Does Treatment of Vulvar Lichen Sclerosus Influence Its Prognosis?

Abstract

To record the clinical features, symptomatic response to topical steroids, and resolution of clinical signs in a large cohort of female patients with vulvar lichen sclerosus.Design: Descriptive cohort study with a mean follow-up of 66 months. Setting:The vulvar clinics of a teaching hospital and of a district general hospital in Oxfordshire, England.Patients: Three hundred twenty-seven patients (74 girls and 253 women) with a definite clinical diagnosis of vulvar lichen sclerosus. Interventions:The patients received topical steroids as part of their normal care.Main Outcome Measures: Symptomatic response to treatment (good, partial, or poor); response of the vulvar signs (total, partial, minor, or poor); and the presence or absence of moderate or severe scarring. Results:The mean age at onset was 5.4 years in girls and 55.1 years in women and first-choice therapy was an ultrapotent topical steroid for 50% of the girls and 89% of the women. Response to treatment was recorded in 255 patients. In 244 patients (96%) symptoms improved with treatment, as 168 (66%) became symptom free and 76 (30%) showed partial response; 11 (4%) had poor response. Among the 253 patients in whom a response of the vulvar signs to topical steroid was recorded, 58 (23%) showed total response, with return to normal skin texture and color; and 173 (68%) showed partial, 18 (7%) showed minor, and 4 (2%) showed poor response. Moderate or severe scarring occurred less often in girls (PϽ.001). Squamous cell carcinoma developed in 6 women (2.4%). Conclusion:Topical ultrapotent steroid is an effective treatment for vulvar lichen sclerosus, giving relief of symptoms in most and completely reversing the skin changes in approximately one fifth of patients.

Clinical variants of lichen planus

“…The risk of development of squamous cell carcinoma on vulvar MLP cannot be defi nitively estimated due to the scarce data. The estimates range from a "low risk" up to a frequency of 2.4 % [26,27]. Malignant transformation of penile MLP is limited to individual case reports [28,29].…”

Vulvar Dermatoses

“…Hastaların %10'unda sırt, bel ve meme altında atrofik, üzerinde foliküler tıkaçların bulunduğu morfea benzeri plaklar görülebilir. LS'nin bül ve erode plaklarla seyreden varyantı da bulunmaktadır (35,(39)(40)(41)(42)(43)(44). LS'li çocuklarda istismar düşünülerek yanlış tanı konulabilir.…”

“…Günde iki kez ve 3 ay kullanımı birçok hastada etkilidir. Üç ay sonra kortikosteroidler azaltılarak semptomların baskılandığı idame doza geçilir (haftada bir veya iki kez) (37,42,45). Takrolimus ve pimekrolimus gibi kalsinörin inhibitörlerinin de etkili olduğu rapor edilmiştir.…”

Current views on the diagnosis and treatment of genital lichen sclerosus

“…W okresie późniejszym przedmiotowo stwierdza się płaskie plamy, porcelanowobiałe grudki z odcieniem kości słoniowej, które mogą zlewać się w ogniska zanikowo-twardzinowe z przewagą zaniku lub hiperkeratotyczne [2]. U 80% kobiet i 30% dziewcząt zmianom towarzyszy bliznowacenie [3] oraz objaw Koebnera [4].…”