Инволютивные изменения вульвовагинальной области
- Авторы: Суркичин С.И.1, Круглова Л.С.1, Аполихина И.А.2, Майоров Р.Ю.1, Авин М.3
-
Учреждения:
- Центральная государственная медицинская академия Управления делами Президента Российской Федерации
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени В.И. Кулакова
- Медицинский центр «Столица»
- Выпуск: Том 20, № 2 (2021)
- Страницы: 161-174
- Раздел: Обзоры
- URL: https://journals.rcsi.science/1681-3456/article/view/90013
- DOI: https://doi.org/10.17816/1681-3456-2021-20-2-8
- ID: 90013
Цитировать
Аннотация
Инволютивные изменения вульвовагинальной области подразумевают ряд трансформаций, приводящих к вульвовагинальной атрофии в период менопаузы. Признаки и симптомы, наиболее часто отмечаемые при данном синдроме, — сухость влагалища (54,4–100%), диспареуния (17,6–77,6%), жжение (2,0–56,9%), зуд (7,8–56,6%) и дизурия (5,9–36,1%). Другие жалобы включают деформацию вульвы, раздражение, а также рецидивирующие бактериальные инфекции мочевыводящих путей или влагалища, дрожжевую инфекцию. Сухость, диспареуния и раздражение влагалища — это симптомы, которые больше всего влияют на качество жизни женщины.
В статье проанализированы современные представления о мочеполовом синдроме менопаузы, изучены механизмы его возникновения, описана клиническая картина. Подробно рассматриваются вопросы терапии атрофии вульвовагинальной области, особое внимание уделено физиотерапевтическим методам лечения.
Полный текст
Открыть статью на сайте журналаОб авторах
Сергей Иванович Суркичин
Центральная государственная медицинская академия Управления делами Президента Российской Федерации
Автор, ответственный за переписку.
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0003-0521-0333
к.м.н., доцент
Россия, МоскваЛариса Сергеевна Круглова
Центральная государственная медицинская академия Управления делами Президента Российской Федерации
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-код: 1107-4372
д.м.н.
Россия, МоскваИнна Анатольевна Аполихина
Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени В.И. Кулакова
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0002-4581-6295
SPIN-код: 6282-7435
д.м.н., профессор
Россия, МоскваРоман Юрьевич Майоров
Центральная государственная медицинская академия Управления делами Президента Российской Федерации
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0003-1911-6743
Россия, Москва
Марика Авин
Медицинский центр «Столица»
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0002-8317-0800
Россия, Москва
Список литературы
- Portman D.J., Gass M.L., on behalf of the Vulvovaginal Atrophy Conference Panel: Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society // Climateric. 2014. Vol. 21. Р. 1063–1068. doi: 10.1097/GME.0000000000000329
- Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society // Menopause. 2013. Vol. 20, N 9. Р. 888–902;quiz 903-4. doi: 10.1097/GME.0b013e3182a122c2
- Robinson D., Cardozo L. The pathophysiology and management of postmenopausal urogenital oestrogen deficiency // J Br Menopause Soc. 2001. Vol. 7, N 2. Р. 67–73. doi: 10.1258/136218001100321263
- Ettinger B., Hait H., Reape K.Z., Shu H. Measuring symptom relief in studies of vaginal and vulvar atrophy: the most bothersome symptom approach // Menopause. 2008. Vol. 15, N 5. Р. 885–889. doi: 10.1097/gme.0b013e318182f84b
- Palacios S., Nappi R.E., Bruyniks N., et al. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause // Climacteric. 2018. Vol. 21, N 3. Р. 286–291. doi: 10.1080/13697137.2018.1446930
- Nappi R.E., Seracchioli R., Salvatore S., et al. Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study // Gynecol Endocrinol. 2019. Vol. 35, N 5. Р. 453–459. doi: 10.1080/09513590.2018.1563883
- Lester J., Pahouja G., Andersen B., Lustberg M. Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue // J Pers Med. 2015. Vol. 5, N 2. Р. 50–66. doi: 10.3390/jpm5020050
- Palma F., Xholli A., Cagnacci A., as the writing group of the AGATA study. The most bothersome symptom of vaginal atrophy: Evidence from the observational AGATA study // Maturitas. 2018. Vol. 108. Р. 18–23. doi: 10.1016/j.maturitas.2017.11.007
