clobetasol and Vulvar-Lichen-Sclerosus

The purpose of the present systematic review is to evaluate the available medical treatments for vulvar lichen sclerosus, using an arm-based network meta-analysis protocol.. We searched Medline (1966-2019), Scopus (2004-2019), Cochrane Central Register of Controlled Trials CENTRAL (1999-2019), Clinicaltrials.gov (2008-2019) databases, and Google Scholar (2004-2019) database along with the reference list of all included studies.. All observational, randomized, and single-arm studies that evaluated medical treatments for vulvar lichen sclerosus were considered eligible for inclusion in the present systematic review.. A network meta-analysis was carried out in R 3.4.3 using the pcnetmeta package, which uses a Bayesian hierarchical model (based in Markov chain Monte Carlo convergence simulation).. Sixteen studies were included in this present meta-analysis, which recruited 954 women with vulvar lichen sclerosus. Their quality was evaluated with the JADAD, Cochrane risk of bias, and risk of bias in nonrandomised studies of interventions-I tools. Clobetasol treatment ranked as the best treatment for disease remission after evaluating rank probabilities (40% chance of ranking first compared with tacrolimus [38%]). However, the density plot revealed partial overlapping with tacrolimus. The lowest probability of experiencing a relapse was observed with pimecrolimus (15% [2-48%]); however, the density plot revealed significant overlapping with mometasone furoate, testosterone, and clobetasol.. Robust evidence concerning the superiority of potent steroids at least over calcineurin inhibitors is still lacking in the field of vulvar lichen sclerosus. On the other hand, the gross heterogeneity in terms of selected population, duration of treatment, administered regimen, outcome reporting, and selection of outcome measures leaves several fields unanswered.

Topics: Androgens; Anti-Inflammatory Agents; Calcineurin Inhibitors; Clobetasol; Female; Glucocorticoids; Humans; Mometasone Furoate; Network Meta-Analysis; Practice Guidelines as Topic; Recurrence; Remission Induction; Tacrolimus; Testosterone; Vulvar Lichen Sclerosus

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

Clobetasol propionate is the most potent of all topical steroids. It is successfully applied in the treatment of various skin diseases such as atopic dermatitis, psoriasis and vulvar lichen sclerosus. The therapy is, however, mainly symptomatic. A preventive effect is only reported in the treatment of the latter. Clobetasol propionate exerts antiinflammatory, immunosuppressive and antimitotic effects influencing the growth, differentiation and function of various cells and inhibiting cytokine production. Seven different dosage forms are available to deliver the drug to the living cells of the skin. Their choice might additionally affect patient compliance. The potency of clobetasol propionate, however, is accompanied by local and systemic side effects, such as skin atrophy and hypothalamic-pituitary-adrenal axis suppression. Patients applying clobetasol propionate must be well instructed in how to use it. Physicians prescribing clobetasol propionate should consider a diversity of factors and be able to answer the questions where, when and why.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Clobetasol; Dermatitis, Atopic; Female; Humans; Immunosuppressive Agents; Psoriasis; Vulvar Lichen Sclerosus

Topics: Administration, Topical; Clobetasol; Female; Glucocorticoids; Humans; Pilot Projects; Platelet-Rich Plasma; Vulvar Lichen Sclerosus

Topics: Administration, Topical; Clobetasol; Female; Glucocorticoids; Humans; Pilot Projects; Platelet-Rich Plasma; Vulvar Lichen Sclerosus

The main objective of the study was to describe and compare the feasibility of using fractional CO. The clinical/anatomical characteristics of the vulva did not differ between the treatment groups, as much before as after its performance. There was no statistically significant difference between the treatments performed regarding the impact on the life quality of the patients. A higher satisfaction degree with the treatment was obtained with the patients in the Laser group in the third month of evaluation. Laser therapy also revealed higher occurrence of telangiectasia after treatment completion. Fractional CO2 laser has proven to be well accepted and is a promising therapeutic option. Registration number and name of trial registry The institutional review board status was approved by the Research Ethics Committee of HU/ UFJF under advisory number 2881073 and registered in the Brazilian Clinical Trials, with consent under registration RBR-4p9s5y. Access link: https://ensaiosclinicos.gov.br/rg/RBR-4p9s5y.

Topics: Carbon Dioxide; Clobetasol; Feasibility Studies; Female; Glucocorticoids; Humans; Lasers, Gas; Quality of Life; Vulvar Lichen Sclerosus

