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Treatment of Vulvar Lichen Sclerosus

In studies with long-term follow-up, topical corticosteroid treatment proved beneficial.

Ultrapotent topical corticosteroids are standard treatment for vulvar lichen sclerosus (VLS), but what exactly do these agents do, and do they prevent malignancy? Two recent studies followed relatively large numbers of patients over long periods to assess the effects of treatment for VLS. Cooper and colleagues followed a group of 327 patients with a definite clinical diagnosis of lichen sclerosus (74 girls and 253 women) for a median of 5.5 years, and Renaud-Vilmer and colleagues followed 83 women with histologically confirmed disease for a median of 4.7 years.

In the first study, complete remission occurred in 23% of patients. In the second study, remission occurred but was regularly succeeded by relapse. Squamous cell carcinoma of the vulva occurred in six of the adult women (2.4%) in the first study and eight women (9.6%) in the second study and tended to be related to delay in diagnosis, irregular use of therapy, or lack of treatment. Both groups of investigators suggest that corticosteroids might decrease the risk for malignancy, but neither presents adequate evidence to support this hypothesis. The authors of the first study document differences in symptoms between girls and women with VLS and express concern that local immunosuppression related to the use of steroid-sparing agents like calcineurin inhibitors might increase the risk for malignancy.

Comment: These large studies with long-term follow-up demonstrate benefits from potent topical corticosteroid therapy for vulvar lichen sclerosus -- namely, improved symptoms and, perhaps, remission and prevention of malignant transformation. Alternative agents may be useful but should be used only when toxicity has been clearly documented. Early recognition and aggressive therapy may prevent malignant transformation.

— Jeffrey P. Callen, MD

Published in Journal Watch Dermatology July 14, 2004

Citation(s):

Cooper SM et al. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol 2004 Jun; 140:702-6.

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Renaud-Vilmer C et al. Vulvar lichen sclerosus: Effect of long-term topical application of a potent steroid on the course of the disease. Arch Dermatol 2004 Jun; 140:709-12.

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• Medline abstract (Free)