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Response of Vulvar Lichen Sclerosus and Squamous Cell Hyperplasia to Graduated Topical Steroids

2000; Lippincott Williams & Wilkins; Volume: 55; Issue: 3 Linguagem: Inglês

10.1097/00006254-200003000-00017

1533-9866

T. Justin Clark, Ian J. Etherington, David Luesley,

Urological Disorders and Treatments

This study was undertaken to investigate the response of vulvar lichen sclerosus and squamous cell hyperplasia to treatment with graduated topical steroids. From a review of the medical records of patients at a specialist vulvar clinic, 137 patients were identified who had biopsy-proven vulvar lichen sclerosus (N = 84), squamous hyperplasia (N = 42), or both diseases in combination (N = 11). All patients were treated with 4 weeks of twice-daily local application of clobetasol propionate, 0.05 percent, followed by 4 weeks of twice-daily local application of betamethasone valerate, 1 percent, and, finally, 4 weeks of twice-daily local application of hydrocortisone, 0.1 percent. Follow-up examinations were conducted 3 and 6 months after initiation of treatment. Sixty-nine percent of the study participants were postmenopausal; however, there were significantly fewer postmenopausal women in the lichen sclerosus group (mean age, 53 years; median age, 47 years) than in the squamous cell hyperplasia group (mean age, 58 years; median age, 62 years) (P = .003). Women with squamous hyperplasia had experienced symptoms for 1 year longer than women with squamous cell hyperplasia and longer still than women with both diseases. At 3 months, 59 percent of all patients had no symptoms of disease (P = .035). More women in the lichen sclerosus group (62 percent) were symptom free than in the squamous hyperplasia (48 percent) or combination group (45 percent). Fewer than two-thirds of patients returned for the 6-month follow-up examination, and 58 percent of the patients examined were free of symptoms. Of those who returned for follow-up, 66 percent in the lichen sclerosus group, 41 percent in the squamous hyperplasia group, and 55 percent of women with both diseases reported experiencing no symptoms. This difference was significant for the lichen sclerosus group as compared with the squamous hyperplasia group (P = .026) and as compared with the squamous hyperplasia and combination disease groups (P = .035). To remain symptom free, 82 percent of the women with squamous cell hyperplasia and 69 percent of those with lichen sclerosus needed to use a maintenance or intermittent dose of mild to moderate topical steroids. Only 4 of the 137 women in the study group reported experiencing side effects (local rashes, erythema, and excoriation) as a result of the treatment regimen. One patient with lichen sclerosus and one with squamous cell hyperplasia developed squamous cell carcinoma of the vulva during the follow-up period. J Reprod Med 1999;44:958–962