Vulvar Lichen Sclerosus

Abstract

Background: Lichen sclerosus is an inflammatory disease of unknown etiology affecting the anogenital skin and associated with the development of squamous cell carcinoma. It is not known whether long-term topical treatment with a potent steroid can cure this disease and thus prevent malignant evolution.Objectives: To analyze the rates of remission, recurrence, and chronic evolution of vulvar lichen sclerosus (VLS) treated with 0.05% clobetasol propionate ointment and determine whether this treatment can decrease the risk of malignant evolution.Design: Prospective study, conducted between 1981 and 2001, of 83 women with VLS who were treated until complete clinical and histologic remission and followed up for evidence of clinical and histologic recurrence (median follow-up, 4.7 years).Setting: Dermatology department of a large urban teaching hospital. Results: Complete remission was obtained in 45 patients (54%). The probability of remission was sig-(REPRINTED) ARCH DERMATOL / VOL 140, JUNE 2004 WWW.ARCHDERMATOL.COM

Genital Lichen Sclerosus in Male Patients: A New Treatment with Polydeoxyribonucleotide

“…A review of the literature highlighted that steroids, considered the gold standard for treating LS, were effective only for short periods of time and featured a high percentage of relapses during the long-term follow-up period (50-80%) [18,19,20]. Chronic treatment with a steroid could moreover cause serious side effects that at times were even serious, such as skin atrophy, rebound effects, fungal infections, re-activation of the papilloma virus (HPV), infections due to the Herpes simplex virus and systemic absorption [24,29].…”

“…The standard pharmacological treatment is based on the use of topical steroids, which have proved their efficacy in 60-70% of cases but with a high rate of relapses in time (50-80% of the patients of both sexes) [18,19,20]. The topical calcineurin inhibitors pimecrolimus and tacrolimus have a significant anti-inflammatory activity, immunomodulatory effects and a low systemic immunosuppressive potential; however, they are off-label and considered dangerous to develop tumours [21,22].…”

Health-Related Quality of Life and Patient-Defined Benefit of Clobetasol 0.05% in Women with Chronic Lichen Sclerosus of the Vulva

“…To date there are no other studies regarding the patient-defined therapeutic benefit of treatment interventions in LS. Marked benefit in terms of symptoms control has been shown for clobetasol and calcineurin inhibitors [4,13,14,42,43,44,45]. There is one randomized trial comparing the calcineurin inhibitor pimecrolimus with clobetasol, demonstrating superiority of clobetasol [46].…”

BritishAssociation ofDermatologists' guidelines for the management of squamous cell carcinomain situ(Bowen's disease) 2014

“…Lack of circumcision, HPV, 150 infection and genital lichen sclerosus [151][152][153][154] are important risk factors in all forms of PIN. 147,155 Circumcision is therefore an essential component of the management of most cases of PIN. 147 PIN that is associated with HPV tends to be more undifferentiated, and histologically associated with full-thickness dysplasia (bowenoid), while PIN associated with lichen sclerosus is differentiated, and can therefore be more subtle histologically and easily overlooked on histopathology.…”

“…147 PIN that is associated with HPV tends to be more undifferentiated, and histologically associated with full-thickness dysplasia (bowenoid), while PIN associated with lichen sclerosus is differentiated, and can therefore be more subtle histologically and easily overlooked on histopathology. 155 There are increasing reports of PIN in association with biologics for the treatment of rheumatology and dermatology patients. 156 Treatment can be difficult, especially in cases with urethral involvement.…”