Topical Interventions for Genital Lichen Sclerosus

Summary

A Cochrane review [Abstract] 1 included 7 studies with a total of 249 subjects. Clobetasol propionate 0.05% was better than placebo for 'participant-rated improvement or remission of symptoms' (RR 2.85, 95% CI 1.45 to 5.61; 1 trial, n=39) and 'investigator-rated global degree of improvement' (standardised mean difference (SMD) 5.74, 95% CI 4.26 to 7.23; 1 trial, n=39). When mometasone furoate 0.05% was compared to placebo, there was a significant improvement in the 'investigator-rated change in clinical grade of phimosis' (SMD -1.04, 95% CI -1.77 to -0.31; 1 trial, n=33). Both trials found no significant differences in reported adverse drug reactions between the corticosteroid and placebo groups. The data from four trials found no significant benefit for topical testosterone, dihydrotestosterone, and progesterone. One trial (n=36) found no differences between pimecrolimus and clobetasol propionate in relieving symptoms through change in pruritus and burning/pain. However, pimecrolimus was less effective than clobetasol propionate with regard to the 'investigator-rated global degree of improvement' (SMD -1.64, 95% CI -2.40 to -0.87).

A prospective longitudinal cohort study 2 included 507 women with biopsy-proved lichen sclerosis. Duration of symptoms at presentation was 5.0 years and duration of follow-up was 4.7 years. Remission was induced with a potent topical corticosteroids (TCS), followed by regular preventive TCS treatment of a potency titrated to achieve the target outcome. Patients were followed up at least annually. Biopsy-proved squamous cell carcinoma or vulvar intraepithelial neoplasia occurred during follow-up in 0 of the compliant patients vs. 7 (4.7%) of the partially compliant patients. Suppression of symptoms occurred in 333 (93.3%) compliant patients vs. 87 (58.0%) partially compliant patients (P < .001). Adhesions and scarring occurred during follow-up in 12 (3.4%) compliant patients and 60 (40.0%) partially compliant patients. Reversible TCS-induced cutaneous atrophy occurred in 4 (1.1%) compliant patients and 3 (2.0%) partially compliant patients.