clobetasol and Vulvar-Diseases

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

To observe the effectiveness of chlortetracycline (aureomycin) treatment on vulval white lesions and to explore its possible pathogenesis.. From January 2001 to April 2011, 194 patients with vulvar non-neoplastic epithelial disorders were divided into three groups according to therapy regimens received, ie, chlortetracycline treatment group (72 cases), chlortetracycline + beclomethasone treatment group (66 cases), and beclomethasone treatment group (56 cases); their local changes of vulvar lesions were observed and efficacy of these treatment profiles was evaluated after one year.. Effective rates of chlortetracycline group, chlortetracycline + clobetasol group and clobetasol groups were 86.1% (62/72), 87.9% (58/66), and 62.5% (35/56), respectively. There was a significant difference among these three groups (Hc = 10.7766,p = 0.0046), the curative rate of clobetasol group was markedly lower than that of the former two groups (p = 0.0072 and p = 0.0019), but was not statistical significant (p = 0.6077) when compared between the former groups.. The occurrence of vulvar non-neoplastic epithelial disorders may be associated with chlamydia and mycoplasma infection, the chlortetracycline is an effective drug for this illness, the mechanism of which might be related to killing pathogens directly and inhibiting inflammatory mediators.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Chlortetracycline; Clobetasol; Female; Humans; Male; Middle Aged; Vulvar Diseases; Young Adult

Genital erosive lichen planus (GELP) in women is a chronic inflammatory disease characterized by painful vulval and vaginal erosions. Topical photodynamic therapy (PDT) is increasingly used in premalignant and malignant diseases and may have an effect in inflammatory diseases.. To assess the feasibility, efficacy and safety of hexyl 5-aminolevulinate-hydrocloride (HAL)-PDT in GELP.. Forty women, diagnosed with GELP at a specialized vulva clinic, were randomized to one session HAL-PDT in vulva and/or vagina (n = 20) or daily applications of clobetasol propionate 0·05% ointment in vulva and optional hydrocortisone acetate 1·0% foam in vagina for 6 weeks (n = 20). After 6 weeks, all patients were allowed to use topical corticosteroids as needed. Clinical examinations were performed at weeks 0, 6 and 24, using a clinical score developed for the study. All patients wrote a weekly log on pain, topical corticosteroid use and adverse events.. Three patients, all in the corticosteroid group, withdrew from the study after 1-3 weeks. The mean reduction in clinical scores was similar in the PDT group and the corticosteroid group; 25% vs. 22% after 6 weeks (P = 0·787) and 35% vs. 38% after 24 weeks (P = 0·801). The mean reduction in pain visual analogue scale scores was 38% vs. 55% after 6 weeks (P = 0·286) and 39% vs. 12% after 24 weeks (P = 0·452). Patients in the PDT group reported significantly less topical corticosteroid use during weeks 7-24 than those in the corticosteroid group. No major adverse events were reported.. Vulvovaginal HAL-PDT seems to be an effective and safe treatment for GELP.

Topics: Administration, Cutaneous; Administration, Intravaginal; Aminolevulinic Acid; Clobetasol; Dermatologic Agents; Feasibility Studies; Female; Glucocorticoids; Humans; Hydrocortisone; Lichen Planus; Middle Aged; Photochemotherapy; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Vaginal Diseases; Vulvar Diseases

Super potent topical steroids are an effective treatment for many patients with vulval lichen sclerosus, but concerns exist about their long-term safety. Review of 12 women up to 39 months following a course of super potent topical steroids shows that subsequent control of disease activity and symptoms is much easier than before therapy, with most patients requiring only small amounts of moderate potency topical steroid. Apart from a background erythema no long term cutaneous side effects were observed.

Topics: Administration, Topical; Clobetasol; Female; Follow-Up Studies; Humans; Lichenoid Eruptions; Sclerosis; Vaginal Creams, Foams, and Jellies; Vulva; Vulvar Diseases

A randomized study was conducted on 79 patients with vulval lichen sclerosus who were treated for three months with four topical drugs including testosterone (2%), progesterone (2%), clobetasol propionate (.05%) and a cream based preparation. To evaluate the efficacy of the treatments, patients were examined before and after therapy for symptoms, gross appearance of the lesions and histopathologic features. Patients treated with clobetasol had a better response than responses recorded in the other groups. Remission of symptoms occurred in 75% of patients treated with clobetasol compared to 20% treated with testosterone, 10% treated with progesterone and 10% treated with a cream based preparation. The clobetasol group was the only group with gross changes and histologic evaluations before and after treatment, that showed a highly significant difference (P < .001). In a condition characterized by epidermal atrophy, we observed a significant reduction in epidermal atrophy after treatment. This study suggests that clobetasol propionate (.05%) (a very potent topical steroid) is the therapy of choice in vulval lichen sclerosus.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Clobetasol; Female; Humans; Lichenoid Eruptions; Middle Aged; Progesterone; Sclerosis; Testosterone; Vaginal Creams, Foams, and Jellies; Vulva; Vulvar Diseases