The first-line treatment for vulvar lichen sclerosus (VLS) is 3 months of topical corticosteroid therapy. However, limited evidence is available concerning the use of fat grafting and platelet-rich plasma as a second-line treatment for patients who do not respond to first-line treatment.. This prospective single-center randomized pilot trial included 20 patients with a clinical and histological diagnosis of moderate to severe VLS. The patients in the treatment group (TG) received two infiltrations (at 3-month intervals) of nanofat mixed with platelet-rich plasma (PRP) into the vulvar area, while the control group (CG) received standard topical corticosteroid therapy. Fat was aspirated from the medial thigh or lower abdomen regions. Microfat was obtained after centrifugation and was emulsified to obtain a nanofat suspension. Treatment efficacy was determined by measuring changes in the vulvar skin elasticity, histopathology, and clinical signs, symptoms, and patient quality of life at after 1 year.. A total of 19 patients were finally assessed (9 TG and 10 CG). At the end of the study (1 year), there had been no significant improvement in vulvar skin elasticity. However, patients in the TG showed a significant improvement in their symptoms (itching, pain, burning, and dyspareunia) and clinical signs (cervical erosions, fissures, stenosis, and leukoderma). Analysis of skin biopsies revealed a significant decrease in all inflammatory cell types in the TG. No adverse events related to the autologous treatment were recorded.. Compared with topical corticosteroids, two infiltrations delivered 3 months apart decreased the inflammation of the vulva and improved most of the clinical signs and symptoms associated with VLS. Nonetheless, no improvement in vulvar skin elasticity was derived from the autologous treatment.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Clobetasol; Female; Glucocorticoids; Humans; Hyperplasia; Pilot Projects; Platelet-Rich Plasma; Prospective Studies; Quality of Life; Vulvar Lichen Sclerosus

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

To compare 6-month safety and efficacy outcomes of fractionated CO2 laser (laser) with topical clobetasol propionate (steroid) for treatment of symptomatic vulvar lichen sclerosus.. We conducted a single-center randomized controlled trial that compared fractionated CO2 laser with steroid treatment for patients with biopsy-proven lichen sclerosus. Randomization was stratified by prior clobetasol propionate use. The primary outcome was mean change in Skindex-29 score at 6 months. A total sample size of 52 participants were recruited to detect a mean difference of 16 points on the Skindex-29 (SD±22) with 80% power, based on a one-sided two-sample t test with α=0.05, accounting for 10% attrition. Secondary outcomes included validated subjective and objective measures. Intention-to-treat, per protocol, and regression analysis based on prior steroid exposure were performed.. From October 2015 to July 2018, 202 women were screened, 52 were randomized, and 51 completed a 6-month follow-up. No significant difference was found in baseline demographics, symptoms, and physician assessment scores. There was greater improvement in the Skindex-29 score in the laser arm at 6-months (10.9 point effect size, 95% CI 3.42-18.41; P=.007). Overall, 89% (23/27) of patients in the laser group rated symptoms as being "better or much better" compared with 62% (13/24) of patients in the steroid group, P=.07. More patients (81%, 21/27) were "satisfied or very satisfied" with laser treatment compared with steroid treatment (41%, 9/24); P=.01. After stratification for previous steroid use, the significant change of Skindex-29 score was only seen in the previously exposed group. There was one adverse event in each group: minor burning and blistering at the laser site and reactivation of genital herpes 1 week after starting steroid.. Fractionated CO2 laser treatment showed significant improvement in subjective symptoms and objective measures compared with clobetasol propionate, without serious safety or adverse events at 6 months.. ClinicalTrials.gov, NCT02573883.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Lasers, Gas; Middle Aged; Patient Satisfaction; Retreatment; Severity of Illness Index; Vulvar Lichen Sclerosus

Twice-weekly proactive application of mometasone furoate 0.1% ointment (MMF) over 52 weeks was found to be an effective and safe therapy option in maintaining vulvar lichen sclerosus (VLS) remission and in preventing relapse.. To assess and compare the effectiveness and safety of two different topical corticosteroids, clobetasol propionate 0.05% ointment (CP) and MMF, administered twice weekly as a maintenance therapy of VLS previously stabilized with a topical corticosteroid course.. Forty-eight patients affected with VLS who had responded to therapy with either CP or MMF in an earlier 12-week randomized active treatment phase trial were enroled in a 52-week maintenance phase (MP) to apply their previous treatment twice weekly. The main efficacy parameters were the relapse rate, the mean time of relapse, and the change in symptom and sign severity throughout MP.. By the end of the 52-week MP, 2 (8.33%) subjects among the CP patients and 1 (4.17%) among the MMF patients experienced a relapse; among relapsing patients the mean time to relapse was 30 weeks. Neither subjective nor objective scores changed significantly during MP among CP and MMF patients. No significant differences were found in any of the assessed efficacy endpoints between CP and MMF. Both treatments were well tolerated and the proactive regimen was judged as convenient by patients.. Proactive application of the ultra-potent CP and the potent MMF was found to be an effective, safe and suitable maintenance treatment for long-term management of VLS. There were no differences between the two corticosteroids.

Topics: Aged; Clobetasol; Female; Humans; Middle Aged; Mometasone Furoate; Patient Compliance; Vulvar Lichen Sclerosus

The aim of this study was to evaluate the effectiveness of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for the treatment of vulvar lichen sclerosus (VLS) and compare its effectiveness with that of clobetasol propionate. Four sessions of topical photodynamic therapy (PDT) were administered at 2-week intervals (n = 20). Clobetasol propionate (0.05%) was used daily for 8 weeks (n = 20). The rate of complete response in the PDT group (14/20) was double that of the clobetasol propionate group (7/20) (p < 0.05, 2 = 4.912). Horizontal visual analogue scores indicated that PDT was more effective than clobetasol propionate. Pain intensity numeric rating scale values for PDT were between 3.05 and 4.45. One month after the final session of PDT, only one patient relapsed and all 7 patients in clobetasol propionate group relapsed. ALA-PDT is a well-tolerated and effective option for the treatment of VLS.

Topics: Aminolevulinic Acid; Clobetasol; Female; Glucocorticoids; Humans; Middle Aged; Pain Measurement; Photochemotherapy; Photosensitizing Agents; Prospective Studies; Treatment Outcome; Vulvar Lichen Sclerosus

A 3-month topical application of clobetasol propionate (CP) represents the recommended and accepted first-line treatment for vulvar lichen sclerosus (VLS); however, to date, no randomized controlled trials have compared the efficacy and safety of CP with other topical corticosteroids.. To compare the effectiveness and tolerability of two different topical corticosteroids, CP 0·05% ointment and mometasone furoate (MMF) 0·1% ointment, in the treatment of VLS.. Fifty-four patients with VLS were enrolled in a 12-week active treatment phase (ATP) and randomized to apply either CP or MMF in a tapering regimen. The main efficacy parameters were the response rate, the rate of patients achieving an improvement from baseline of ≥ 75% in the subjective and objective scores, and the mean reduction in subjective and objective scores throughout the treatment.. By the end of the 12-week ATP, 24 (89%) patients were considered to be responders among the CP patients and 24 (89%) among the MMF patients; 59% and 37% of patients in the CP group and 67% and 48% in the MMF group achieved an improvement of at least 75% in subjective and objective scores, respectively. The decrease in mean symptom and sign scores was significant compared with baseline with both treatments. No significant differences were found in any of the assessed efficacy endpoints between CP and MMF. Both treatments were well tolerated.. Clobetasol propionate and MMF appeared similarly efficacious and well tolerated for the treatment of VLS and both may represent the first-line treatment for the disease.

Topics: Administration, Cutaneous; Age of Onset; Clobetasol; Drug Administration Schedule; Female; Glucocorticoids; Humans; Medication Adherence; Middle Aged; Mometasone Furoate; Ointments; Patient Satisfaction; Pregnadienediols; Vulvar Lichen Sclerosus

Topical corticosteroids are the current first-line therapy for vulvar lichen sclerosus (VLS). UV-A1 phototherapy may be a promising alternative treatment option, but controlled studies are lacking.. To compare the efficacy of high-potent topical corticosteroids with UV-A1 phototherapy in the treatment of VLS.. A 2-arm randomized clinical trial was conducted at a university hospital dermatology department according to the intention-to-treat principle with last observation carried forward. The study population comprised 30 female patients with VLS.. Treatment of VLS with clobetasol propionate, 0.05%, ointment applied once daily for 3 months or medium-dose UV-A1 (50 J/cm²) home-based phototherapy, performed 4 times weekly for 3 months.. Mean relative reduction of the total clinician's score (TCS) was considered the primary outcome measure. Secondary outcome measures included the reduction of pruritus and burning and/or pain according to a visual analog scale (VAS), a health-related quality of life score (Skindex-29), 20-MHz ultrasonography, and histopathological analysis before and after 3 months of therapy.. Fifteen patients were randomized in each treatment arm, and 2 patients dropped out in both treatment arms. After therapy, both therapies resulted in a significant decrease in mean TCS (51.4% [95% CI, 39.7% to 63.0%] for clobetasol ointment [P < .001] and 35.6% [95% CI, 18.2% to 53.1%] for UV-A1 phototherapy [P = .006]). No significant difference was found between both treatments (P > .05). The Skindex-29 (mean difference [MD], 29.6 [95% CI, 7.9 to 51.2] [P = .009]) and the VAS score for pruritus (MD, 4.6 [95% CI, 1.5 to 7.7] [P = .005]) and burning and/or pain (MD, 4.2 [95% CI, 1.9 to 6.6] [P = .001]) significantly decreased after clobetasol treatment. After UV-A1 phototherapy, the VAS score for burning and/or pain (MD, 3.2 [95% CI, 0.7 to 5.7] [P = .01]) was also significantly reduced; however, there was no significant reduction in pruritus (MD, 2.1 [95% CI, 0.5 to 3.7] [P = .16]) and in the Skindex-29 score (MD, 4.9 [95% CI, -12.6 to 22.4] [P > .99]). A significant reduction of the corium thickness and a significant increase in dermal density in 20-MHz ultrasonography as well as significant histopathological reduction of the inflammatory infiltrate was observed after clobetasol treatment but not after UV-A1 phototherapy.. Although resulting in a significant clinical improvement, UV-A1 phototherapy was inferior to the current gold standard treatment with topical high-potent corticosteroids with respect to practicability, relief of itch, and improvement in quality of life. UV-A1 phototherapy may be considered a potential second-line treatment for VLS.. clinicaltrials.gov Identifier: NCT01400022.

Topics: Adult; Aged; Aged, 80 and over; Clobetasol; Female; Glucocorticoids; Humans; Middle Aged; Ultraviolet Therapy; Vulvar Lichen Sclerosus; Young Adult

Vulvar lichen sclerosus is a chronic condition usually responsive to topical corticosteroids.. We sought to evaluate the efficacy (reduction of signs and symptoms) and safety of clobetasol propionate 0.05% and tacrolimus 0.1% in the treatment of vulvar lichen sclerosus.. This double-blind, randomized study comparing 2 treatments over a 3-month period, enrolled 58 female patients with newly diagnosed vulvar lichen sclerosus or untreated vulvar lichen sclerosus for at least 1 month.. In all, 55 patients were included in the statistical analysis. A total of 28 patients were assigned to the tacrolimus group and 27 patients to the clobetasol group. Both groups showed a significant difference in the decrease of symptoms and signs of lichen sclerosus. At the end of the study, 28 participants (19 tacrolimus and 9 clobetasol) still had some clinical signs of lichen sclerosus (χ(2) = 6.56, P = .015). However, a significantly higher number of patients in the clobetasol group (n = 15) had absence of signs and symptoms of lichen sclerosus (χ(2) = 10.35, P = .002; χ(2) = 10.35, P = .002). No adverse events were reported.. Short length of trial and recruitment through our vulvar disease referral center are limitations.. This study showed that topical clobetasol propionate was significantly more effective in treating vulvar lichen sclerosus than topical tacrolimus.

