clobetasol and Vulvar-Neoplasms

Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma that can affect the vulval skin. Surgical excision is the gold-standard treatment, however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects. We describe one of the largest case series to-date (n = 6) on the use of topical 5% imiquimod cream as a novel treatment option and discuss our experiences. With the addition of our six cases to the literature, there are now 29 documented cases of vulval EMPD treated with 5% imiquimod cream. Of these, 50% of primary disease cases and 73% of recurrent primary disease cases have achieved clinical resolution with 5% imiquimod therapy alone. These findings suggest that imiquimod provides a viable alternative to surgical excision for vulval EMPD. However, we acknowledge that this is a simple retrospective analysis and that treatment scheduling and follow-up needs investigation in a trial setting.

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Aminoquinolines; Anti-Inflammatory Agents; Antineoplastic Agents; Clobetasol; Female; Humans; Imiquimod; Middle Aged; Paget Disease, Extramammary; Vulvar Neoplasms

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

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

Topics: Biopsy; Clobetasol; Crohn Disease; Dermatologic Agents; Female; Glucocorticoids; Humans; Lymphangioma; Middle Aged; Skin; Treatment Outcome; Vulvar Neoplasms

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

Topics: Administration, Topical; Anti-Inflammatory Agents; Biopsy; Carcinoma in Situ; Clobetasol; Diagnosis, Differential; Female; Humans; Middle Aged; Plasma Cells; Vulvar Neoplasms; Vulvitis

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

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; 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

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

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