clobetasol and Lichen-Sclerosus-et-Atrophicus

Lichen sclerosus is a chronic, inflammatory skin condition that most commonly occurs in adult women, although it may also be seen in men and children. It primarily affects the genital area and around the anus, where it causes persistent itching and soreness. Scarring after inflammation may lead to severe damage by fusion of the vulval lips (labia); narrowing of the vaginal opening; and burying of the clitoris in women and girls, as well as tightening of the foreskin in men and boys, if treatments are not started early. Affected people have an increased risk of genital cancers.. To assess the effects of topical interventions for genital lichen sclerosus and adverse effects reported in included trials.. We searched the following databases up to 16 September 2011: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), LILACS (from 1982), CINAHL (from 1981), British Nursing Index and Archive (from 1985), Science Citation Index Expanded (from 1945), BIOSIS Previews (from 1926), Conference Papers Index (from 1982), and Conference Proceedings Citation Index - Science (from 1990). We also searched ongoing trial registries and scanned the bibliographies of included studies, published reviews, and papers that had cited the included studies.. Randomised controlled trials (RCTs) of topical interventions in genital lichen sclerosus.. Two authors independently selected trials, extracted data, and assessed the risk of bias. A third author was available for resolving differences of opinion.. We included 7 RCTs, with a total of 249 participants, covering 6 treatments. Six of these RCTs tested the efficacy of one active intervention against placebo or another active intervention, while the other trial tested three active interventions against placebo.When compared to placebo in one trial, clobetasol propionate 0.05% was effective in treating genital lichen sclerosus in relation to the following outcomes: 'participant-rated improvement or remission of symptoms' (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.45 to 5.61) and 'investigator-rated global degree of improvement' (standardised mean difference (SMD) 5.74, 95% CI 4.26 to 7.23).When mometasone furoate 0.05% was compared to placebo in another trial, there was a significant improvement in the 'investigator-rated change in clinical grade of phimosis' (SMD -1.04, 95% CI -1.77 to -0.31).Both trials found no significant differences in reported adverse drug reactions between the corticosteroid and placebo groups. The data from four trials found no significant benefit for topical testosterone, dihydrotestosterone, and progesterone. When used as maintenance therapy after an initial treatment with topical clobetasol propionate in another trial, topical testosterone worsened the symptoms (P < 0.05), but the placebo did not.One trial found no differences between pimecrolimus and clobetasol propionate in relieving symptoms through change in pruritus (itching) (SMD -0.33, 95% CI -0.99 to 0.33) and burning/pain (SMD 0.03, 95% CI -0.62 to 0.69). However, pimecrolimus was less effective than clobetasol propionate with regard to the 'investigator-rated global degree of improvement' (SMD -1.64, 95% CI -2.40 to -0.87). This trial found no significant differences in reported adverse drug reactions between the pimecrolimus and placebo groups.. The current limited evidence demonstrates the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital lichen sclerosus. Further RCTs are needed to determine the optimal potency and regimen of topical corticosteroids, examine other topical interventions, assess the duration of remission or prevention of flares, evaluate the reduction in the risk of genital squamous cell carcinoma or genital intraepithelial neoplasia, and examine the efficacy in improving the quality of the sex lives of people with this condition.

Topics: Adult; Anti-Inflammatory Agents; Child; Clobetasol; Dermatologic Agents; Dihydrotestosterone; Female; Genital Diseases, Male; Humans; Lichen Sclerosus et Atrophicus; Male; Mometasone Furoate; Pregnadienediols; Randomized Controlled Trials as Topic; Tacrolimus; Testosterone Propionate; Vulvar Lichen Sclerosus

Topics: Acitretin; Carcinoma in Situ; Clobetasol; Female; Humans; Lichen Sclerosus et Atrophicus; Precancerous Conditions; Randomized Controlled Trials as Topic; Treatment Outcome; Vulva; Vulvar Neoplasms

Topics: Acitretin; Carcinoma in Situ; Clobetasol; Female; Humans; Lichen Sclerosus et Atrophicus; Precancerous Conditions; Vulva; Vulvar Neoplasms

Lichen sclerosus (LS) affects anogenital skin alone in 80% of cases. When extragenital disease occurs, it usually affects the trunk, neck, axillae and wrist flexures. Nail involvement with LS is rare. In contrast, lichen planus (LP) commonly affects extragenital skin. Mucosal lesions occur in 50% of cases, affecting the mouth and genitalia. Nail disease in LP is common, and, if severe, can lead to destruction of the nail bed. LS and LP can coexist. We report two cases of LS with nail involvement. In the Case 1 disease was confined to the nail, and nail biopsy confirmed LS. In the Case 2, the nail changes formed part of the widespread genital and extragenital LS, confirmed histologically. We review existing literature on nail disease in LS and discuss the possible aetiology of the nail changes.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Female; Foot Dermatoses; Glucocorticoids; Hand Dermatoses; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Nails; Nails, Malformed; Vulva; Vulvar Diseases

Lichen sclerosus (LS) is a skin condition that affects genital and extra genital epithelia in both males and females of all ages and it may occur in association with other autoimmune disease. Currently, the first line effective treatment is an ultra-potent topical corticosteroid. The long-term sequelae of LS include scarring, malignancy, which is rare, and psychosexual disfunction, which is common.