Topics: Administration, Topical; Adult; Clobetasol; Double-Blind Method; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Middle Aged; Ointments; Prospective Studies; Tacrolimus; Treatment Outcome; Vulvar Lichen Sclerosus

Lichen sclerosus (LS) is a lymphocyte-mediated chronic cutaneous disorder with a predilection for the vulva. The current gold standard treatment is topical ultrapotent corticosteroids such as clobetasol.. We sought to compare the safety and efficacy of clobetasol and pimecrolimus in the treatment of vulvar LS.. This double-blind, randomized trial enrolled 38 women with biopsy-proven vulvar LS. This study consisted of a 2-week screening period and a 12-week treatment period. The primary efficacy variable was the change in inflammation, as determined by a dermatopathologist, on the biopsy specimens obtained at screening and at the week 12 visit. Secondary efficacy variables included the change from baseline in pruritus and burning/pain as assessed by patients using a visual analog scale and a clinical evaluation by the investigator.. Clobetasol was found to be superior in improving inflammation when compared with pimecrolimus (P = .015). Both groups showed improvement in pruritus and burning/pain but this difference was not statistically significant (P = .32 and .93, respectively). Both clobetasol and pimecrolimus were found to be effective in decreasing both the total score on the Investigator Global Assessment (P = .001) and all 3 subscales. Serum levels of pimecrolimus and clobetasol did not approach levels of concern during the study period. No adverse events were reported.. This study was limited by the relatively short study duration.. Both clobetasol and pimecrolimus appear efficacious and well tolerated for the treatment of vulvar LS; however, clobetasol is more effective than pimecrolimus and should remain first-line therapy for LS.

Topics: Anti-Inflammatory Agents; Clobetasol; Double-Blind Method; Female; Glucocorticoids; Humans; Pain Measurement; Tacrolimus; Treatment Outcome; Vulvar Lichen Sclerosus

: The purpose of our study was to evaluate whether briefs made of Dermasilk fabric could be an adjuvant tool in the management of vulvar lichen sclerosus (LS).. : A controlled, randomized, double-blind study versus placebo was conducted, comparing Dermasilk versus standard cotton briefs in patients affected by LS during treatment with clobetasol propionate 0.05% ointment and vitamin E moisturizer. For each patient, an evaluation of objective genital signs and subjective symptoms typical of LS was recorded before the start of treatment, after 1 month, and after 6 months of the study. Statistical analysis was performed with SPSS 17.0 for Windows.. : Forty-two women affected by LS were recruited and divided into those wearing Dermasilk or cotton briefs. Patients wearing Dermasilk briefs showed a better improvement in the clinical symptoms of burning sensation, skin irritation, and pain (Fisher test, p < .0001) compared with the cotton placebo group. The improvement in itching was also faster in the Dermasilk group (Fisher exact test, p < .05). Erythema also showed a better improvement in the Dermasilk group (Fisher test, p < 0.05).. : Dermasilk fabric seems to be a useful adjunct to topical treatment in producing a better and more rapid control of symptoms in patients with LS.

Topics: Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Clothing; Cotton Fiber; Double-Blind Method; Female; Humans; Middle Aged; Placebos; Textiles; Treatment Outcome; Vitamin E; Vulvar Lichen Sclerosus

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

Lichen sclerosus (LS), a chronic inflammatory dermatosis localized in the anogenital region, is known to be associated with lower urinary tract symptoms (LUTS) in postmenopausal women; however, there is a paucity of data on prepubertal girls. We sought to characterize the relationship between LS, LUTS, and constipation among premenarchal girls.. We conducted a retrospective chart review of premenarchal girls presenting at the pediatric adolescent gynecology and pediatric urology clinics at our institution diagnosed with vulvar LS during a 4-year period. Demographics, clinical presentation, time from onset of urinary and/or bowel symptoms to LS diagnosis, and treatment response were assessed. Analysis was completed using median, range, and nonparametric statistical analysis where appropriate.. Nineteen premenarchal girls with LS met inclusion criteria. The median age at LS diagnosis was 6.2 years (range = 3.3-13.3 yrs). Most girls (12/19, 63.2%) presented with LUTS during LS evaluation, and 11 (57.9%) of 19 patients had constipation. Pruritus and hypopigmentation were the most frequently encountered LS symptom and sign, respectively. Fourteen (73.7%) of the 19 girls had resolution/improvement of LS symptoms after LS treatment. Of the 12 patients with LUTS, 7 (58.3%) had resolution/improvement of LUTS symptoms, 3 (25.0%) had unchanged voiding symptoms, and 2 (16.7%) had unknown changes.. Although further studies are needed to better characterize the relationship between LUTS, constipation, and LS, our findings suggest that premenarchal subjects presenting with LUTS should be assessed for LS. Likewise, patients presenting with LS should be assessed for LUTS and constipation.

