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S. M. Cooper, MD, MRCP; X.-H. Gao, MD, PhD; J. J. Powell, MD, MRCP; F. Wojnarowska, DM, FRCP

Arch Dermatol. 2004;140:702-706.

Objective  To record the clinical features, symptomatic response to topical steroids, and resolution of clinical signs in a large cohort of female patients with vulvar lichen sclerosus.

Design  Descriptive cohort study with a mean follow-up of 66 months.

Setting  The vulvar clinics of a teaching hospital and of a district general hospital in Oxfordshire, England.

Patients  Three hundred twenty-seven patients (74 girls and 253 women) with a definite clinical diagnosis of vulvar lichen sclerosus.

Interventions  The patients received topical steroids as part of their normal care.

Main Outcome Measures  Symptomatic response to treatment (good, partial, or poor); response of the vulvar signs (total, partial, minor, or poor); and the presence or absence of moderate or severe scarring.

Results  The mean age at onset was 5.4 years in girls and 55.1 years in women and first-choice therapy was an ultrapotent topical steroid for 50% of the girls and 89% of the women. Response to treatment was recorded in 255 patients. In 244 patients (96%) symptoms improved with treatment, as 168 (66%) became symptom free and 76 (30%) showed partial response; 11 (4%) had poor response. Among the 253 patients in whom a response of the vulvar signs to topical steroid was recorded, 58 (23%) showed total response, with return to normal skin texture and color; and 173 (68%) showed partial, 18 (7%) showed minor, and 4 (2%) showed poor response. Moderate or severe scarring occurred less often in girls (P<.001). Squamous cell carcinoma developed in 6 women (2.4%).

Conclusion  Topical ultrapotent steroid is an effective treatment for vulvar lichen sclerosus, giving relief of symptoms in most and completely reversing the skin changes in approximately one fifth of patients.

From the Departments of Dermatology, Churchill Hospital, Oxford, England (Drs Cooper, Powell, and Wojnarowska) and No. 1 Hospital of China Medical University, Shenyang, China (Dr Gao). The authors have no relevant financial interest in this article.

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