Does treatment of vulvar lichen sclerosus influence its prognosis?
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.


METHODS
Descriptive cohort study with a mean follow-up of 66 months.


METHODS
The vulvar clinics of a teaching hospital and of a district general hospital in Oxfordshire, England.


METHODS
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.


METHODS
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%).


CONCLUSIONS
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.
Cooper
S M
SM
Department of Dermatology, Churchill Hospital, Oxford, England. sm_nc@btopenworld.com
Gao
X-H
XH
Powell
J J
JJ
Wojnarowska
F
F
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002990:Clobetasol / Q000008:administration & dosage*; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D008499:Medical Records; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology
D005938:Glucocorticoids; D002990:Clobetasol