Topics: Administration, Topical; Anti-Inflammatory Agents; Anus Diseases; Clobetasol; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Penile Diseases; Sexual Dysfunctions, Psychological; Vulvar Diseases

Several treatment modalities of lichen sclerosus have been described. Topical testosterone (2%) has been the therapy of choice with improvement of symptoms in 67-100% of the patients. Newer placebo-controlled studies report success rates for testosterone of 20% which is not much higher than for placebo (10%). Treatment with the very potent steroid-like clobetasol 0.05% has been shown to be much more effective with success rates of up to 75%, while corticosteroid-related side effects like skin atrophy have not been a major problem.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Child; Clobetasol; Female; Glucocorticoids; Hormones; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Progesterone; Prospective Studies; Randomized Controlled Trials as Topic; Testosterone; Vulvar Diseases

Lichen sclerosus et atrophicus is a depigmenting mucocutaneous disease most frequently affecting the female genitalia. Genital lesions are symptomatic and may be functionally debilitating. Oral lesions are of little significance other than the esthetic concerns of perioral lesions. In view of the rarity of reported cases, one lesion of the labial mucocutaneous area and a second of the palate are presented along with a description of the disease's clinical and histopathologic findings and a brief review of the literature. The lip lesion was partially resolved with topical corticosteroids and was then fully eliminated with topical testosterone. Histologic verification and examination for the simultaneous occurrence or absence of oral and the more common genital-cutaneous lesions is essential if meaningful information in the medical-dental literature is to be obtained in the future.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Antineoplastic Agents, Hormonal; Clobetasol; Diagnosis, Differential; Glucocorticoids; Humans; Lichen Planus, Oral; Lichen Sclerosus et Atrophicus; Lip Diseases; Male; Mouth Diseases; Palate, Soft; Testosterone

Lichen sclerosus (LS) is a chronic inflammatory skin disease that mostly affects the anogenital region of women and lowers patients' quality of life. Current standard treatment of LS is topical steroids.. To evaluate the efficacy of topical progesterone 8% ointment and compare to standard therapy with topical clobetasol propionate 0.05% in premenopausal women presenting with previously untreated early onset LS.. Randomized, double-blind, 2-arm, single center superiority trial in premenopausal women with histologically confirmed vulvar LS who were randomized in a 1:1 ratio to receive clobetasol propionate 0.05% ointment or progesterone 8% ointment. The primary outcome was the clinical severity LS score after 12 weeks, which consists of six clinical features assessed by the physician. Secondary outcomes were the symptom severity LS score, which consists of three symptoms rated by the patient, the Short Form SF-12 physical and mental health scores, and adverse events. Response to medication was assessed by biopsy at the end of the treatment to evaluate inflammatory parameters.. Overall, 105 women were screened, 102 underwent vulvar biopsy and 37 received a histologically confirmed diagnosis of LS and were randomized: 17 to progesterone and 20 to clobetasol propionate. At 12 weeks, the mean clinical LS scores improved from 4.6 (SD 2.0) to 4.5 (SD 1.7) in the progesterone arm, and from 4.6 (SD 2.8) to 2.9 (SD 2.2) in the clobetasol propionate arm (difference in favor of clobetasol 1.61; 95% CI 0.44 to 2.77, p = 0.009), and the mean symptom severity LS scores improved from 4.5 (SD 3.8) to 3.1 (SD 3.0) in the progesterone arm, and from 4.7 (SD 2.8) to 1.9 (SD 1.8) in the clobetasol propionate arm (difference in favor of clobetasol 1.32; 95% CI -0.25 to 2.89, p = 0.095). LS was in complete remission in 6 out of 10 patients (60%) with available biopsy in the progesterone arm, and in 13 out of 16 patients (81.3%) in the clobetasol propionate arm (odds ratio in favor of clobetasol 0.35; 95% CI 0.06 to 2.06, p = 0.234). No drug-related serious adverse event occurred during the trial.. Topical progesterone 8% ointment is inferior to standard therapy with topical clobetasol propionate 0.05% in previously untreated premenopausal women with vulvar LS after 12 weeks treatment.

Topics: Administration, Topical; Chronic Disease; Clobetasol; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Ointments; Pilot Projects; Progesterone; Quality of Life; Vulvar Lichen Sclerosus

Clobetasol propionate 0.05% has been the mainstay in treating vulvar lichen sclerosus (VLS) for the past ten years. The usual length of therapy is two to 12 weeks. We conducted this study to evaluate the efficacy and safety of treating severe lesions of VLS in postmenopausal women for a longer time on a regular basis using clobetasol propionate.. From 1997-2000, 137 women with VLS were examined in the Colposcopy and Laser Surgery Unit of "Alexandra" Hospital. Patients who were premenopausal, had previous therapy, exhibited mild or moderate disease or showed VIN or invasive cancer on vulvar biopsies were excluded from the study. The remaining women were divided into two groups. The first group applied clobetasol propionate 0.05% for three months and afterwards on an "as required" basis, whereas the second group used the ointment for six months on a regular basis. All patients were examined at two, three, six and 12 months following treatment. Signs and symptoms before and after therapy as well as side-effects caused by the ointment were recorded.. The mean age of the women was 60.2 years. Fifty-four patients were divided into two categories. In the 6-month follow-up, 59% of the 1st group and 85% of the second had complete response regarding their symptoms whereas on the 12-month follow-up, the respective numbers were 48% and 74%. Concerning the signs, 30% of the first group and 55.5% of the second showed to have complete response after six months and 26% and 41% respectively after 12 months. All differences between the two groups, except the signs after 12 months, were statistically significant. There were no side-effects from the long-term use of clobetasol propionate 0.05%.. Conservative management of severe lesions of VLS in postmenopausal women using clobetasol propionate 0.05% for a long time (6 months) on a regular basis, seems to be a safe and effective therapy. Improvement is observed primarily on the symptoms and less on the signs.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Clobetasol; Drug Administration Schedule; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Postmenopause; Severity of Illness Index; Treatment Outcome; Vulvar Neoplasms

To observe the clinical effects of short-term application of ultrapotent topical corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients.. Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent topical corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years.. Pediatric dermatology clinic (referral center).. Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus.. Topical ultrapotent corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks.. Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms.. All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent topical corticosteroid. No significant adverse effects were noted after the initial 6- to 8-week course of therapy or during the 6-month to 3-year follow-up period.. A 6- to 8-week course of ultrapotent topical corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clobetasol; Female; Follow-Up Studies; Genital Diseases, Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus

To evaluate the possible effects of topical testosterone as maintenance therapy after clobetasol propionate treatment.. Thirty-two patients with biopsy-proven vulvar lichen sclerosus (LS), after 24 weeks of treatment with 0.05% clobetasol propionate cream, were randomly distributed into two groups of 16 each and treated for a further length of time (24 weeks) with testosterone 2% ointment or a cream-based preparation (placebo). The patients were examined before and after treatment for symptoms, gross aspects and histologic features.. With clobetasol propionate all patients had a marked improvement (P < .001) in both clinical and histologic parameters. After clobetasol propionate therapy, the 16 testosterone-treated patients had significant worsening of their symptoms (P < .05%) and no evident changes in gross aspects (P = NS). The placebo-treated group had good symptomatic control of their disease, with no significant changes in symptoms or gross aspects (P = NS).. After the good results obtained with clobetasol propionate, treatment with testosterone appeared to have a negative effect, while a regularly provided emollient cream was useful in symptom control.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Biopsy; Clobetasol; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Severity of Illness Index; Testosterone; Vulvar Lichen Sclerosus

To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin.. Prospective, randomised, double-blind study.. University hospital, Sweden.. 30 Boys randomised to be treated with clobetasol propionate (n = 15) or placebo (n = 15).. The boys were examined 1, 2 and 6 months, respectively, after treatment.. Comparison between the effects of clobetasol propionate and placebo.. Two patients in the steroid group and one in the placebo group withdrew from the study. 10 Boys in the steroid group showed an improvement within 2 months. The remaining 3 boys had no effect and were circumcised. Histopathological examination showed lichen sclerosus et atrophicus. Seven boys in the placebo group improved. The 7 non-responders were prescribed clobetasol propionate ointment, and all 7 improved.. 17 of 27 boys referred with "phimosis" were successfully treated with an ointment and gentle traction. When clobetasol propionate was given the non-responders success rate was increased to 24/27 (89%).

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Circumcision, Male; Clobetasol; Diagnosis, Differential; Double-Blind Method; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Penile Diseases; Phimosis; Prospective Studies; Treatment Outcome

Topics: Clobetasol; Humans; Lichen Sclerosus et Atrophicus; Male; Quality of Life; Steroids; Urethra

We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported outcome measures and nonprogression to surgery.. We conducted a review of our prospective ongoing quality improvement study to determine outcomes of our current standard practice for males with penile and urethral biopsy proven lichen sclerosus. Data were collected between 2011 and 2019, and included patient demographic information, medical and surgical histories, and location and extent of lichen sclerosus related pathology. The primary outcomes for this study were voiding function and voiding related quality of life, and were assessed using the AUASS (American Urological Association Symptom Score) and quality of life bother index, respectively.. We identified 42 patients with biopsy proven lichen sclerosus related urethral stricture disease. Of these patients 85.7% were treated with intraurethral steroids alone and did not require surgical intervention. Median AUASS significantly improved from 12 to 8, and median quality of life bother index improved from 4 ("mostly dissatisfied") to 2 ("mostly satisfied"). Average stricture length of those with penile urethral disease and bulbar urethral disease was 4.8 cm (SD 3.0) and 16.2 cm (SD 6.5), respectively. Median followup was 8.4 months (IQR 2.6-26.4).. Lichen sclerosus related urethral stricture disease can be effectively managed with intraurethral steroids. This minimally invasive management strategy improves patient reported voiding symptoms and voiding quality of life.

Topics: Administration, Topical; Adult; Biopsy; Clobetasol; Follow-Up Studies; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Patient Reported Outcome Measures; Patient Satisfaction; Penis; Prospective Studies; Quality of Life; Retrospective Studies; Skin Cream; Treatment Outcome; Urethra; Urethral Stricture; Urination

Topics: Child, Preschool; Clobetasol; Diagnosis, Differential; Female; Genital Diseases, Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Ointments; Triamcinolone

The study group included eleven female patients aged 18-77 years with a diagnosis of lichen sclerosus. Basic therapy consisted in the application of clobetasol in the first month and then once a day for the following two months. Then, clobetasol was recommended once a week until full resolution of the symptoms.. In nine patients with three-month basic therapy with clobetasol we observed a reduction of symptoms. Improvement of skin lesions was obtained in seven patients. After maintenance therapy lasting from four to twelve months the relapse of symptoms was observed in four women. Five women did not experience a relapse of the disease. The ointment with testosterone was applied in five women. Two women had poor tolerance of this drug. Two patients stopped the treatment after one month and after 11 months of using testosterone due to the relapse of the disease. One patient with good tolerance is currently continuing the therapy.. Vulvar lichen sclerosus et atrophicus is a chronic condition requiring long-term treatment. Topical use of steroids as first-line drugs bring a good local control of lesions in most women, yet further search of other possible causes of LSA is necessary.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Recurrence; Testosterone; Treatment Outcome; Young Adult

We describe an unusual presentation of lichen sclerosus in a postmenarchal, virginal girl.. A 14-year-old girl first presented with acute urinary retention due to labial agglutination and developed bilateral tubo-ovarian abscesses in 10 days of the conservative management period. Abscesses were treated with antibiotherapy and percutaneous drainage; simple division of the labial agglutination and vulvar biopsies were performed with a preliminary diagnosis of lichen sclerosus. Postoperative follow-up with antibiotherapy and clobetasol propionate 0.05% ointment was uneventful.. Lichen sclerosus should be considered in cases of labial agglutination with atypical presentations. Finally, this case reminds us that pelvic inflammatory disease and tubo-ovarian abscess must be kept in mind even in virginal adolescents, especially in the presence of obstructive lesions of the genital tract.