- Nappi R.E., Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) ― results from an international survey // Climacteric. 2012. Vol. 15, N 1. Р. 36–44. doi: 10.3109/13697137.2011.647840
- Omi T., Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology // Laser Ther. 2014. Vol. 23, N 1. Р. 49–60. doi: 10.5978/islsm.14-RE-01
- Andelloux M. Products for sexual lubrication: understanding and addressing options with your patients // Nurs Womens Health. 2011. Vol. 15, N 3. Р. 253–257. doi: 10.1111/j.1751-486X.2011.01642.x
- Kennedy S.H., Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants // J Clin Psychopharmacol. 2009. Vol. 29, N 2. Р. 157–164. doi: 10.1097/JCP.0b013e31819c76e9
- Edwards D., Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? // Climacteric. 2016. Vol. 19, N 2. Р. 151–161. doi: 10.3109/13697137.2015.1124259
- Nappi R.E., Palacios S., Bruyniks N., et al.; investigators ES. The burden of vulvovaginal atrophy on women's daily living: implications on quality of life from a face-to-face real-life survey // Menopause. 2018. Vol. 26, N 5. Р. 485–491. doi: 10.1097/GME.0000000000001260
- Kingsberg S.A., Larkin L., Krychman M., et al. WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history // Menopause. 2019. Vol. 26, N 2. Р. 124–131. doi: 10.1097/GME.0000000000001194
- De Landsheere L., Munaut C., Nusgens B., et al. Histology of the vaginal wall in women with pelvic organ prolapse: a literature review // Int Urogynecol J. 2013. Vol. 24, N 12. Р. 2011–2020. doi: 10.1007/s00192-013-2111-1
- Gandhi J., Chen A., Dagur G., et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management // Am J Obstet Gynecol. 2016. Vol. 215, N 6. Р. 704–711. doi: 10.1016/j.ajog.2016.07.045
- Phillips N.A., Bachmann G.A. Genitourinary syndrome of menopause: common problem, effective treatments // Cleve Clin J Med. 2018. Vol. 85, N 5. Р. 390–398. doi: 10.3949/ccjm.85a.15081
- Lachowsky M., Nappi R.E. The effects of oestrogen on urogenital health // Maturitas. 2009. Vol. 63, N 2. Р. 149–151. doi: 10.1016/j.maturitas.2009.03.012
- Briggs P. Genitourinary syndrome of menopause // Post Reprod Health. 2020. Vol. 26, N 2. Р. 111–114. doi: 10.1177/2053369119884144
- Athanasiou S., Pitsouni E., Antonopoulou S., et al. The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women // Climacteric. 2016. Vol. 19, N 5. Р. 512–518. doi: 10.1080/13697137.2016.1212006
- Mac Bride M.B., Rhodes D.J., Shuster L.T. Vulvovaginal atrophy // Mayo Clin Proc. 2010. Vol. 85, N 1. Р. 87–94. doi: 10.4065/mcp.2009.0413
- Am F.E. Genitourinary syndrome of menopause // Aust Fam Physician. 2017. Vol. 46, N 7. Р. 481–484.
- Goldstein I. Recognizing and treating urogenital atrophy in postmenopausal women // J Womens Health (Larchmt). 2010. Vol. 19, N 3. Р. 425–432. doi: 10.1089/jwh.2009.1384
- Jannini E.A., Nappi R.E. Couplepause: a new paradigm in treating sexual dysfunction during menopause and andropause // Sex Med Rev. 2018. Vol. 6, N 3. Р. 384–395. doi: 10.1016/j.sxmr.2017.11.002
- Bachmann G. Urogenital ageing: an old problem newly recognized // Maturitas. 1995. Vol. 22. Р. S1–S5. doi: 10.1016/0378-5122(95)00956-6
- Palacios S., Mejía A., Neyro J.L. Treatment of the genitourinary syndrome of menopause // Climacteric. 2015. Vol. 18, Suppl. 1. Р. 23–29. doi: 10.3109/13697137.2015.1079100
- ACOG Committee No. Opinion 659. The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer // Obstet Gynecol. 2016. Vol. 127, N 3. Р. e93–96. doi: 10.1097/AOG.0000000000001351
- Bachmann G.A., Komi J.O. Ospemifene effectively treats vulvovaginal atrophyin postmenopausal women: results from a pivotal phase 3 study // Menopause. 2010. Vol. 17, N 3. Р. 480–486. doi: 10.1097/gme.0b013e3181c1ac01
- Portman D.J., Bachmann G.A., Simon J.A. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy // Menopause. 2013. Vol. 20, N 6. Р. 623–630. doi: 10.1097/gme.0b013e318279ba64
- Ampt A.J., Roach V., Roberts C.L. Vulvoplasty in New South Wales, 2001–2013: a population-based record linkage study // Med J Aust. 2016. Vol. 205, N 8. Р. 365–369. doi: 10.5694/mja16.00512
- Barbara G., Facchin F., Buggio L., et al. Vaginal rejuvenation: current perspectives // Int J Womens Health. 2017. Vol. 9. Р. 513–519. doi: 10.2147/IJWH.S99700
- Kaplan I. The CO2 surgical laser // Photomed Laser Surg. 2010. Vol. 28. Р. 847–848.
- Gold M., Andriessen A., Bader A., et al. Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation // J Cosmet Dermatol. 2018. Vol. 17, N 3. Р. 289–297. doi: 10.1111/jocd.12524
- Salvatore S., Athanasiou S., Candiani M. The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy // Curr Opin Obstet Gynecol. 2015. Vol. 27. Р. 504–508. doi: 10.1097/GCO.0000000000000230
- Salvatore S., Nappi R.E., Zerbinati N., et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study // Climacteric. 2014. Vol. 17, N 4. Р. 363–369. doi: 10.3109/13697137.2014.899347
- Samuels J.B., Garcia M.A. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women // Aesthet Surg J. 2019. Vol. 39, N 1. Р. 83–93. doi: 10.1093/asj/sjy087
- Quick A.M., Zvinovski F., Hudson C., et al. Fractional CO2 laser therapy for genitourinary syndrome of menopause for breast cancer survivors // Support Care Cancer. 2020. Vol. 28, N 8. Р. 3669–3677. doi: 10.1007/s00520-019-05211-3
- Sokol E.R., Karram M.M. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy // Menopause. 2016. Vol. 23, N 10. Р. 1102–1107. doi: 10.1097/GME.0000000000000700
- Pitsouni E., Grigoriadis T., Tsiveleka A., et al. Microablative fractional CO2-laser therapy and the genitourinary syndrome of menopause: an observational study // Maturitas. 2016. Vol. 94. Р. 131–136. doi: 10.1016/j.maturitas.2016.09.012
- Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women // Int J Women Health. 2017. Vol. 9. Р. 591–595. doi: 10.2147/IJWH.S136857
- Athanasiou S., Pitsouni E., Falagas M.E., et al. CO2 laser for the genitourinary syndrome of menopause. How many laser sessions? // Maturitas. 2017. Vol. 104. Р. 24–28. doi: 10.1016/j.maturitas.2017.07.007
- Eder S.E. Early effect of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy // Laser Ther. 2018. Vol. 27, N 1. Р. 41–47. doi: 10.5978/islsm.18-OR-04
- Tovar-Huamani J., Mercado-Olivares F., Grandez-Urbina J.A., et al. Efficacy of fractional CO2 laser in the treatment of genitourinary syndrome of menopause in Latin-American Population: First Peruvian experience // Lasers Surg Med. 2019. Vol. 51, N 6. Р. 509–515. doi: 10.1002/lsm.23066
- Siliquini G.P., Tuninetti V., Bounous V.E., et al. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women // Climacteric. 2017. Vol. 20, N 4. Р. 379–384. doi: 10.1080/13697137.2017.1319815
- Becorpi A., Campisciano G., Zanotta N., et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects // Lasers Med Sci. 2018. Vol. 33, N 5. Р. 1047–1054. doi: 10.1007/s10103-018-2471-3
- Perino A., Calligaro A., Forlani F., et al. Vulvovaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser // Maturitas. 2015. Vol. 80, N 3. Р. 296–301. doi: 10.1016/j.maturitas.2014.12.006
- Cruz V.L., Steiner M.L., Pompei L.M., et al. Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women // Menopause. 2018. Vol. 25, N 1. Р. 21–28. doi: 10.1097/GME.0000000000000955
- Pieralli A., Fallani M.G., Becorpi A., et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors // Arch Gynecol Obstet. 2016. Vol. 294, N 4. Р. 841–846. doi: 10.1007/s00404-016-4118-6
- Behnia-Willison F., Sarraf S., Miller J., et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause // Eur J Obstet Gynecol Reprod Biol. 2017. Vol. 213. Р. 39–44. doi: 10.1016/j.ejogrb.2017.03.036
