Early onset vulvar Lichen Sclerosus in premenopausal women and oral contraceptives.
OBJECTIVE
For vulvar Lichen sclerosus (LS) immunological factors, genetic predisposition, and decreased 5 alpha-reductase activity have been discussed as aetiological factors. During the last decade an increase of LS in young women has been suspected. Aim of this study was to evaluate data of premenopausal women with early onset LS to find potential risk factors focussing on the use of oral contraceptives.


METHODS
We retrospectively analyzed the data of 40 premenopausal patients with early onset LS regarding use of oral contraceptives (OCPs), and first occurrence of LS. To compare these data in a case-control study we analyzed a matched control group of 110 healthy women.


RESULTS
All our LS patients were using OCPs compared to 73 women (66.4%) in the control group. OCPs with anti-androgenic activity (chlormadinone acetate, cyproterone acetate, dienogest, and drospirenone) were used by 28 (70%) of the LS patients and by 35 (47.9%) of the 73 women using OCPs in the control group. Thus, the odds ratio for early onset LS for women using anti-androgenic OCPs was 2.53 (95% CI: 1.12-5.75).


CONCLUSIONS
Our data suggest that disturbance of the androgen dependent growth of the vulvar skin by OCPs and especially by OCPs with anti-androgenic properties might trigger the early onset of LS in a subgroup of susceptible young women.
University of Goettingen, Department Obstetrics & Gynaecology, Robert Koch-Str. 40, 37075 Goettingen, Germany.
Andreas R
AR
Günthert
Melanie
M
Faber
Gabriele
G
Knappe
Simin
S
Hellriegel
Günter
G
Emons
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000634:Aminoquinolines / Q000627:therapeutic use; D000726:Androgen Antagonists / Q000009:adverse effects*; D000736:Androstenes / Q000009:adverse effects; D016022:Case-Control Studies; D002715:Chlormadinone Acetate / Q000009:adverse effects; D002990:Clobetasol / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000009:adverse effects*; D017373:Cyproterone Acetate / Q000009:adverse effects; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D000077271:Imiquimod; D015994:Incidence; D009277:Nandrolone / Q000009:adverse effects / Q000031:analogs & derivatives; D017697:Premenopause; D011374:Progesterone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D007724:Vulvar Lichen Sclerosus / Q000139:chemically induced* / Q000188:drug therapy*
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000726:Androgen Antagonists; D000736:Androstenes; D003276:Contraceptives, Oral; D005938:Glucocorticoids; D002715:Chlormadinone Acetate; C023635:dienogest; D011374:Progesterone; D017373:Cyproterone Acetate; D009277:Nandrolone; D002990:Clobetasol; C035144:drospirenone; D000077271:Imiquimod