Topics: Abscess; Adolescent; Agglutination; Anti-Bacterial Agents; Biopsy; Clobetasol; Drainage; Fallopian Tubes; Female; Humans; Lichen Sclerosus et Atrophicus; Magnetic Resonance Imaging; Ovary; Vulva

Several factors such as genetic susceptibility, autoimmunity, hormones, infections, local trauma, urine, and occlusion have been speculated to play a role in the pathogenesis of lichen sclerosus. We report two male patients with lichen sclerosus around 'ectopic' urethral openings and the opposing surfaces of the penile shaft and scrotum, providing further evidence in support of urine and occlusion as contributing factors in the development of lichen sclerosus.

Topics: Aged; Anti-Inflammatory Agents; Biopsy; Clobetasol; Humans; Lichen Sclerosus et Atrophicus; Male; Penis; Treatment Outcome; Urethra; Urethral Stricture; Young Adult

Lichen sclerosus (LS) is a chronic, inflammatory condition of the skin, affecting primarily the anogenital region potentially leading to changes in vaginal architecture and vulvar squamous cell carcinoma. Current recommended treatment for LS is high-potency corticosteroids. Calcineurin inhibitors may also have a role.. The objective of this study is to introduce a treatment regimen involving clobetasol to induce remission, then tacrolimus to maintain remission in pediatric females with LS.. As a retrospective case series, we report 14 pediatric females between 2 and 10 years of age with LS treated with clobetasol 0.05% topical ointment and systematically bridged to tacrolimus 0.1% topical ointment. For each patient, gender, age at disease onset, and clinical symptoms and features were noted. Time in weeks to 75% clearance and to complete clearance were recorded.. Thirteen patients showed complete clearance. One patient showed significant clearance of the disease. The time to complete clearance averaged 43.1 weeks, with a range of 4-156 weeks.. The use clobetasol to induce remission and tacrolimus to maintain remission can be used to treat LS in pediatric females. This regimen may minimize side effects associated with long-term, high-potency corticosteroid use and reduce the risk of changes to genital architecture secondary to LS.

Topics: Calcineurin Inhibitors; Child; Child, Preschool; Chronic Disease; Clobetasol; Dermatologic Agents; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Sclerosus et Atrophicus; Retrospective Studies; Tacrolimus

We investigated outcomes of the contemporary practice of administering intraurethral steroids to treat stricture disease in patients with biopsy proven lichen sclerosus.. We performed an institutional review board approved review of the records of patients with biopsy proven lichen sclerosus stricture disease from October 2010 to September 2015. Study inclusion criteria were age 18 years or greater and male gender. Extracted data included patient demographics, comorbidities, location of lichen sclerosus, previous therapies and need for further interventions. Management was considered successful when there was no need for subsequent escalation of therapy. The intraurethral steroid regimen consisted of applying clobetasol cream to the affected urethra to lubricate a calibration device such as a urinary catheter or meatal dilator. The initial phase of therapy included twice daily application for 2 to 3 months, at which point the frequency was decreased by the clinician, enabling the patient to titrate medication use as needed.. We identified 40 patients with biopsy proven lichen sclerosus who had urethral stricture as part of the disease state. Of these patients 28 received the intraurethral steroid regimen and success was achieved in 25 (89%). Mean followup was 24.8 months. No patient who was started on the intraurethral steroid regimen proceeded to urethroplasty.. Based on our outcomes we have developed a stepwise treatment algorithm for patients with biopsy proven lichen sclerosus stricture disease that uses intraurethral steroids before initiating plans for invasive surgery.

Topics: Administration, Topical; Clobetasol; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture

A retrospective case-notes review was undertaken of all women with lichen sclerosus seen during a 12-month period to review their characteristics and care. A total of 273 case-notes were reviewed. The mean age was 61 years (range, 14-94), and the mean duration of symptoms was 6.4 years (range, 1-50). The mean age at diagnosis was 55 years (range, 7-92). Sixty-two (23%) had at least one other autoimmune condition. Autoimmune conditions were seven times more frequent overall compared with United Kingdom prevalences. On-going symptoms were reported as none/minimal in 196 (72%), moderate in 65 (24%) and severe in 12 (4%). A total of 233 women (85%) had on-going treatment with clobetasol propionate (Dermovate) ointment with a mode of eight applications per month (range, 0-30). Forty-three women (16%) reported sexual dysfunction and 13 (5%) had needed at least one surgical procedure to restore sexual function. Eighty-six (32%) had undergone at least one biopsy. Nine squamous cell cancers (3%) had been diagnosed in six women (2%). These patients were managed in line with all current guidance. It is surprising that there is still no evidence to direct long-term management.

Topics: Adult; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Disease Management; Female; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Retrospective Studies; Treatment Outcome; United Kingdom; Vulvar Diseases

Lichen sclerosus is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, labial adhesions, and loss of pigmentation. Treatment includes topical anti-inflammatory agents and long-term follow-up as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with history of lichen sclerosus. These recommendations are intended for pediatricians, gynecologists, nurse practitioners and others who care for pediatric/adolescent girls in order to facilitate diagnosis and treatment.

Topics: Adolescent; Anti-Inflammatory Agents; Betamethasone Valerate; Child; Clobetasol; Humans; Immunosuppressive Agents; Lichen Sclerosus et Atrophicus; Recurrence; Tacrolimus

To assess the efficacy of clobetasol propionate 0.05% cream in male patients suffering from genital lichen sclerosus (GLS), as well as the efficacy of methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment as maintenance therapy.. The study was conducted retrospectively. At baseline, male patients with GLS (n = 41) were treated with clobetasol propionate 0.05% cream applied twice daily for 8 weeks. Visual Analog Scale (VAS) score for pruritus, Investigator's Global Assessment (IGA) score and Dermatology Life Quality Index (DLQI) were recorded at baseline, week 8 and week 20. At week 8, patients responsive to treatment (n = 37) were further treated with methylprednisolone aceponate 0.1% cream twice weekly (n = 17) or tacrolimus 0.1% ointment once daily (n = 20), as maintenance therapy until week 20.. VAS, IGA and DLQI median scores were significantly decreased from baseline to week 8 (p < 0.001). At week 20, patients treated with methylprednisolone aceponate 0.1% cream presented no significant difference in median IGA score (p = 0.865), median DLQI score (p = 0.853) or median VAS score (p = 0.474) compared with patients treated with tacrolimus 0.1% ointment.. Clobetasol propionate 0.05% cream is effective as first-line treatment in male GLS. The data suggest that there is no difference between methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment in preventing the relapses.

