The outcome after cryosurgery and intralesional steroid injection in vulvar lichen sclerosus corresponds to preoperative histopathological findings.
BACKGROUND
Vulvar lichen sclerosus (LS) still presents a therapeutic challenge.


OBJECTIVE
The aim of the present study was to investigate whether there is a correlation between preoperative histopathological findings in female LS and long-term results after cryosurgery and intralesional steroid injections.


METHODS
22 females with LS, mean age 65.3 +/- 10.5 years, were treated with cryosurgery (-186 degrees C) using the contact method with 1 freeze-thaw cycle per lesion and intralesional triamcinolone acetonide injection. The time between surgery and follow-up examination was 27.8 +/- 14.6 months. We compared the clinical outcome and the thickness of the epidermis, the zone of sclerosis and the inflammatory infiltrate in biopsy specimens taken before treatment.


RESULTS
In 14 of 22 patients, a relapse after cryosurgery occurred (median after 7.5 months). Patients would 'moderately' recommend cryosurgery for LS (2.2 +/- 0.9; minimum: 0, optimum: 4). Pruritus was significantly reduced (visual analog scale: preoperative 7.1 +/- 2.6 vs. postoperative 2.0 +/- 2.4; p = 0.001) even in patients with relapse (preoperative 7.6 +/- 2.4 vs. postoperative 3.1 +/- 2.28; p = 0.001). Women with relapse showed a significantly higher composed thickness of epidermis, sclerosis and inflammatory infiltrate (430 +/- 139.0 microm) than those without relapse (314 +/- 41.2 microm; p = 0.046).


CONCLUSIONS
In our patients, cryosurgery and intralesional steroid injections were efficient in the treatment of LS. Patients showing relapse had a thicker epidermis and a stronger inflammatory infiltrate. Therefore a treatment of LS should be performed at an early stage of the disease.
Stücker
Markus
M
Department of Dermatology and Allergology, Ruhr University Bochum, St. Josef Hospital, DE-44791 Bochum, Germany. M.Stuecker@derma.de
Grape
Jonas
J
Bechara
Falk Georges
FG
Hoffmann
Klaus
K
Altmeyer
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003452:Cryosurgery; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D018459:Lichen Sclerosus et Atrophicus / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage; D014845:Vulvar Diseases / Q000473:pathology / Q000601:surgery*
D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide