title: A retrospective analysis of pediatric patients with lichen sclerosus treated with a standard protocol of class I topical corticosteroid and topical calcineurin inhibitor.
abstract: BACKGROUND
  Lichen sclerosus (LS) is a chronic, inflammatory condition of the skin, affecting primarily the anogenital region potentially leading to changes in vaginal architecture and vulvar squamous cell carcinoma. Current recommended treatment for LS is high-potency corticosteroids. Calcineurin inhibitors may also have a role.
  
  
  OBJECTIVE
  The objective of this study is to introduce a treatment regimen involving clobetasol to induce remission, then tacrolimus to maintain remission in pediatric females with LS.
  
  
  METHODS
  As a retrospective case series, we report 14 pediatric females between 2 and 10 years of age with LS treated with clobetasol 0.05% topical ointment and systematically bridged to tacrolimus 0.1% topical ointment. For each patient, gender, age at disease onset, and clinical symptoms and features were noted. Time in weeks to 75% clearance and to complete clearance were recorded.
  
  
  RESULTS
  Thirteen patients showed complete clearance. One patient showed significant clearance of the disease. The time to complete clearance averaged 43.1 weeks, with a range of 4-156 weeks.
  
  
  CONCLUSIONS
  The use clobetasol to induce remission and tacrolimus to maintain remission can be used to treat LS in pediatric females. This regimen may minimize side effects associated with long-term, high-potency corticosteroid use and reduce the risk of changes to genital architecture secondary to LS.
authors.affiliation: a Department of Dermatology and.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anderson
authors.affiliation: a Department of Dermatology and.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ascanio
authors.affiliation: a Department of Dermatology and.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Kinney
authors.affiliation: a Department of Dermatology and.|b Department of Pediatrics , Wake Forest School of Medicine , Winston-Salem , NC , USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Krowchuk
authors.affiliation: a Department of Dermatology and.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Jorizzo
mesh_terms: D065095:Calcineurin Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D002990:Clobetasol / Q000008:administration & dosage* / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D065095:Calcineurin Inhibitors; D003879:Dermatologic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D002990:Clobetasol; D016559:Tacrolimus
keywords: Clobetasol; lichen sclerosis et atrophicus; tacrolimus; treatment