Topics: Adult; Clobetasol; Genital Diseases, Male; Humans; Lichen Sclerosus et Atrophicus; Maintenance Chemotherapy; Male; Methylprednisolone; Pruritus; Quality of Life; Retrospective Studies; Secondary Prevention; Skin Cream; Tacrolimus

Topics: Anti-Inflammatory Agents; Clobetasol; Female; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Mucous Membrane; Pruritus; Uterine Prolapse; Vagina

Topics: Adult; Ainhum; Anti-Inflammatory Agents; Clobetasol; Constriction, Pathologic; Drug Therapy, Combination; Humans; Lichen Sclerosus et Atrophicus; Male; Penile Diseases; Tretinoin

When not recognized and treated aggressively, lichen sclerosus may progress and cause debilitating symptoms. It also may result in significant morbidity in patients undergoing treatment for urethral strictures because unrecognized, it may result in rapid and severe recurrence after surgical treatment. We present our experience treating patients with lichen sclerosus in an equal access health care system.. We performed an institutional review board approved retrospective review of all adult men with lichen sclerosus treated at our institution during a 10-year period. We analyzed all patients diagnosed with lichen sclerosus, and recorded patient demographics and therapies. We recorded characteristics of the disease process including external and internal manifestations. We also recorded the various treatments, and whether the patients experienced recurrence.. A total of 43 patients were diagnosed with lichen sclerosus during the review period. Of those patients presenting with more severe (urethral) involvement and undergoing 1 or 2-stage urethroplasties, we noted 7 with recurrence. In the remainder of patients presenting with less severe disease who were treated aggressively with clobetasol and/or minor procedures, no recurrences were noted on followup examination, and all of these patients had documented normal flow patterns on noninvasive urodynamics.. Our data suggest that early aggressive topical therapy plus minimally invasive surgical therapy to relieve high pressure voiding may prevent the progression of lichen sclerosus in patients who present with limited disease involving the skin and meatus.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Clobetasol; Disease Progression; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Retrospective Studies; Urethral Stricture; Young Adult

We describe details of a very rare variant of lichen sclerosus in an elderly man. This pattern was characterized by involvement of most of the body surface by bullae, erosions and scarring, including scarring alopecia. Our patient responded to topical corticosteroids and doxycycline. Borrelia spp. have been implicated in a previous case of this variant, but we could not find any evidence of this in our patient.

Topics: Aged, 80 and over; Alopecia; Cicatrix; Clobetasol; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Skin

A major complication following hematopoietic stem cell transplantation is graft versus host disease. Cutaneous manifestations of chronic graft versus host disease (cGVHD) are varied and this condition impacts patient outcomes and quality of life. We describe two cases of lichen sclerosus et atrophicus-like cGVHD developing in patients after hematopoietic stem cell transplantation. Both patients presented clinically with patches of pigmentary changes and scaling that displayed classic histologic features of lichen sclerosus et atrophicus. The skin is a frequent target organ of cGVHD and often the presenting location of the disease, making dermatologists key in recognition and management. It has been proposed that cutaneous cGVHD is a spectrum of disease and the lesions may evolve through various stages. Lichen sclerosus et atrophicus-like cGVHD may represent a phase in this continuum or a distinct sub-type of disease. Remaining cognizant of the potential manifestations of disease is key for prompt recognition and proper treatment.

Topics: Clobetasol; Combined Modality Therapy; Diagnosis, Differential; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Hydrocortisone; Immunosuppressive Agents; Leukemia, Promyelocytic, Acute; Lichen Sclerosus et Atrophicus; Lymphocyte Transfusion; Male; Middle Aged; Photopheresis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Tacrolimus; Triamcinolone

Two hundred and two patients with clinically typical or biopsy-confirmed vulval lichen sclerosus were reviewed either at consultation (75%) or by retrospectively examining their chart. At diagnosis, 79% were 50 years or older. Ninety-six per cent complained of itching, pain and/or dyspareunia. Lichen sclerosus most often affected the labia minora and perineum but 50% had perianal and 13% had extragenital disease. Thirty-five patients gave a history of psoriasis (17%), which affected the vulval area in 10. Thyroid disease was reported in 39 patients (19%), and 33 gave a family history of thyroid disease. Of those tested (142), 20% had elevated thyroid antibodies. Topical clobetasol propionate was very effective but at least intermittent treatment was required long term in 85%. At follow up, 101 of 185 patients (56%) were asymptomatic but 22 (12%) continued to have moderate-to-severe symptoms. Thyroid disease and psoriasis are common associated conditions.

Topics: Administration, Cutaneous; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Female; Humans; Infant; Interviews as Topic; Lichen Sclerosus et Atrophicus; Medical Records; Middle Aged; New Zealand; Psoriasis; Retrospective Studies; Severity of Illness Index; Vulvar Diseases

The main aim of our paper was to point out the rare localization of erosive lichen planus in vulvar region and vagina. Moreover, these untreated lesions may be the starting point of squamous cell carcinoma.

