ro13-9904 and Lichen-Sclerosus-et-Atrophicus

Current therapy for lichen sclerosus centers on topical steroids, particularly clobetasol propionate. As some evidence suggests an infectious etiology owing to Borrelia, we studied the effect of penicillin and cephalosporin therapy on patients with lichen sclerosus who had responded poorly to treatment with potent topical corticosteroids. Fifteen patients with lichen sclerosus were treated for 3-21 months with either penicillin or cephalosporins in an observational study. Thirteen patients (nine women, four men) received penicillin, including intramuscular penicillin G benzathine suspension and/or oral penicillin V potassium, amoxicillin, or amoxicillin/clavulanate potassium. Two additional men received cephalosporins, either intramuscular ceftriaxone sodium or oral cefadroxil monohydrate. All patients showed a significant response, evident within a few weeks. Most striking was the rapid relief of pain, pruritus and burning. Four patients cleared completely, four experienced marked improvement, and the remaining seven had a favorable improvement of symptoms with incomplete clearing of lesions. We recommend treatment of lichen sclerosus with either intramuscular ceftriaxone every 3 weeks or intramuscular penicillin every 2-3 weeks. The addition of oral penicillin or cephalosporin presumably helps maintain antibiotic blood levels and may be a sufficient treatment in some cases.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefadroxil; Ceftriaxone; Cephalosporins; Humans; Injections, Intramuscular; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Penicillins; Retrospective Studies; Skin; Time Factors; Treatment Outcome

We report on a case of chronic cutaneous borreliosis with manifestations clinically compatible with morphea and lichen sclerosus et atrophicus. The histopathologic features of these lesions were those of acrodermatitis chronica atrophicans. Our case illustrates the concept that clinical aspects of morphea and lichen sclerosus et atrophicus pertain to the spectrum of cutaneous borreliosis.

Topics: Abdomen; Aged; Aged, 80 and over; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; Chronic Disease; Diagnosis, Differential; Female; Humans; Lichen Sclerosus et Atrophicus; Lyme Disease; Scleroderma, Localized