Vulvar lichen sclerosus: effect of maintenance treatment with a moisturizer on the course of the disease.
OBJECTIVE
Vulvar lichen sclerosus (LS) is an inflammatory disease of unknown etiology that may result in significant discomfort and psychological distress in postmenopausal women. One of the most troublesome features of LS is its chronically relapsing nature. The aim of this study was to investigate the effect of maintenance therapy with a moisturizer in preventing the risk of relapse and progression of vulvar LS in postmenopausal women.


METHODS
Between January 1995 and January 2006, 34 postmenopausal women with vulvar LS were included in a prospective open trial. The participants were treated with a topical corticosteroid cream (0.1% betamethasone valerate) once daily for 1 month and then with maintenance therapy with a moisturizing cream alone once daily. Follow-up visits were scheduled after 1 month and then twice per year (median follow-up, 58 mo).


RESULTS
Overall the symptoms of all women improved after therapy with a topical steroid. Twenty-four women (71%) became symptom free, and 10 (29%) experienced partial response. Eighteen of the 24 women (75%) who became symptom free and 6 of the 10 women (60%) who exhibited a partial response reported no worsening of their symptoms while on therapy with a cold cream alone. Total resolution of the clinical signs occurred in 6 of the 19 women with mild vulvar architectural changes. Partial resolution of clinical signs was observed in 22 women (64%). No change was noticed in six (18%) women. None of the participants experienced worsening of vulvar scarring. None of the participants developed vulvar intraepithelial neoplasia or squamous cell carcinoma during the follow-up period. There were no side effects.


CONCLUSIONS
Long-term maintenance therapy of vulvar LS with a moisturizing cream can maintain the symptom relief induced by topical corticosteroids in women with vulvar LS while being safe and inexpensive. This treatment may also be associated with a reduction in topical corticosteroid use because more than half of the women could eliminate corticosteroids altogether.
Simonart
Thierry
T
Department of Dermatology, Erasme University Hospital, Brussels, Belgium. tsimonar@ulb.ac.be
Lahaye
Marc
M
Simonart
Jean-Marie
JM
D000287:Administration, Topical; D001623:Betamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D009824:Ointments; D017060:Patient Satisfaction; D017698:Postmenopause; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D007724:Vulvar Lichen Sclerosus / Q000188:drug therapy* / Q000517:prevention & control; D016387:Women's Health
D005938:Glucocorticoids; D009824:Ointments; D001623:Betamethasone