title: Testosterone versus clobetasol for maintenance of vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia.
abstract: OBJECTIVE
  To evaluate the therapeutic regimens and symptomatic response rates in patients with vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia (mixed disease).
  
  
  METHODS
  Eighty-three women with biopsy-proven vulvar mixed disease were evaluated for this retrospective study. All patients were initially treated with topical fluorinated corticosteroids, and then 2% testosterone propionate in petrolatum or 0.05% clobetasol 17-propionate (44 (53%) versus 39 (47%)).
  
  
  RESULTS
  The remission rates were 82 and 93% in the testosterone and clobetasol subgroups at the end of 6 months (p=0.112), respectively. The disease recurred in 8% of the patients. The recurrence rates in the testosterone and clobetasol arms were 13 and 5%, respectively (p=0.163). The histopathological review of the repeat vulvar biopsies of the patients without symptomatic relief revealed 6 (60%) patients with persistent disease, 2 (20%) with lichen sclerosus, 1 (10%) with atypical squamous hyperplasia, and 1 (10%) with VIN1. Two patients with recurrent disease and 2 patients with vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia were treated with skinning vulvectomy.
  
  
  CONCLUSIONS
  Clobetasol resulted in higher remission and lower recurrence rates than those in testosterone therapy, although statistically significant differences were not obtained. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Ayhan
authors.forename: Emine Seda Guvendag
authors.initials: ES
authors.lastname: Guven
authors.forename: Suleyman
authors.initials: S
authors.lastname: Guven
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sakinci
authors.forename: N Utku
authors.initials: NU
authors.lastname: Dogan
authors.forename: Turkan
authors.initials: T
authors.lastname: Kucukali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002990:Clobetasol / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006965:Hyperplasia / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D043343:Testosterone Propionate / Q000627:therapeutic use*; D007724:Vulvar Lichen Sclerosus / Q000188:drug therapy* / Q000473:pathology
chemical_list: D005938:Glucocorticoids; D002990:Clobetasol; D043343:Testosterone Propionate