Topics: Carcinoma, Squamous Cell; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus; Lichen Sclerosus et Atrophicus; Middle Aged; Precancerous Conditions; Rare Diseases; Treatment Outcome; Vagina; Vaginal Discharge; Vaginal Diseases; Vulva; Vulvar Diseases; Vulvar Neoplasms; Vulvovaginitis

Lichen sclerosus (LS) is a chronic cutaneous disorder of uncertain aetiology seen predominantly in females. It is characterized by white atrophic macules and plaques with a predilection for involvement of the genitalia and perianal skin. Gender-identity disorder (transsexualism) is a descriptive term for individuals having the genetic, somatic and hormonal basis of one sex but who identify sexually with the opposite sex. Surgical gender reassignment is a fundamental step in the management of these complex patients and is driven by the individual's belief of being the opposite sex 'trapped' in the wrong body. We report a case of genital lichen sclerosus in hair-bearing skin originally from the scrotum, in an individual who had undergone male-to-female gender reassignment. To our knowledge, no similar cases have been reported to date.

Topics: Adult; Anti-Inflammatory Agents; Clobetasol; Emollients; Emulsifying Agents; Female; Humans; Lichen Sclerosus et Atrophicus; Male; Scrotum; Transsexualism; Treatment Outcome; Vulvar Diseases

A review of the English literature since 1940 did not reveal a reported case of lichen sclerosus involving the vaginal mucosa. Diagnosis of lichen sclerosus involving the vagina must thus be a rare occurrence.. This report presents the findings on a 54-year-old white woman with a history of lichen sclerosus involving the vulva. She was found to have lichen sclerosus involving the vaginal mucosa extending to the posterior vaginal fornix. The patient was started on the use of topical clobetasol ointment 0.05% to the vulva to be used twice daily for 1 month, at bedtime for 2 months, and every other day for 3 months. At follow-up, the vulvar and vaginal lichen sclerosus was unchanged, but the patient was asymptomatic. She was using the clobetasol 1 to 2 times per week.. Lichen sclerosus involving the vagina is a rare occurrence. Each case must be assessed separately and therapy initiated accordingly in each circumstance. Biopsy must be performed in all cases to identify the disease process and rule out malignancy.

Topics: Administration, Topical; Anti-Inflammatory Agents; Biopsy; Clobetasol; Female; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Vagina; Vulvar Lichen Sclerosus

To record the clinical features, symptomatic response to topical steroids, and resolution of clinical signs in a large cohort of female patients with vulvar lichen sclerosus.. Descriptive cohort study with a mean follow-up of 66 months.. The vulvar clinics of a teaching hospital and of a district general hospital in Oxfordshire, England.. Three hundred twenty-seven patients (74 girls and 253 women) with a definite clinical diagnosis of vulvar lichen sclerosus. Interventions The patients received topical steroids as part of their normal care.. Symptomatic response to treatment (good, partial, or poor); response of the vulvar signs (total, partial, minor, or poor); and the presence or absence of moderate or severe scarring.. The mean age at onset was 5.4 years in girls and 55.1 years in women and first-choice therapy was an ultrapotent topical steroid for 50% of the girls and 89% of the women. Response to treatment was recorded in 255 patients. In 244 patients (96%) symptoms improved with treatment, as 168 (66%) became symptom free and 76 (30%) showed partial response; 11 (4%) had poor response. Among the 253 patients in whom a response of the vulvar signs to topical steroid was recorded, 58 (23%) showed total response, with return to normal skin texture and color; and 173 (68%) showed partial, 18 (7%) showed minor, and 4 (2%) showed poor response. Moderate or severe scarring occurred less often in girls (P<.001). Squamous cell carcinoma developed in 6 women (2.4%).. Topical ultrapotent steroid is an effective treatment for vulvar lichen sclerosus, giving relief of symptoms in most and completely reversing the skin changes in approximately one fifth of patients.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Child; Child, Preschool; Clobetasol; Cohort Studies; England; Female; Glucocorticoids; Humans; Infant; Lichen Sclerosus et Atrophicus; Medical Records; Middle Aged; Prognosis; Retrospective Studies; Severity of Illness Index; Vulvar Neoplasms

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Diagnosis, Differential; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Nails

Using a highly sensitive polymerase chain reaction (PCR) technique, based on general GP5+/GP6+ PCR primers covering 34 different human papillomavirus (HPV) types, the presence of HPV DNA was studied in paraffin-embedded penile biopsies from 20 men treated topically with corticosteroids. Clobetasol propionate was applied for 2-16 (mean 7) weeks by 19 men (age 18-73; mean 40) with lichen sclerosus. High-risk HPV was detected prior to therapy in three patients (16%) who lacked clinical or histopathological signs of HPV infection. Following therapy high-risk HPV was detected in biopsies from four men (21%), of whom three also exhibited clinical and/or light microscopic signs of HPV infection. Low-risk HPV DNA was not detected in any of these samples. Four biopsies were collected during a 5-year period from a 51-year-old man who was treated repeatedly with topical mild-moderate potent corticosteroids at intervals of up to 10 weeks for penile erosive lichen planus, followed by nine clinical outbreaks of typical condylomas that consistently showed the presence of low-risk HPV DNA only. These observations indicate that long-lasting topical corticosteroid therapy occasionally may be associated with opportunistic reactivation of a latent high- and low-risk mucosotrophic HPV type infection. The importance of clinical follow-up is underlined.

