Long-term management of vulval lichen sclerosus in adult women.
BACKGROUND
Adult vulval lichen sclerosus (VLS) is usually a lifelong disease with an estimated remission rate after treatment of only 16% [Arch Dermatol 2004; 140 (6): 709]. Although superpotent topical corticosteroid (TCS) is the validated gold standard treatment to induce remission, little data are available on how remission should be maintained.


OBJECTIVE
We present a retrospective chart review of 129 adult patients with VLS who have been under surveillance by the authors for a minimum duration of three years.


METHODS
Remission was maintained in most patients with low-to-moderate potency TCS. All subjects' symptoms, signs, treatment regimes and response to treatment including compliance, symptom remission, disease progression with scarring, squamous cell carcinoma and side effects were recorded. Data were compared for the compliant and non-compliant groups. Fischer's exact test was used to identify significant differences.


RESULTS
The mean age at presentation was 53.6 years and mean duration of follow-up was 6.2 years. Compliance was excellent: 84 (65%) of patients' self-reporting as being fully compliant. Symptom remission was achieved in 98% of compliant and 75% of non-compliant patients (P = 0.001) Progression of disease with scarring was not encountered in any of the compliant patients, but was seen in 35% of non-compliant patients (P = 0.0001). One patient had squamous cell carcinoma on first presentation. Carcinoma subsequently occurred in none of the compliant patients, and in five partly compliant patients (P = 0.004). Mild, reversible corticosteroid side effects were encountered in 7% of patients.


CONCLUSIONS
Long-term treatment of adult VLS with individualised regimes using moderate potency TCS is safe and effective. Patients require long-term follow-up.
Bradford
J
J
Department of Obstetrics and Gynaecology, Blacktown Hospital, University of Western Sydney, Campbelltown, NSW, Australia.
Fischer
G
G
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D002921:Cicatrix / Q000139:chemically induced; D003872:Dermatitis / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D007724:Vulvar Lichen Sclerosus / Q000188:drug therapy* / Q000473:pathology; D014846:Vulvar Neoplasms / Q000175:diagnosis; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents