Combining topical tretinoin with mometasone furoate in the treatment of vulvar lichen sclerosus: Results of dermoscopic assessment

Abstract

The main purpose of the present study was to compare the dermoscopic changes on vulvar lichen sclerosus (VLS) induced by two different 12‐week treatment protocols, namely mometasone furoate 0.1% ointment plus tretinoin 0.05% cream in short‐contact therapy (group A) versus the same corticosteroid plus emollient (group B). All dermoscopic images captured before and after treatment were assessed. Each dermoscopic variable selected for the study purpose was arbitrarily graded according to a 4‐point scale by dermatologists blinded to both the time at which the images were captured and treatment allocation. Seventeen patients in group A and 15 in group B were included. The vessel mean dermoscopic scores increased significantly after treatment, whereas the scores of (a) patchy, structure‐less, whitish areas, (b) whitish background, (c) comedo‐like openings, and (d) purpuric blotches decreased. At the control visit, the two protocols did not differ significantly for any of the dermoscopic parameters, both in terms of mean score change and in the number of patients showing changes. Although the complementary action of the two molecules may suggest a therapeutic benefit, the association of tretinoin in short contact therapy with a potent corticosteroid did not induce significant changes in the dermoscopic features of VLS compared with the same corticosteroid alone.

Dermoscopy of genital diseases: a review

“…Genital lichen sclerosus is a chronic inflammatory, immune‐mediated disease which is a recognized precursor of genital cancer 51–53 . Dermoscopy has been reported extensively in both sexes 22,54–60 . Whitish background and patchy structureless areas, varying in colour from white‐yellowish to milky‐pinkish, are the most prevalent dermoscopic features (Fig.…”

The effect of vulvar lichen sclerosus on quality of life and sexual functioning

“…It has a bimodal age distribution; its incidence peaks at prepubertal and postmenopausal ages. Even though several environmental and genetic factors were accused, it is believed that autoimmunity and chronic inflammation play essential roles in its pathogenesis [8][9][10]. Karadag et al [11] investigated 350 LS patients, 98% of which had vulvar involvement, and reported that autoimmune antibodies (anti-thyroid, anti-nuclear, anti-mitochondrial antibodies) were detected in 22%.…”

“…Several studies showed that topical treatments were useful for pain relief in women with VLS [7][8][21][22]; however, these treatments did not necessarily lead to an improvement in sexual function. Two studies showed that topical immunomodulators could provide symptomatic relief and histopathological improvement in VLS patients [22,23], nevertheless, sexual dysfunction could be permanent despite these positive changes.…”

“…Treatment of VLS is essential, not only because of its impact on the quality of life and sexual function of the patients but also due to the risk of squamous cell cancer in the long term [3]. Topical and intradermal (intralesional) corticosteroids constitute the first-line treatment of VLS [8]. Care should be taken regarding the risk of regional atrophy and systemic adverse effects [23].…”

“…Long-term treatment with these agents does not lead to regional atrophy, which is their main advantage over corticosteroids [2]. Other treatment options are oral acitretin, cyclosporin, methotrexate, topical progesterone, testosterone, ultraviolet A1 phototherapy, and photodynamic therapy [1,[8][9]. However, in complicated VLS which presents with structural deformities, severe adhesions, and scar formation, surgical treatment is indicated [25,26].…”