Topics: Administration, Topical; Adolescent; Adult; Aged; Biopsy, Needle; Chi-Square Distribution; Clobetasol; Condylomata Acuminata; Culture Techniques; DNA, Viral; Humans; Lichen Planus; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Polymerase Chain Reaction; Prospective Studies; Recurrence; Risk Assessment

We describe the case of a 66-year-old Hispanic man with an atypical presentation of lichen sclerosus (LS). The unusual presentation included bilateral axilla involvement (not previously reported to our knowledge), scrotal involvement (not common in men, despite common vulvar involvement in women), and an uncommonly thick plaque on his back.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Axilla; Clobetasol; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Skin; Triamcinolone

To assess the effectiveness of treating premenarchal vulvar lichen sclerosus with clobetasol propionate.. A retrospective chart review was performed of girls presenting to the University of Michigan Pediatric and Adolescent Gynecology Clinic from January, 1995, to July, 2000, with premenarchal lichen sclerosus. Subjects in the study were treated with topical clobetasol propionate ointment 0.05% for 2-4 weeks, and then tapered to a less potent steroid. Information was extracted concerning age at onset, symptoms, vulvar examination, previous treatments, effectiveness of clobetasol, follow-up, and complications. The parents were contacted for a follow-up telephone survey.. Fifteen girls averaging 5.7 years at the start of symptoms met criteria. The diagnosis of lichen sclerosus was made visually in 11 and by biopsy in four. Follow-up ranged from 2 months to 6 years. Fourteen girls had good improvement within 4-7 weeks. One girl developed a yeast superinfection and one developed transient erythema. At least 1 year of follow-up by clinic visit or telephone interview was available in 11 girls. Of these 11, two girls had no further vulvar symptoms after the initial treatment, five had one or two total flares, three reported three to eight flares per year, and one girl continues to be unresponsive to therapy.. Clobetasol propionate was an effective treatment of premenarchal vulvar lichen sclerosus in this small group; however, recurrences were common and required additional steroid treatment. Furthermore, complications of treatment were infrequent, minor, and easily treatable.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Recurrence; Retrospective Studies; Vulvar Diseases

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Colostomy; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus

To characterise the clinical presentation and response to treatment of lichen sclerosus (LS) in men attending a department of genitourinary medicine.. A case note review of all men attending a GUM department over a 32 month period, who had been diagnosed as having LS.. 66 men were seen with genital LS. The mean age at diagnosis was 36.5 years but symptoms had been present for up to 10 years before the diagnosis was made. 55 men underwent biopsy and the diagnosis was made histologically in 47 of these men. At the time of presentation 30% of men had no symptoms relating to their LS. All were treated with potent topical steroids and surgery was avoided in nearly all of them.. LS is not uncommon in men presenting to a GUM department, and is often asymptomatic. The disease responds well to potent topical steroids allowing the normal anatomy to be preserved in most individuals.

Topics: Administration, Topical; Adult; Aged; Ambulatory Care; Anti-Inflammatory Agents; Circumcision, Male; Clobetasol; Dilatation; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Urethra

Treatment with clobetasol propionate 0.05% cream is effective against lichen sclerosus et atrophicus (LSA) of the vulva.. The purpose of this study was to retrospectively evaluate whether clinical and histologic responses to topical clobetasol can be accomplished in penile LSA.. A self-assessment questionnaire was obtained from 22 men with LSA, and a clinical examination was performed in 21 of them. Biopsy specimens from 15 cases were compared before and after treatment.. Itching, burning, pain, dyspareunia, phimosis, and dysuria decreased significantly (P < .001 to .05) after 1 to 2 daily applications, for a mean of 7.1 weeks (2-16 weeks). Additional operation for phimosis was required in 6 of the 22 men. All histologic LSA criteria were significantly (P < .01 to .05) reduced after treatment.. Topical treatment of penile LSA with clobetasol propionate represents a safe and effective therapy with no risk of epidermal atrophy but with some potential for triggering latent infections, most importantly human papillomavirus.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Biopsy; Candidiasis; Clobetasol; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Retrospective Studies; Treatment Outcome; Tumor Virus Infections

To assess the efficacy of graduated topical steroids for long-term maintenance therapy for vulvar lichen sclerosus.. A prospective observational study was performed in the Gynaecological Oncology Department, City Hospital, Birmingham, U.K. Fifty-four patients were recruited for the study. The diagnosis was confirmed with histopathologic examination. After confirmation of the diagnosis, patients were started on a diminishing regimen of topical steroid.. Of the 54 patients in the study, 51 responded to the steroid regimen, and three did not.. The graduated topical steroid regimen has a high response rate and takes a relatively short time to achieve, justifying the use of graduated topical steroids for this condition. Graduated dose reduction allows the majority of patients to remain in asymptomatic remission and minimize steroid exposure.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Betamethasone; Clobetasol; Drug Administration Schedule; Female; Follow-Up Studies; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Prospective Studies; Treatment Outcome; Vulvar Diseases

Vulvar lichen sclerosus is rare disease in children. 5 girls (age 5-16) with LS were treated locally with clobetasol propionate. All patients showed clinical improvement or full regression of symptoms without side effects.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Vulvar Diseases

Effects of treating of the vulvar lichen scleroses by topical using of clobetasol propionate. The period of observation was 1 year. All patients showed clinical improvement or full regression depending on the period of disease. In all cases histopathologic examination was performed.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Treatment Outcome; Vulvar Diseases

Our goal was to evaluate short-term (3 months) and long-term (1 year) treatment of vulvar lichen sclerosus, by comparing topical application of testosterone propionate 2% in petrolatum with the corticosteroid clobetasol dipropionate 0.05%.. There were 20 women in each treatment group. The patients' symptoms and the gynecologist's examination findings were recorded before treatment, at 3 months, and at 1 year after initiation of therapy.. The symptomatic (subjective) effect of clobetasol treatment was similar to that of testosterone at the 3-month follow-up (p < or = 0.34), although objectively the signs of lichen sclerosus had improved more in the clobetasol group (p < or = 0.033). Both symptoms and signs were significantly more improved in the clobetasol-treated group at the 1-year follow-up examination (p < or = 0.02). Seventy percent of women treated by testosterone discontinued treatment because of a lack of response, whereas only 10% of the women treated with clobetasol stopped the treatment for that reason (p < or = 0.00042).. Clobetasol is more effective than testosterone in the treatment of women with lichen sclerosus, especially in the long term.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Clobetasol; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Incidence; Lichen Sclerosus et Atrophicus; Middle Aged; Testosterone; Treatment Outcome; Vulvar Diseases; Vulvar Neoplasms

Treatment of the vulvar squamous cell hyperplasia and lichen sclerosus et atrophicus by topical using of corticosteroids and 2% testosterone ointment. The period of observation was from 6 months to 18 months. All patients showed clinical improvement or full regression depending on the period of disease. In all cases histopathologic examination was performed.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Neoplasms, Squamous Cell; Ointments; Testosterone; Vulvar Neoplasms

A case of lichen sclerosus that developed in a pattern corresponding to the lines of Blaschko is described. This pattern of extragenital lichen sclerosus has not, to our knowledge, previously been reported and could result from an epidermal clone with altered androgen sensitivity supporting a hormonal pathogenesis for this disease.

