Ultrapotent Topical Corticosteroid Treatment of Childhood Genital Lichen Sclerosus

Abstract

To observe the clinical effects of shortterm application of ultrapotent topical corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients.Design: Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent topical corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years. Setting: Pediatric dermatology clinic (referral center).Patients: Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus.Intervention: Topical ultrapotent corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks.Main Outcome Measure: Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms.Results: All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent topical corticosteroid. No significant adverse effects were noted after the initial 6-to 8-week course of therapy or during the 6-month to 3-year follow-up period. Conclusion:A 6-to 8-week course of ultrapotent topical corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.

Phototherapy of Sclerosing Skin Diseases

“…Therefore, we consider PUVA bath photochemotherapy or medium-dose UVA1 phototherapy as first-line therapy of localized scleroderma and topical steroids as first-line therapy of extragenital or genital lichen sclerosus. The same rules apply to the treatment of children [21], especially as localized scleroderma may cause constrictions [5]. The data reported here and earlier [16, 17, 18]suggest that selected patients with lichen sclerosus may profit from either cream PUVA or UVA1.…”

Paediatric vulval lichen sclerosus

“…42 In a similar small cohort, American researchers demonstrated the effectiveness of a 6-8 week course of twice daily high-potency topical corticosteroids. 43 More recently, it has been confirmed by a large study of 327 patients, which included 74 girls, that ultrapotent topical corticosteroids are an effective treatment for vulval LS, relieving symptoms in most and completely reversing the skin changes in 23% of patients. 44 In this study, patients were treated for a minimum of 3 months with potent topical corticosteroids, including clobetasol propionate 0.05%, betamethasone 0.1% and clobetasone butyrate 0.05%.…”

Frequency of balanitis xerotica obliterans among boys with phimosis

“…Balanitis xerotica obliterans, lichen sclerosus, fimoza used as a therapy for BXO represent ultra potent corticosteroids, such as Clobetasol, Diflorasone and Betamethasone (8). Surgical treatment depends on the progression of the disease.…”