Topics: Adolescent; Adrenarche; Child; Child, Preschool; Clobetasol; Connecticut; Female; Glucocorticoids; Humans; Retrospective Studies; Urinary Tract Infections; Vulvar Lichen Sclerosus

The objective of this study was to evaluate the efficacy of rescue fractional microablative CO2 laser treatment in women with severe symptoms and sexual dysfunction related to lichen sclerosus not responsive to long-term ultra-potent topical corticosteroid treatment.. Consecutive eligible women with lichen sclerosus referred to our unit who received fractional microablative CO2 laser treatment after failure of ultra-potent topical corticosteroid treatment were enrolled in the study. The diagnosis was confirmed by histological assessment in all cases. Patients underwent two cycles of CO2 laser every 30 to 40 days. The severity of lichen sclerosus-related symptoms, sexual function, and procedure discomfort were evaluated with a visual analog scale in the same individual at baseline, after completion of each treatment cycle. Follow-up visits were scheduled during each treatment cycle and at least 1 month after completion of the treatment. The Friedman ANOVA test was used to evaluate differences in the visual analog scale scores of each symptom during treatment.. A total of 100 patients with vulvar lichen sclerosus were screened, 40 of whom fulfilled the eligibility criteria. We found a significant improvement in vulvar itching (χ [2] = 31,182, P < 0.001), vulvar dryness (χ [2] = 40,364, P < 0.001), superficial dyspareunia (χ [2] = 37,488, P < 0.001), and sensitivity during intercourse (χ [2] = 22,143, P < 0.001) after two CO2 laser cycles. Pain related to probe movement and laser application was low and did not change significantly consequent to treatment. No systemic or local adverse effects occurred during or after laser treatment.. Fractional microablative CO2 laser treatment is safe and might represent an effective rescue procedure for patients suffering from lichen sclerosus who fail to respond to long-term ultra-potent topical corticosteroid treatment. These preliminary findings require further study with adequately powered randomized controlled trials.

Topics: Aged; Clobetasol; Female; Glucocorticoids; Humans; Lasers, Gas; Longitudinal Studies; Menopause; Middle Aged; Prospective Studies; Sexual Dysfunction, Physiological; Vulvar Lichen Sclerosus

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Betamethasone; Carcinoma in Situ; Carcinoma, Squamous Cell; Clobetasol; Desonide; Female; Humans; Hydrocortisone; Methylprednisolone; Middle Aged; Neoplasm Recurrence, Local; Vulvar Lichen Sclerosus; Vulvar Neoplasms

Lichen sclerosus is a chronic inflammatory dermatological condition with a predilection for the anogenital area.. We describe a case of iatrogenic Cushing syndrome from the administration of high-potency topical steroids for vulvar lichen sclerosus in a 6-year-old girl. Her symptoms resolved after the cessation of topical steroid treatment.. This case brings attention to iatrogenic Cushing syndrome as a potential complication when using high-potency topical corticosteroids in the anogenital region.

Topics: Administration, Topical; Child; Clobetasol; Cushing Syndrome; Female; Glucocorticoids; Humans; Vulvar Lichen Sclerosus

Topics: Aged; Anal Canal; Anti-Inflammatory Agents; Antineoplastic Agents, Immunological; Clobetasol; Female; Humans; Melanoma; Nivolumab; Perineum; Skin Neoplasms; Vulvar Lichen Sclerosus

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Candidiasis, Vulvovaginal; Clobetasol; Diflucortolone; Female; Herpes Genitalis; Humans; Middle Aged; Papillomavirus Infections; Telangiectasis; Time Factors; Vulvar Lichen Sclerosus; Young Adult

To compare the efficacy of the short-term application of clobetasol propionate 0.05% (CLB) and mometasone furoate 0.05% (MMF) in the treatment of vulvar lichen sclerosus (VLS).. This study was a retrospective review of 96 women who were diagnosed with lichen sclerosus with a follow-up of at least 1 year. Of these 96 women, 47 were treated with the topical application of CLB and 49 were treated with the topical application of MMF. All patients received treatment for 8 weeks. The drug was administered once daily for 4 weeks and then twice weekly for another 4 weeks in combination with a moisturizing cream that was continued as maintenance therapy. Subsequently, a topical steroid was applied on an as-needed basis if symptoms recurred. Follow-up visits were scheduled at 3, 6, and 12 months. The primary endpoint was the clinical response of the patients.. A mean of 77.3% of the patients were defined as responders at the 12-month observation, without any significant difference between the 2 treatment groups (CLB mean 73% vs MMF mean 81.6%, p = .2). A pronounced improvement in itching was observed after 3 months of treatment in the MMF group (p = .04), whereas the other symptoms were not significantly different between the 2 groups.. This study indicates that CLB 0.05% and MMF 0.1% in a short protocol regimen are effective, safe, and reliable treatments for VLS, with no significant difference between the 2 steroids in their efficacy. However, a moisturizing cream should be an integral part of the treatment.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Dermatologic Agents; Female; Follow-Up Studies; Humans; Middle Aged; Mometasone Furoate; Retrospective Studies; Treatment Outcome; Vulvar Lichen Sclerosus