- Salvatore S., Nappi R.E., Parma M., et al. Sexual function after fractional microablative CO2 laser in women with vulvovaginal atrophy // Climacteric. 2015. Vol. 18, N 2. Р. 219–225. doi: 10.3109/13697137.2014.975197
- Maggiore L.U., Parma M., Candiani M., Salvatore S. Microablative fractional CO2 laser for vulvovaginal atrophy in women with a history of breast cancer // J Minim Invasive Gynecol. 2015. Vol. 22, N 6S. Р. S100. doi: 10.1016/j.jmig.2015.08.269
- Harris V., Dickison P., Lim A., Fischer G. Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause // Australas J Dermatol. 2018. Vol. 59, N 4. Р. 341–343. doi: 10.1111/ajd.12765
- Pagano I., Gieri S., Nocera F., et al. Evaluation of the CO2 laser therapy on vulvo-vaginal atrophy (VVA) in oncological patients: preliminary results // J Can Ther. 2017. Vol. 8, N 5. Р. 452–463. doi: 10.4236/jct.2017.85039
- Samuels J.B., Garcia M.A. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women // Aesthet. 2019. Vol. 39, N 1. Р. 83–93. doi: 10.1093/asj/sjy087
- Gordon C., Gonzales S., Krychman M.L. Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy // Menopause. 2019. Vol. 26, N 4. Р. 423–427. doi: 10.1097/GME.0000000000001293
- Athanasiou S., Pitsouni E., Grigoriadis T., et al. Microablative fractional CO2 laser for the genitourinary syndrome of menopause: up to 12-month results // Menopause. 2019. Vol. 26, N 3. Р. 248–255. doi: 10.1097/GME.0000000000001206
- Sokol E.R., Karram M.M. Use of a novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes // Menopause. 2017. Vol. 24, N 7. Р. 810–814. doi: 10.1097/GME.0000000000000839
- Cruz V.M., Wajsfeld T., Steiner M.M., et al. Vaginal CO2 laser versus topical estriol treatment for vaginal atrophy in postmenopausal women: 1-year follow-up [20P] // Obstet Gynecol. 2019. Vol. 133, Suppl 1. Р. 175–176. doi: 10.1097/01.AOG.0000558908.60309.79
- Food and Drug Admnistration. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures [accessed on 16 September 2019]. FDA Safety Communication; 2018. Available from: https://www.iuga.org/news/fda-warns-against-use-of-energy-based-devices-to-perform-vaginal-rejuvenation-or-vaginal-cosmetic-procedures-fda-safety-communication
- Gambacciani M., Levancini M., Russo E., et al. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause // Climacteric. 2018. Vol. 21, N 2. Р. 148–152. doi: 10.1080/13697137.2018.1436538
- Gambacciani M., Levancini M., Cervigni M. Vaginal erbium laser: the second generation thermotherapy for the genitourinary syndrome of menopause // Climacteric. 2015. Vol. 18, N 5. Р. 757–763. doi: 10.3109/13697137.2015.1045485
- Gaspar A., Brandi H., Gomez V., Luque D. Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause // Lasers Surg Med. 2017. Vol. 49, N 2. Р. 160–168. doi: 10.1002/lsm.22569
- Bojanini J.F. Treatment of genitourinary syndrome of menopause with Erbium:YAG laser: a prospective study of efficacy and safety of the treatment for women after menopause of natural origin and therapy-induced menopause in breast cancer survivors // J Laser Health Academy. 2016. Vol. 2016, N 1. Р. 35–40.
- Gambacciani M., Levancini M. Short-term effect of vaginal erbium laser on the genitourinary syndrome of menopause // Minerva Ginecol. 2015. Vol. 67, N 2. Р. 97–102.
- Areas F., Valadares A.L., Conde D.M., Costa-Paiva L. The effect of vaginal erbium laser treatment on sexual function and vaginal health in women with a history of breast cancer and symptoms of the genitourinary syndrome of menopause: a prospective study // Menopause. 2019. Vol. 26, N 9. Р. 1052–1058. doi: 10.1097/GME.0000000000001353
- Gaviria J.E., Korosec B., Fernandez J., Montero G. Up to 3-year follow-up of patients with vaginal relaxation syndrome participating in laser vaginal tightening // J Laser Health Academy. 2016. Vol. 2016, N 1. Р. 6–11.
- Pagano T., De Rosa P., Vallone R., et al. Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study // Menopause. 2018. Vol. 25, N 6. Р. 657–662. doi: 10.1097/GME.0000000000001053
- Pagano T., De Rosa P., Vallone R., et al. Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study // Menopause. 2016. Vol. 23, N 10. Р. 1108–1113. doi: 10.1097/GME.0000000000000672
- Caruth J.C. Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment // Surg Technol Int. 2018. Vol. 32. Р. 145–149.
- Vicariotto F., Raichi M. Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device // Minerva Ginecol. 2016. Vol. 68, N 3. Р. 225–236.
- Vicariotto F., de Seta F., Faoro V., Raichi M. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety // Minerva Ginecol. 2017. Vol. 69, N 4. Р. 342–349. doi: 10.23736/S0026-4784.17.04072-2
- Alinsod R.M. Transcutaneous temperature controlled radiofrequency for atrophic vaginitis and dyspareunia // J Minim Invasive Gynecol. 2015. Vol. 22, N 6S. Р. S226–S227. doi: 10.1016/j.jmig.2015.08.798
- ACOG Position Statement. Fractional laser treatment of vulvovaginal atrophy and U.S. Food and Drug Administration clearance [accessed on 16 September 2019]. The American College of Obstetricians and Gynecologists; Washington, DC, USA; 2016. Available from: https://www.menopause.org/docs/default-source/default-document-library/nams-responds-to-fda-mandate-on-vaginal-laser-manufacturers-08-01-2018.pdf
- Ruiz-Rodriguez R., Sanz-Sánchez T., Córdoba S. Photodynamic photorejuvenation // Dermatol Surg. 2002. Vol. 28, N 8. Р. 742–744. doi: 10.1046/j.1524-4725.2002.02018.x
- Kohl E., Torezan L.A., Landthaler M., et al. Aesthetic effects of topical photodynamic therapy // J Eur Acad Dermatol Venereol. 2010. Vol. 24, N 11. Р. 1261–1269. doi: 10.1111/j.1468-3083.2010.03625.x
- Philipp-Dormston W.G. Photodynamic therapy for aesthetic-cosmetic indications // G Ital Dermatol Venereol. 2018. Vol. 153, N 6. Р. 817–826. doi: 10.23736/S0392-0488.18.05982-5
- Morton C.A., Szeimies R.M., Basset-Séguin N., et al. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications — field cancerization, photorejuvenation and inflammatory/infective dermatoses // J Eur Acad Dermatol Venereol. 2020. Vol. 34. Р. 17–29. doi: 10.1111/jdv.16044
- Marmur E.S., Phelps R., Goldberg D.J. Ultrastructural changes seen after ALA-IPL photorejuvenation: a pilot study // J Cosmet Laser Ther. 2005. Vol. 7, N 1. Р. 21–24. doi: 10.1080/147641700510037725
- Orringer J.S., Hammerberg C., Hamilton T., et al. Molecular effects of photodynamic therapy for photoaging // Arch Dermatol. 2008. Vol. 144, N 10. Р. 1296–1302. doi: 10.1001/archderm.144.10.1296
- Sakamoto F.H., Lopes J.D., Anderson R.R. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice: Part I. Acne vulgaris: when and why consider photodynamic therapy? // J Am Acad Dermatol. 2010. Vol. 63, N 2. Р. 183–193. doi: 10.1016/j.jaad.2009.09.056
- Rossi R., Bruscino N., Ricceri F., et al. Photodynamic treatment for viral infections of the skin // G Ital Dermatol Venereol. 2009. Vol. 144, N 1. Р. 79–83.
- Zhang F., Li D., Shi L., et al. 5-ALA-photodynamic therapy in refractory vulvar lichen sclerosus et atrophicus // Int J Clin Exp Pathol. 2020. Vol. 13, N 12. Р. 3100–3110.