Tacrolimus ointment for the treatment of vulvar lichen sclerosus

Assmann, Till; Becker‐Wegerich, P.; Grewe, Markus; Megahed, Mosaad; Ruzicka, Thomas

doi:10.1067/mjd.2003.8

Cited by 81 publications

(81 citation statements)

References 15 publications

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“…[9][10][11] Should tacrolimus prove to be as effective as a class 1 superpotent topical steroid, it will offer a tremendous advantage because of the absence of side effects. However, additional trials of tacrolimus in LS patients and careful surveillance of their course are needed to determine if this drug will cure, maintain remission, or only be effective for short-term use.…”

Section: Discussionmentioning

confidence: 99%

Constipation as a Feature of Anogenital Lichen Sclerosus in Children

Maronn

Esterly

2005

Pediatrics

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Results. Eighteen of 24 questionnaires were completed and returned. The average age of onset of LS was 4.2 years, but average age at diagnosis was 5.2 years; only 1 patient was diagnosed correctly by her primary care physician. Itching was the most common symptom (78%). Severe constipation was reported in 67% of patients, and 89% had at least 1 gastrointestinal complaint (bleeding with bowel movements, fissuring, soiling, fecal impaction, or constipation).Conclusions. L ichen sclerosus (LS) is an uncommon inflammatory disorder that can occur at any age, but has a predilection for the vulvar skin of prepubertal girls and postmenopausal women (Fig 1). It is an eruption, the typical appearance of which is an ivory-white, sharply demarcated figure-8 pattern encircling the vagina and anus. It begins as papules containing a central depression and often coalesces into plaques. The skin surface may appear finely wrinkled or have purpuric spots, fissures, and erosions. Although less common, lesions may also present extragenitally. An often-unappreciated sign of LS, extremely distressing to these children, is severe constipation, which is unrelieved by standard treatment measures.During the past 2.5 years we have seen 24 girls with LS in the pediatric dermatology clinic at the Medical College of Wisconsin (Milwaukee, WI). A significant number of their parents have expressed considerable anger and frustration due to the failure of their physicians to recognize the association between severe constipation and LS, resulting in a long delay in diagnosis. The English-language literature, including major textbooks of medicine, pediatrics, obstetrics and gynecology, and dermatology, fail to mention constipation as a feature of LS. By reporting our experience with these patients, we hope to bring this association to the attention of primary care physicians. We asked about timing of complaints in relation to actual diagnosis of LS. The questionnaire also focused on specific signs and symptoms, diagnosis, and specialists consulted for the problem. RESULTSOf the 24 surveys mailed, 18 (75%) were completed and returned.The patients ranged in age from 4 to 17 years (mean: 8 years). The average age at onset of symptoms was 4.2 years, but the average age at diagnosis was 5.2 years. There was a time lag of ϳ1 year from onset of signs and symptoms until diagnosis of LS, the longest interval being 3 years. Only 1 patient was diagnosed by a primary care physician (a family practitioner). Two children were diagnosed in a hospital pediatric gastrointestinal (GI) clinic, and a pediatric dermatologist diagnosed all others. Efforts to obtain a diagnosis also prompted families to make multiple visits to pediatricians, gynecologists, and pediatric general and vascular surgeons. Table 1 lists the signs and symptoms of LS in our patients and indicates those that were most bothersome. Itching was the most common complaint, but GI-related complaints were also quite prevalent. Twelve of 18 patients had constipation, and 9 had perianal fissuring. Eleven o...

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Section: Discussionmentioning

confidence: 99%

Constipation as a Feature of Anogenital Lichen Sclerosus in Children

Maronn

Esterly

2005

Pediatrics

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“…It is possible that topical calcineurin inhibitors such as tacrolimus ointment, which produce less skin atrophy, may play a role in the treatment of LS in the future. [24][25][26] The theoretical disadvantage of topical calcineurin inhibitors is an increased risk of malignant transformation due to local immunosuppression.…”

Section: Commentmentioning

confidence: 99%

Does Treatment of Vulvar Lichen Sclerosus Influence Its Prognosis?

Cooper¹,

Gao²,

Powell³

et al. 2004

Arch Dermatol

236

242

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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.Design: Descriptive cohort study with a mean follow-up of 66 months. Setting:The vulvar clinics of a teaching hospital and of a district general hospital in Oxfordshire, England.Patients: 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.Main Outcome Measures: 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. Results: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 (PϽ.001). Squamous cell carcinoma developed in 6 women (2.4%). Conclusion: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.

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“…47 In 2006, a multicentre research group released the results of their phase II trial to assess the safety and efficacy of tacrolimus ointment 0.1% for the treatment of LS. 48 They had 84 patients (49 women, 32 men and three girls) aged between 5 and 85 years with longstanding, active LS, who were treated with topical tacrolimus ointment 0.1% twice daily.…”

Section: Other Topical Therapiesmentioning

confidence: 99%

Paediatric vulval lichen sclerosus

Smith

Fischer

2009

Aust J Dermatology

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Lichen sclerosus (LS) in children is uncommon; however, it is an important differential diagnosis in any pre-pubertal child presenting with chronic vulval symptoms. The long-term prognosis is unknown; however, recent data suggests that the assumption that the condition will resolve at puberty may be incorrect. Children with LS require long-term management with topical corticosteroids, which remains the treatment of choice, as well as long-term follow up. We review the current literature on paediatric vulval LS.

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Tacrolimus ointment for the treatment of vulvar lichen sclerosus

Cited by 81 publications

References 15 publications

Constipation as a Feature of Anogenital Lichen Sclerosus in Children

Constipation as a Feature of Anogenital Lichen Sclerosus in Children

Does Treatment of Vulvar Lichen Sclerosus Influence Its Prognosis?

Paediatric vulval lichen sclerosus

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