The paper describes a study carried out in 40 patients affected by lichen sclerosus (LS) of the vulva. The mean age of patients was 60.9 years (range 27-83) and 31 were in menopause. Patients were divided randomly into two groups of 20. The symptoms (itching, burning, pain, dyspareunia), clinical aspects (atrophy, hyperkeratosis, sclerosis) and histological alterations (atrophy of the epithelium, edema, inflammatory infiltrate, fibrosis) were quantified in each patient by a score. The mean scores relating to the three parameters examined were then calculated for each group. One group was treated with testosterone propionate 2% and the other with a strong synthetic corticosteroid, clobetasol dipropionate 0.05%. After 24 weeks of treatment patients were again evaluated in relation to clinical (symptoms and clinical aspects) and histological parameters, following the procedure used before the start of treatment. The mean scores obtained were then compared with those before the start of treatment. Statistical analyses were performed using Student's t-test. Testosterone was found to be effective in relation to symptoms but no significant change was observed in relation to clinical aspects and histological alterations. It also caused major secondary effects which led to the suspension of treatment in one patient. Clobetasol was shown to be highly effective both in relation to symptoms and in terms of clinical aspects and histological alterations, and did not cause any noteworthy collateral effects, especially contact dermatitis. In the context of the objective parameters examined in this study, sclerosis and hyperkeratosis were easily modified by corticosteroid treatment in comparison to atrophy, especially in those patients with a longer duration of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Clobetasol; Drug Evaluation; Female; Humans; Lichen Planus; Middle Aged; Sclerosis; Testosterone; Vulvar Diseases

Topics: Aged; Clobetasol; Crohn Disease; Dermatologic Agents; Female; Glucocorticoids; Humans; Infliximab; Methylprednisolone Hemisuccinate; Ulcer; Vulvar Diseases

The aim of this study was to assess the efficacy of a postoperative steroid regimen in maintaining vulvovaginal architecture and vaginal patency following surgical adhesiolysis in severe erosive lichen planus (ELP) and genital graft versus host disease (GVHD). Sixteen women applied potent topical steroids to the vulva and vagina from 48 hours after surgery. Sexual and urinary function and vulvovaginal anatomy were assessed at 6 weeks, 6, 12 and 24 months. All of the patients had failed sexual function due to vaginal stenosis. Eleven patients were unable to have cervical smears and three had associated haematocolpos. Vaginal adhesiolysis achieving complete patency occurred in all patients with stenosis. Fifteen (93.7%) patients were compliant with the regimen. After two years, 12 (75%) patients had maintained complete vaginal patency. Four patients (25%) developed vaginal restenosis. This study demonstrates that the potent topical steroids used post-operatively are very effective in maintaining vaginal patency and function. Impact statement What is already known on this subject? Potent topical steroids are the first line treatment for ELP and GVHD and have been reported to be helpful after surgery to release adhesions. What do the results of this study add? Topical steroids used immediately after surgical adhesiolysis in patients with vulvo-vaginal lichen planus and graft-versus-host disease improves the outcomes and maintains function, which can give a prolonged benefit. What are the implications of these findings for clinical practice and/or further research? The use of potent topical steroids should be considered as routine practice after surgery in erosive inflammatory disease to control inflammation and improve the long term outcomes for these patients.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Clobetasol; Female; Graft vs Host Disease; Humans; Hydrocortisone; Lichen Planus; Postoperative Care; Retrospective Studies; Sexual Dysfunction, Physiological; Vaginal Diseases; Vulvar Diseases

Localized vulvar bullous pemphigoid of childhood is an excessively rare variant of bullous pemphigoid and affects almost exclusively young girls of 7-12 years of age. In contrast to adult-onset bullous pemphigoid, a prompt response to potent topical corticosteroids is observed in the majority of cases, with a favorable prognosis and rare relapses. We report the case of a 7-year-old girl who presented with this condition. Our case reinforces the recognition of this rare subtype of childhood bullous pemphigoid as a distinct entity and enlightens the importance of performing a cutaneous biopsy when clinically indicated.

Topics: Child; Clobetasol; Female; Glucocorticoids; Humans; Pemphigoid, Bullous; Vulvar Diseases

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

This report describes a young black Caribbean woman with a three-year history of recurrent genital ulceration initially diagnosed as genital herpes. This diagnosis had been made clinically by the general practitioner but never confirmed on culture or nucleic acid amplification testing; sequential treatment with aciclovir and famciclovir over a four-month period did not alleviate her genital symptoms. Presentation to our genitourinary (GU) medicine clinic identified painful aphthous genital and oral ulcers, erythema nodosum bilaterally and a history of eye irritation. A clinical diagnosis of Behçet's disease was made. Treatment with hydrocortisone mouth pellets and dermovate ointment was initiated in addition to dermatology and ophthalmology referral. This report reminds clinicians to consider alternative diagnoses in clinical practice when faced with patients who are resistant to treatment. It also highlights the importance of recognizing systemic disease and maintaining a holistic approach when treating patients.

