Treatment of vulvar lichen sclerosus with topical corticosteroids in children: a study of 72 children

Abstract

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.

Evidence‐based (S3) Guideline on (anogenital) Lichen sclerosus

“…Furthermore, Casey et al published that ultra-potent steroids were superior to mid-potent topical steroids in the treatment of LS in children. 5 It is a matter of quantity and frequency, a potent topical steroid will have a similar effect and adverse effect to ultra-potent topical steroids if used in higher quantities and frequencywe propose that a physician must be familiar with a particular regimen which he or she will be able to explain to patientsin any case it needs to meet the individual needs of a patient's disease.…”

Lichen Sclerosus—Presentation, Diagnosis and Management

“…Lichen sclerosus is typically a lifelong disease. When lichen sclerosus begins in childhood, permanent remission in puberty cannot be expected with certainty (14,34). Disease activity appears to be reduced in puberty.…”

The treatment of vulval lichen sclerosus in prepubertal girls: a critically appraised topic

“…We then subdivided the papers into groups according to the treatment used. Twenty-one studies included topical steroids 2,6,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and eight used other topical treatments. 27,[30][31][32][33][34][35][36] One study included patients treated with both topical steroids and calcineurin inhibitors.…”

“…Case series The largest series of 62 patients 16 treated once daily with CP 0Á05% for 3 months showed 97% and 90% improvement in symptoms and signs, respectively. In total 37% required some intermittent maintenance treatment, but this was usually less than once weekly.…”

“…A retrospective cohort of 31 patients used hydrocortisone 1% or clobetasone butyrate 0·05% . This regimen caused clearing of the LS in 32% of patients at 3 months, but no comparative analysis between the two preparations was conducted.…”