Topics: Abdomen; Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Atrophy; Clobetasol; Clone Cells; Dehydroepiandrosterone Sulfate; Epidermis; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Purpura; Skin; Telangiectasis; Testosterone

Topics: Clobetasol; Contraindications; Female; Humans; Lichen Sclerosus et Atrophicus; Testosterone; Vulvar Diseases

To assess the efficacy of treating lichen sclerosus with clobetasol propionate.. A retrospective chart review of 81 consecutive symptomatic private practice and clinic patients with biopsy-proven lichen sclerosus were included. All subjects' punch biopsies, baseline histories and physical examinations were reviewed by the same examiner. Each subject's symptomatology and responses to previous treatment modalities were recorded. A standard regimen of 0.05% clobetasol propionate cream was initiated. Subjects were reevaluated at three months and asked to rate the improvement of symptoms. Follow-up examinations were conducted 6-12 months later on 36 subjects. Descriptive statistics and chi 2 analyses were performed.. The mean age of subjects was 54 +/- 15.5 years (range, 15-86), and the average duration of treatment prior to clobetasol use was 6 +/- 6.9 years (range, 0.5-29). Twenty-seven subjects did not complete the study or were lost to follow-up. The average subject had tried 2.25 treatment modalities (range, 1-13). The most common symptoms were pruritus (98%) and irritation (61%), with complaints of burning and dyspareunia. Most subjects (76%) had labial involvement, with concomitant involvement of the clitoris (70%), perineum (68%) and perianus (32%). The majority (88%) of subjects had a primary lesion of white and crinkled tissue. With clobetasol, 77% of subjects had complete remission of symptoms, 18% had partial remission and 5% reported no change. A change in clinical appearance was noted for the complete-remission (32%) and partial-remission groups (46%). Twenty-two percent revealed no change.. Clobetasol propionate cream is recommended for treatment of lichen sclerosus, with a 77% chance of complete remission of symptoms and a 47% chance of improvement in the clinical appearance of the vulva. Women may have to continue to use clobetasol as needed after finishing a base treatment course.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Dyspareunia; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Pruritus; Retrospective Studies; Treatment Outcome; Vulvar Diseases

The authors looking for a better treatment of vulvar lichen sclerosus, treated 10 patients by topical application of clobetasol propionate (twice a day for 45 days and once a day for additional 45 days). Before and after therapy changes of subjective symptoms were studied with Vaona algometer as well as the histological modifications found in the biopsies of lesions like atrophy, hyperkeratosis, inflammatory infiltration, sclerosis, hyalinization and edema.. The results seem to confirm the good improvement of subjective symptoms for the itching and also for burning. The histological results were encouraging, in fact we noticed a marked reduction of inflammatory infiltration and an improvement of atrophy, hyperkeratosis, hyalinization and edema.. The clinical and histological results seem to confirm the therapeutic effect of the use of clobetasol propionate for the treatment of vulvar lichen sclerosus.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Biopsy; Clobetasol; Drug Evaluation; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Middle Aged; Remission Induction; Time Factors; Vulva; Vulvar Diseases

In a 10-year old girl with irritated vulva lichen sclerosus et atrophicus (LSA) was diagnosed. She was successfully treated with local application of equal amounts of a cortisol ointment and zinc oil. LSA is a disease of the skin infrequently seen in children, and then mostly in girls. Diagnosis is based on typical lesions in the anogenital region (sharply delineated ivory discoloration, moderate sclerosis and atrophy, haemorrhagic erosions). Knowledge of this disease is important in order to distinguish it from sexual abuse.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child Abuse, Sexual; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Vulvar Diseases; Zinc

Histological changes of lichen sclerosus (LS)--a chronic inflammatory disease--are frequently found in association with squamous cell carcinoma (SCC) of the vulva, suggesting that women with this disorder are at increased risk. However, follow-up studies have been less convincing, showing that the vast majority of these patients do not go on to develop cancer. In this study, a series of 211 women affected by histologically demonstrated vulval LS were treated with topical therapy (testosterone, clobetasol) and followed prospectively by repetitive vulval examination. Three patients developed SCC of the vulva (two invasive, one in situ) at the sites affected by LS during an average follow-up period of 1 year and 8 months. Compared with the reference population, the number of cases of invasive SCC detected significantly exceeded the number estimated to occur in a comparable age-matched group. The standardized incidence rate of vulval SCC in the LS cohort was 317 (95% CI 35.7-1146.2). Cumulative risk was 14.8% (0.06% in the general female population), with a relative risk of 246.6. In conclusion, these data support the view that LS is a precursor of SCC, although characterized by slight tendency to evolve to carcinoma. Medical treatment of LS, although useful in the control of severity of disease, did not seem to be able to prevent the evolution to malignancy.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Carcinoma in Situ; Carcinoma, Squamous Cell; Case-Control Studies; Clobetasol; Cohort Studies; Female; Follow-Up Studies; Glucocorticoids; Humans; Incidence; Italy; Lichen Sclerosus et Atrophicus; Longitudinal Studies; Middle Aged; Neoplasm Invasiveness; Precancerous Conditions; Prospective Studies; Risk Factors; Testosterone; Vulvar Diseases; Vulvar Neoplasms