Topics: Adult; Behcet Syndrome; Clobetasol; Diagnosis, Differential; Female; Humans; Hydrocortisone; Oral Ulcer; Stomatitis, Aphthous; Ulcer; Vulvar Diseases

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

Cicatricial pemphigoid or benign mucous membrane pemphigoid is an autoimmune bullous disease predominantly affecting the mucosal surfaces and healing with scar formation. Localized cicatricial pemphigoid of the vulva in children is rare. We present a child with this rare condition who was initially investigated on suspicion of her being subjected to child sexual abuse, and discuss its management.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone Valerate; Child; Clobetasol; Female; Humans; Pemphigoid, Benign Mucous Membrane; Treatment Outcome; Vulvar Diseases

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

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Clobetasol; Emollients; Female; Humans; Lichen Planus; Precancerous Conditions; Vulvar Diseases

Topics: Biopsy, Needle; Clobetasol; Female; Follow-Up Studies; Humans; Immunohistochemistry; Middle Aged; Risk Assessment; Sarcoidosis; Sarcoidosis, Pulmonary; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Vulvar Diseases

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aminoquinolines; Antineoplastic Agents; Carcinoma in Situ; Clobetasol; Contraceptives, Oral; Female; Humans; Imiquimod; Papillomavirus Infections; Pemphigus; Treatment Outcome; Vulvar Diseases; Vulvar Neoplasms

The purpose of this study was to compare patient satisfaction with the topical immune system modulator tacrolimus to topical clobetasol during treatment for vulvovaginal erosive lichen planus.. Subjects who had been diagnosed with vulvovaginal erosive lichen planus between June 2000 and May 2001 received a mail survey regarding clinical satisfaction and response to treatment with clobetasol and tacrolimus. Satisfaction was assessed with a 100-mm visual analogue scale (very unsatisfied, 0; very satisfied, 100). Satisfaction was compared with the use of a paired t-test.. Nineteen subjects met the inclusion criteria; 17 subjects (89%) returned completed surveys. Sixteen of the 17 women reported clobetasol therapy, and 11 of the 17 subjects acknowledged the use of tacrolimus therapy. All but 1 of the women who received tacrolimus had been treated previously with clobetasol therapy. All subjects reported experiencing sexual pain before their initial examination. After treatment with clobetasol, 2 of 16 women reported pain-free intercourse. Two additional women reported pain-free intercourse after switching to tacrolimus therapy. Ten subjects who had used both treatments rated tacrolimus therapy as significantly more satisfactory than clobetasol therapy (63 vs 38 mm; P=.03).. The use of topical tacrolimus improves satisfaction and may result in better clinical outcomes than therapy with clobetasol for the treatment of vulvovaginal erosive lichen planus.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Health Care Surveys; Humans; Lichen Planus; Middle Aged; Patient Satisfaction; Probability; Severity of Illness Index; Surveys and Questionnaires; Tacrolimus; Treatment Outcome; Vaginal Diseases; Vulvar Diseases

Genital involvement is a rare manifestation in discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE), and there are few reports on vulvar clinical features. We describe a 41-year old Caucasian woman with bilateral vulvar DLE. Although vulvar lesions in lupus are probably more common than is realized, the present report is the first case of genital DLE documented in a female.

Topics: Adult; Clobetasol; Complement System Proteins; Dyspareunia; Female; Glucocorticoids; HLA Antigens; Humans; Immunoglobulins; Lupus Erythematosus, Discoid; Ointments; Vulvar Diseases

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Clobetasol; Cystitis; Diagnosis, Differential; Female; Glucocorticoids; Humans; Ointments; Pelvic Pain; Vulvar Diseases

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

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

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

In 20 women with vulvar lichen sclerosus (LS) we analyzed the immunohistologic features of the dermal lymphoid infiltrate and the number of epidermal CD1a+ cells (Langerhans cells). Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases. The number of CD1a+ epidermal cells was increased, and the cells expressed strong HLA-DR+ staining. These findings suggest activation of the skin immune system in vulvar LS lesions. Conventional 2% testosterone therapy failed to modify the immunohistologic features. Clobetasol, 0.05%, application seemed more effective in down-regulating the skin's immune system activation profile.

Topics: Adolescent; Adult; Aged; Antibodies, Monoclonal; Antigens, CD; Cell Adhesion Molecules; Child; Clobetasol; Epidermal Cells; Epidermis; Female; HLA-DR Antigens; Humans; Langerhans Cells; Lichenoid Eruptions; Middle Aged; Testosterone; Vulvar Diseases

Topics: Clobetasol; Female; Humans; Vulvar Diseases

The clinical and histological response to 12 weeks of treatment with a very potent topical fluorinated steroid was studied in 15 patients with vulval lichen sclerosus (LS) who were treated with twice daily applications of clobetasol propionate 0.05% cream (Dermovate, Glaxo U.K.). Thirteen patients completed the study and all showed a marked clinical improvement. Histological measurements of skin biopsies taken before and after treatment showed a significant reduction in the characteristic features of LS. One patient developed contact sensitivity to clobetasol propionate. There was no evidence of infection or skin atrophy during the study. Patients completing the study have been followed up for up to 22 months and have been maintained in remission with moderately potent topical steroids which had previously been ineffective.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Humans; Middle Aged; Skin; Skin Diseases; Vulvar Diseases