Treatment of vulvar lichen sclerosus (VLS) in children by topical corticosteroids gives control of symptoms and some resolution of physical signs, but large studies are limited. We report the largest study of 72 prepubertal girls with VLS, 62 of whom were prospectively treated with daily application of an ultrapotent topical corticosteroid (UPTC), clobetasol propionate 0.05% ointment, for 3 months, with a follow-up period of 4-8 years [the remaining 10 patients responded to mild to moderate potency topical corticosteroids (MPTCs)]. The results were compared with a retrospective study of 31 prepubertal girls with VLS treated with MPTCs. MPTCs led to symptom clearance in 32.2% of patients, whereas UPTC led to symptom clearance in 72.6% of patients. Improvement in clinical signs following UPTC occurred in 90.3% of children at 3 months, with total resolution of clinical signs occurring in 29.2% at the 4-year follow-up or at puberty. No serious adverse effects occurred with UPTC treatment. In children with VLS, UPTCs relieve symptoms, resolve signs and possibly prevent scarring. UPTCs should therefore be the treatment of choice for VLS in children.

Topics: Administration, Topical; Adolescent; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Female; Glucocorticoids; Humans; Male; Prospective Studies; Vulvar Lichen Sclerosus

The objective of this work was to survey physician members and fellows of the International Society for the Study of Vulvovaginal Disease to determine current expert opinion regarding the management of adult vulvar lichen sclerosus.. A cross-sectional design was used. An electronic survey was emailed to all members and fellows of the International Society for the Study of Vulvovaginal Disease. Responses were analyzed using univariate methods. Subgroup analyses were performed to report treatment differences between gynecologists and dermatologists and between physicians in the United States and Europe.. In total, 128 (42%) of 305 providers responded to the survey. Analysis was confined to the 114 physician respondents who treat patients with lichen sclerosus. Clobetasol propionate 0.05% is the most common first-line agent used in lichen sclerosus (85%). The most common second-line agents used are tacrolimus (39%), other topical steroids (28%), and intralesional steroids (13%). Most physicians (59%) start all patients with lichen sclerosus on drug therapy at an initial visit, regardless of symptoms. Dermatologists are more likely to treat all patients (both symptomatic and asymptomatic) than gynecologists (p < .01). Most physicians (64%) continue maintenance therapy in all patients. Gynecologists are more likely than dermatologists to treat only when patients are symptomatic versus using maintenance therapy (p = .03). Physicians practicing in the United States are more likely than those practicing in Europe to treat all patients with maintenance therapy (p < .01).. Lichen sclerosus management varies among experts. Variations exist between physician specialties and between those practicing in different geographic locations. Uncertainty regarding optimal treatment remains, especially regarding long-term management.

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Dermatology; Europe; Female; Gynecology; Health Surveys; Humans; Immunosuppressive Agents; Internet; Physicians; Societies, Medical; Steroids; Tacrolimus; United States; Vulvar Lichen Sclerosus

Topics: Clobetasol; Dermatologic Agents; Female; Humans; Mometasone Furoate; Vulvar Lichen Sclerosus

To help determine the long-term course of girls diagnosed with lichen sclerosus before puberty.. Retrospective chart review and follow-up interview.. Washington University pediatric gynecology and dermatology clinics.. Premenarchal girls diagnosed with lichen sclerosus from 1989-2010.. Telephone interview.. Resolution of symptoms, specifically pain and/or pruritus.. Follow-up was available for 36 premenarchal girls. The mean age at lichen sclerosus (LS) diagnosis was 7 years (range: 3-14 years). The mean duration of follow-up was 5.3 years (range: 2 months-15 years). Treatment with topical steroids (primarily 0.05% clobetasol propionate ointment) resulted in improvement in symptoms within an average of 14 weeks (range: 2 weeks-2 years) in 33 girls. Eighty-three percent of patients (n = 30) experienced remission after initial treatment. Sixteen patients reported relapses requiring an average of 3.1 years of intermittent maintenance therapy. The mean length of remission to date was 3.6 years (range 1 months-10 years). 72% of patients reported remission at the time of the phone interview. Of note, 7 out of 9 patients in our study who continue to report symptoms are still premenarchal. One postmenarchal patient was asymptomatic but had signs of LS on physical exam.. The prognosis and long term course of LS diagnosed prior to puberty is unclear. Although remission may occur prior to menarche in some cases, once children reach menarche with active disease, complete remission may be less likely. Treatment duration of LS in our study had a wide range, but 3 months appears to be adequate for most patients to obtain remission.

Topics: Adolescent; Adult; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Female; Follow-Up Studies; Humans; Hydrocortisone; Maintenance Chemotherapy; Menarche; Ointments; Recurrence; Remission Induction; Retrospective Studies; Time Factors; Vulvar Lichen Sclerosus; Young Adult

Lichen sclerosus is a commonly misdiagnosed disease that is characterized by thinned, hypopigmented, crinkled skin that often forms a figure-eight shape around the vaginal and anal openings. We present a case of advanced lichen sclerosus in a 53-year-old female patient prescribed a nonsteroidal aromatase inhibitor after the excision of a breast cancer tumor. We present a diagnostic approach to lichen sclerosus by recognizing its common figure-eight pattern, and we review the known causes and treatment of lichen sclerosus. Research has shown that lichen sclerosus is more common in low estrogen states, and thus it is logical that aromatase inhibitors could increase a patient's risk for developing this disease. We therefore propose that all patients prescribed aromatase inhibitors undergo regular vulvo-vaginal exams to rule out lichen sclerosus and other hypoestrogen-related vulvo-vaginal problems.

