVA , USO DE VESTIMENTAS APERTADAS E ROUPAS ÍNTIMAS QUE NÃO SEJAM DE ALGODÃO. ATUALMENTE O TRATAMENTO PRIORITÁRIO INCLUI O USO DE CORTICOSTEROÍDES DE ALTA POTÊNCIA ( O CLOBETASOL ) USADO POR LONGO PERÍODO ( ATÉ 2 ANOS ) . NOS CASOS ONDE HAJA ATROFIA INTENSA O USO DE TESTOSTERONA A 2% TÓPICO PROMOVE AUMENTO DA ESPESSURA DO EPITÉLIO E ALÍVIO DOS SINTOMAS . A INTERRUPÇÃO ABRUPTA DO TRATAMENTO É ACOMPANHADA QUASE QUE DE IMEDIATO DO RETORNO DOS SINTOMAS, POR ISSO A SUPRESSÃO DO TRATAMENTO DEVE SER LENTA , PROGRESSIVA E EM FORMA DE DESMAME E COM FREQUÊNCIA CONSEGUE-SE ESTABELECER DOSE MÍNIMA QUE DEVE SER MANTIDA POR TEMPO PROLONGADO. CIRURGIA É CONTRA-INDICADA COMO TRATAMENTO PRIMÁRIO, SENDO MAIS RESERVADA PARA CASOS DE ESTENOSE DE INTRÓITO VULVAR , SINÉQUIAS LABIAIS E DE CLÍTORIS .
VEJAMOS ABAIXO ALGUMAS ILUSTRAÇÕES EM MULHERES E HOMENS
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