Treatment of vulvovaginal erosive and stenosing lichen planus by surgical dilatation and methotrexate

Abstract

We treated five patients with stenosing lichen planus [LP] of the vulvovaginal region with methotrexate supplemented with ultrapotent corticosteroid cream and tacrolimus, in combination with surgical dilatation. All patients experienced long-term symptom relief, and there was only minimal or moderate re-stenosing of the vagina on follow-up for 2-41 months.

Lichen Sclerosus and Lichen Planus in Women and Girls

“…51 In a retrospective selfadministered survey, 11 women who had undergone surgery for VVLP-associated adhesions, 55% of patients were able to engage in sexual intercourse and were sexually active, whereas 75% had decreased urinary symptoms or infections. All patients reported symptomatic relief and only minimal to moderate restenosis of the vagina after 2 to 41 months.…”

Non‐Infective Cutaneous Conditions of the Vulva

“…Isolated surgical procedures will not help and will invariably lead to further scarring of the vagina. In a small series of five patients, improvement was seen after treatment with topical steroids, tacrolimus ointment, methotrexate and surgical dilatation (Kortekangas-Savolainen & Kiilholma 2007). Regular sexual intercourse will help to preserve patency, but is often impractical because of dyspareunia.…”

Treatment of erosive vulvovaginal lichen planus with methotrexate

“…15 In another case series, the combination of oral methotrexate 7.5 mg once weekly supplemented with local ultrapotent corticosteroid cream and tacrolimus, together with surgical dilation was effective in the treatment of five patients with severe erosive and stenosing vulvovaginal LP. 16 In a retrospective study, oral methotrexate 2.5-12.5 mg once weekly was found to have substantial activity in erosive oral LP, particularly in those patients with treatment refractory and aggressive disease. 17 In all of these studies, low doses of methotrexate were used with marked improvement in genital and/or oral symptoms supported by physical findings.…”

“…7,13 Three publications have suggested that methotrexate might have some promise in managing this debilitating condition. [15][16][17] Although the aetiology of LP is unknown, an autoimmune pathogenesis is postulated with activated T-cells directed against basal keratinocytes. 18 On this basis, methotrexate would be helpful in the treatment of this condition through down-regulation of an immunologically mediated mucosal response.…”