Does treatment of vulvar lichen sclerosus influence its prognosis?

Abstract

OBJECTIVE:

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 (P<.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.

• Authors: S M Cooper, X-H Gao, J J Powell, F Wojnarowska
• Journal: Archives of dermatology (Arch Dermatol) Vol. 140 Issue 6 Pg. 702-6 (Jun 2004) ISSN: 0003-987X [Print] United States
• PMID: 15210461 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids
• Clobetasol

Topics

• Administration, Cutaneous
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (drug therapy, epidemiology, pathology)
• Child
• Child, Preschool
• Clobetasol (administration & dosage)
• Cohort Studies
• England (epidemiology)
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Infant
• Lichen Sclerosus et Atrophicus (drug therapy, epidemiology, pathology)
• Medical Records
• Middle Aged
• Prognosis
• Retrospective Studies
• Severity of Illness Index
• Vulvar Neoplasms (drug therapy, epidemiology, pathology)