title: Lichen sclerosus:  a 5-year follow-up after topical, subdermal, or combined therapy.
abstract: OBJECTIVE
  The purpose of our study was to compare clinical data regarding patients with pruritic lichen sclerosus (LS) at moderate or severe stages using 2 different therapies with a 5-year follow-up.
  
  
  METHODS
  The study was approved by the institutional review board and was presented as a retrospective clinical data review of patients with pruritic biopsy diagnosis LS who underwent therapy at our university private practice from 2002 to 2005. We compared the results of a weekly topical application of high-potency steroid (HPS) with a combined HPS and monthly anesthetic/steroid subdermal injection (ASI). Outcomes were timed to achieve pruritus-free status, the number of symptomatic recurrences, and patient satisfaction with therapy.
  
  
  RESULTS
  Fifty-four patients were diagnosed with LS between 2002 and 2005. There were 13 patients who had mild-stage, 25 who had moderate-stage, and 16 who had severe-stage LS. Five-year follow-up data on 17 patients with moderate-stage LS and 14 patients with severe-stage LS were obtained. Time to pruritus free was 6 weeks with ASI and 19 weeks with HPS for moderate-stage LS (p = .04) and 9 weeks with ASI and 24 weeks with HPS for severe-stage LS (p = .03). Recurrences were more frequent on HPS for moderate-stage LS (p = .04) but not significant with HPS for severe-stage LS (p = .15). Only ASI was successful at treating patients with recalcitrant pruritus.
  
  
  CONCLUSIONS
  In our population, patients with symptomatic moderate-stage LS seem to have a more rapid and prolonged response to ASI than to HPS but are less satisfied with the injections.
authors.affiliation: Boonshoft School of Medicine, Wright State University, Dayton, OH, USA. gary.ventolini@wright.edu
authors.forename: Gary
authors.initials: G
authors.lastname: Ventolini
authors.forename: Krista M
authors.initials: KM
authors.lastname: Swenson
authors.forename: Michael L
authors.initials: ML
authors.lastname: Galloway
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D015331:Cohort Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D018459:Lichen Sclerosus et Atrophicus / Q000175:diagnosis* / Q000188:drug therapy*; D008012:Lidocaine / Q000008:administration & dosage; D008875:Middle Aged; D017060:Patient Satisfaction; D011318:Prilocaine / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D011318:Prilocaine; D008012:Lidocaine