Topics: Anastrozole; Antineoplastic Agents, Hormonal; Aromatase Inhibitors; Breast Neoplasms; Clobetasol; Drug Eruptions; Female; Glucocorticoids; Humans; Middle Aged; Nitriles; Triazoles; Vulvar Lichen Sclerosus

Women with lichen sclerosus (LS) are more likely to have dyspareunia, decreased orgasm, and decreased coital frequency as compared to unaffected women. It is unknown whether standard medical therapy to treat LS results in improved sexual functioning.. To describe sexual function in women with LS and to assess if LS-associated sexual dysfunction decreases after appropriate medical therapy.. Women enrolled in a double-blind trial 12-week trial comparing clobetasol vs. pimecrolimus for the treatment of LS were administered the Female Sexual Distress Scale (FSDS) upon enrollment and at the end of the trial. The difference in the total score on the FSDS between the two groups before and after treatment was assessed with a paired t-test.. The change in mean FSDS score from baseline to 12 weeks.. A total of 31 out of 36 enrolled women had adequate treatment of LS as determined by a dermatopathologist's evaluation of pre and post-treatment biopsy specimens. The mean baseline FSDS score for the clobetasol group was 29 and, post-treatment, it was 15 (P=0.001). In the pimecrolimus group, the mean baseline FSDS score was 27 and, post-treatment, it was 21 (P=0.001).. Despite adequate treatment, women with LS continue to have significant sexual dysfunction as assessed by the FSDS.

Topics: Anti-Inflammatory Agents; Clobetasol; Dyspareunia; Female; Humans; Prospective Studies; Randomized Controlled Trials as Topic; Sexual Behavior; Sexual Dysfunctions, Psychological; Tacrolimus; Vulvar Lichen Sclerosus

This study investigates the health-related quality of life in patients with vulvar lichen sclerosus (LS) and the patient-defined therapeutic benefit of clobetasol.. A survey analysis of 96 women with LS after treatment with clobetasol was performed. Quality of life was assessed with the Skindex-29. The Patient Benefit Index (PBI) was used to determine the therapeutic benefit.. The overall response rate was 59.2%. Quality of life was most impaired by somatic symptoms (scale 'Symptoms' score 3.2) and emotional stress (scale 'Emotions' score 3.1), while social interactions (scale 'Functioning' score 1.9) played an inferior role (p < 0.001). Primary therapeutic goals 'to have confidence in the therapy' and 'to be free of itching' were achieved in 73.2 and 69.0% of patients who indicated the goal applied to them. The global PBI score was 3.06. In 93.2% of patients it was >1, indicating a potential benefit from clobetasol.. Topical clobetasol is of potential therapeutic benefit for patients with vulvar LS and might therefore improve quality of life.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Anti-Inflammatory Agents; Chronic Disease; Clobetasol; Emotions; Female; Humans; Middle Aged; Patient Satisfaction; Quality of Life; Social Participation; Surveys and Questionnaires; Vulvar Lichen Sclerosus; Young Adult

Vulvar lichen sclerosus is a chronic dermatitis which is located in labial, perineal and perianal areas. The etiology of lichen sclerosus is multifactorial including genetic, autoimmune, hormonal and infectious aspects.. A retrospective analysis was carried out of the medical records of 82 patients who were suffering from pruritus vulva. All patients had vulvar biopsy-proven diagnosis of lichen sclerosus.. Sixty-six of patients (80.4%) were in the postmenopausal period and 16 patients (19.5%) were in the premenopausal phase. Fifteen patients (18.2%) had thyroid disease, six had (7.3%) diabetes mellitus, five had (6.09%) asthma and five patients had (6.09%) other autoimmune diseases. Lichen sclerosus was most commonly located on the labia majora--58 cases (70.7%). Sixty-four patients (78.04%) had used only potent corticosteroid therapy as the sole treatment.. The first-line treatment is topical-potent or ultra-potent corticosteroids in the treatment of lichen sclerosis. Vulvar lichen sclerosis may be associated with autoimmune and thyroid diseases.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Clobetasol; Cohort Studies; Drug Administration Schedule; Female; Humans; Middle Aged; Retrospective Studies; Vulvar Lichen Sclerosus

Lichen sclerosus is found in children with an estimated prevalence of at least 1 in 900. Pigmentation in lichen sclerosus is infrequent and melanocytic proliferations in lichen sclerosis are rare and difficult to interpret. In this report, we describe the case of a prepubertal girl presenting with a junctional melanocytic nevus of the labia minora superimposed by lichen sclerosus. The lesion was completely excised and free margins confirmed by histological examination. After a 3 months course of topical clobetasol treatment the girl remained asymptomatic. No local recurrence was notified with a follow-up time of 12 months.

