title: Systematic review and meta-analysis of randomized controlled trials on topical interventions for genital lichen sclerosus.
abstract: BACKGROUND
  Lichen sclerosus (LS) is a chronic inflammatory dermatosis that occurs mainly in the anogenital area and causes itching and soreness. Progressive destructive scarring may result in burying of the clitoris in females and phimosis in males. Affected people have an increased risk of genital cancers.
  
  
  OBJECTIVE
  We sought to assess the effects of topical interventions for genital LS.
  
  
  METHODS
  We undertook a systematic review and meta-analysis using the methodology of the Cochrane Collaboration.
  
  
  RESULTS
  We included 7 randomized controlled trials with a total of 249 participants covering 6 treatments. Clobetasol propionate 0.05% was better than placebo in treating genital LS (participant-rated improvement/remission of symptoms: risk ratio 2.85 [95% confidence interval {CI} 1.45-5.61]; investigator-rated global degree of improvement: standardized mean difference [SMD] 5.74 [95% CI 4.26-7.23]) as was mometasone furoate 0.05% (change in clinical grade of phimosis: SMD -1.04 [95% CI -1.77 to -0.31]). We found no evidence supporting the efficacy of topical androgens and progesterone. There were no differences between pimecrolimus and clobetasol propionate in relieving symptoms through change in pruritus (SMD -0.33 [95% CI -0.99 to 0.33]) and burning/pain (SMD 0.03 [95% CI -0.62 to 0.69]). However, pimecrolimus was less effective than clobetasol propionate in improving gross appearance (investigator-rated global degree of improvement: SMD -1.64 [95% CI -2.40 to -0.87]).
  
  
  CONCLUSIONS
  Most of the included studies were small.
  
  
  CONCLUSIONS
  The current limited evidence supports the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital LS. Further randomized controlled trials are needed.
authors.affiliation: Department of Dermatology and Center for Evidence-Based Medicine, Chang Gung Memorial Hospital-Chiayi, Chang Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Chi
authors.forename: Gudula
authors.initials: G
authors.lastname: Kirtschig
authors.forename: Maha
authors.initials: M
authors.lastname: Baldo
authors.forename: Fiona
authors.initials: F
authors.lastname: Lewis
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Wang
authors.forename: Fenella
authors.initials: F
authors.lastname: Wojnarowska
mesh_terms: D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D052798:Balanitis Xerotica Obliterans / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D007724:Vulvar Lichen Sclerosus / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents