Effects of topical progesterone in vulvar lichen sclerosus
Leonardo MichelettiMario PretiFabrizio BogliattoM. C. Zanotto-ValentinoBruno GhiringhelloM Massobrio
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This study was made in the Oncologic Gynecology's surgery of the Department of Obstetrics and Gynecology of the University of Naples. We evaluated the efficacy of local therapy with testosterone and progesterone in Vulvar Lichen Sclerosus. We treated 65 women suffering from Vulvar Lichen Sclerosus. In the group of 38 women treated with testosterone, we observed a complete response in 26 cases (68%). In the group of 27 women treated with progesterone we observed a complete response in 18 cases (66.6%). This demonstrates the efficacy of local therapy with testosterone and Progesterone in Vulvar Lichen Sclerosus. The authors believe that medical treatment with topical testosterone and progesterone represents an effective alternative to invasive methods for the care of Vulvar Lichen Sclerosus.
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Vulvar lichen sclerosus is a chronic dermatosis in which first-line drugs are topical glucocorticosteroids, and alternative drugs are topical calcineurin inhibitors. To date, there is insufficient data on the effectiveness of using CO₂ lasers in the treatment of VLS, although the authors of the published works note a positive therapeutic effect. The results of step-by-step application of the Lutronic CO₂ fractional laser were studied. The efficiency of the treatment was evaluated using the skin activity index and the lesion area index developed by the author. The study included 8 women diagnosed with VLS. The obtained results demonstrated a positive effect of step-by-step treatment of VLS with sequential use of topical glucocorticosteroid and autologous plasma injections, followed by CO₂ laser fractional exposure. The positive dynamics of the treatment was confirmed by the dermatological index of quality of life, as well as the indices of assessment of the area and activity of the skin process of VLS.
Laser Treatment
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Labia majora
Pimecrolimus
Vulvar Diseases
Clitoris
Topical steroid
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Abstract Background . Testosterone propionate has been shown repeatedly to be effective in the treatment of vulvar lichen sclerosus, yet studies of androgens in serum of women with untreated vulvar lichen sclerosus suggested an abnormal activity of 5‐alpha reductase in these patients. If impairment of 5‐alpha reductase in women with untreated vulvar lichen sclerosus is a proximate cause of this disease, then dihydrotestosterone should be more effective than testosterone propionate in the treatment of the condition. Methods . To test this hypothesis, five women with vulvar lichen sclerosus received topically either dihydrotestosterone or testosterone propionate in a double‐blind crossover study. Results . These androgens appear to be equally effective in inducing objective improvement of the vulvar lichen sclerosus by both gross and microscopic criteria. Conclusions . Impairment of 5‐alpha reductase may not be germane to the pathogenesis of vulvar lichen sclerosus.
Testosterone propionate
Dihydrotestosterone
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Pimecrolimus
Topical steroid
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Primarily diagnosed in prepubertal and postmenopausal patients, vulvar lichen sclerosus (VLS) is a chronic, inflammatory disease that causes symptoms
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ABSTRACT Lichen sclerosus is a chronic inflammatory skin disorder that has a predilection for the anogenital area. Topical corticosteroid is occasionally effective; however, continuous treatment is often required and recurrence after its stoppage is frequent. Herein, we report a case of vulvar lichen sclerosus in a 5‐year‐old girl, which was refractory to topical corticosteroids. After 14 weeks of treatment with 0.03% tacrolimus ointment once daily, the lesions completely resolved without side‐effects. Of interest, the number of milia within the plaque of lichen sclerosus was reduced in tandem with the improvement of lichen sclerosus. This is the first report of topical low‐concentration tacrolimus treatment showing a dramatic effect in the treatment of childhood vulvar lichen sclerosus.
Refractory (planetary science)
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Lichen sclerosus typically affects the vulva of postmenopausal women. Because serum levels of dihydrotestosterone are low in women with vulvar lichen sclerosus and because dihydrotestosterone is an effector androgen in vulvar skin, this double-blind cross-over study assessed five women with vulvar lichen sclerosus to determine the response to treatment with dihydrotestosterone. Objective gross and microscopic improvement in lichen sclerosus accompanied sustained treatment with topical dihydrotestosterone, but not with vehicle alone. However, there was no change in symptoms (itching and dyspareunia) in these women, although dihydrotestosterone did improve some of the features of vulvar lichen sclerosus and may represent a new treatment for this disease.
Dihydrotestosterone
Itching
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