Topics: Biopsy; Child; Clobetasol; Female; Glucocorticoids; Histocytochemistry; Humans; Melanocytes; Nevus, Pigmented; Vulvar Lichen Sclerosus

Topics: Adult; Clobetasol; Female; Glucocorticoids; Humans; Vitiligo; Vulvar Lichen Sclerosus

For vulvar Lichen sclerosus (LS) immunological factors, genetic predisposition, and decreased 5 alpha-reductase activity have been discussed as aetiological factors. During the last decade an increase of LS in young women has been suspected. Aim of this study was to evaluate data of premenopausal women with early onset LS to find potential risk factors focussing on the use of oral contraceptives.. We retrospectively analyzed the data of 40 premenopausal patients with early onset LS regarding use of oral contraceptives (OCPs), and first occurrence of LS. To compare these data in a case-control study we analyzed a matched control group of 110 healthy women.. All our LS patients were using OCPs compared to 73 women (66.4%) in the control group. OCPs with anti-androgenic activity (chlormadinone acetate, cyproterone acetate, dienogest, and drospirenone) were used by 28 (70%) of the LS patients and by 35 (47.9%) of the 73 women using OCPs in the control group. Thus, the odds ratio for early onset LS for women using anti-androgenic OCPs was 2.53 (95% CI: 1.12-5.75).. Our data suggest that disturbance of the androgen dependent growth of the vulvar skin by OCPs and especially by OCPs with anti-androgenic properties might trigger the early onset of LS in a subgroup of susceptible young women.

Topics: Adjuvants, Immunologic; Adolescent; Adult; Aminoquinolines; Androgen Antagonists; Androstenes; Case-Control Studies; Chlormadinone Acetate; Clobetasol; Contraceptives, Oral; Cyproterone Acetate; Female; Glucocorticoids; Humans; Imiquimod; Incidence; Nandrolone; Premenopause; Progesterone; Retrospective Studies; Risk Factors; Treatment Outcome; Vulvar Lichen Sclerosus

To compare the effects of topical testosterone and clobetasol treatments on symptoms remission and recurrence rates in patients with vulvar lichen sclerosus (LS).. A retrospective review of the records showed that, of 140 patients with biopsy-proven vulvar LS, 80 were treated with applications of testosterone propionate 2% in petrolatum and 60 with clobetasol 17-propionate 0.05%.. The response rates after 6 months were 77.5% for patients treated with testosterone and 91.7% for those treated with clobetasol (P=0.02). The recurrence rates were 20% and 6.7% in the 2 groups, respectively (P=0.02). Premenopausal patients had higher remission rates and lower recurrence rates than postmenopausal patients (P>0.05). Considering whole patients, low remission rates and high recurrence rates were observed in patients who had had a hysterectomy (P>0.05).. Treatment of LS with a corticosteroid provided excellent remission rates. In this study, clobetasol 17-propionate 0.05% was superior to testosterone for both remission induction and maintenance therapy.

Topics: Administration, Topical; Adult; Androgens; Clobetasol; Female; Glucocorticoids; Humans; Middle Aged; Recurrence; Retrospective Studies; Testosterone Propionate; Vulvar Lichen Sclerosus

Lichen sclerosus (LS) is a chronic inflammatory disease of skin and mucosal surfaces which is generally difficult to treat.. We evaluated the efficacy of oral cyclosporine in refractory vulvar LS.. Five patients with refractory vulvar LS were treated with oral cyclosporine (3-4 mg/kg/d) for 3 months. They were followed up on a monthly basis.. At the end of the treatment, the mean total symptom score regressed significantly and clinical findings such as erythema and erosion showed marked improvement. Mild adverse effects were seen in 3 patients.. The patients did not give consent to rebiopsy at the end of the treatment.. Moderate dose of oral cyclosporine could be an effective alternative in the treatment of refractory vulvar LS.

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Cyclosporine; Female; Follow-Up Studies; Humans; Middle Aged; Ointments; Retrospective Studies; Treatment Outcome; Vulvar Lichen Sclerosus

To evaluate the therapeutic regimens and symptomatic response rates in patients with vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia (mixed disease).. Eighty-three women with biopsy-proven vulvar mixed disease were evaluated for this retrospective study. All patients were initially treated with topical fluorinated corticosteroids, and then 2% testosterone propionate in petrolatum or 0.05% clobetasol 17-propionate (44 (53%) versus 39 (47%)).. The remission rates were 82 and 93% in the testosterone and clobetasol subgroups at the end of 6 months (p=0.112), respectively. The disease recurred in 8% of the patients. The recurrence rates in the testosterone and clobetasol arms were 13 and 5%, respectively (p=0.163). The histopathological review of the repeat vulvar biopsies of the patients without symptomatic relief revealed 6 (60%) patients with persistent disease, 2 (20%) with lichen sclerosus, 1 (10%) with atypical squamous hyperplasia, and 1 (10%) with VIN1. Two patients with recurrent disease and 2 patients with vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia were treated with skinning vulvectomy.. Clobetasol resulted in higher remission and lower recurrence rates than those in testosterone therapy, although statistically significant differences were not obtained. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.

Topics: Adult; Aged; Aged, 80 and over; Clobetasol; Female; Glucocorticoids; Humans; Hyperplasia; Middle Aged; Retrospective Studies; Secondary Prevention; Testosterone Propionate; Vulvar Lichen Sclerosus

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

Topics: Administration, Topical; Child; Clobetasol; Female; Follow-Up Studies; Humans; Vulvar Lichen Sclerosus