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Topical tretinoin in the treatment of vulvar lichen sclerosus: an advisable option?

  • Therapy
  • Published:
European Journal of Dermatology Aims and scope

Abstract

Objective

To assess the effectiveness and safety of a 24-week application of tretinoin 0.025% cream, with an alternate-day regimen, in achieving control of VLS signs and symptoms.

Methods

17 patients affected with VLS were included. The main efficacy parameters were the response rate, as defined by protocol parameters, the rate of patients achieving an improvement from baseline of ≥75% in the subjective and objective scores, and the mean reduction in subjective and objective scores throughout the treatment. The safety of the treatment was also assessed.

Results

By the end of the 24-week treatment, 12 patients (70.6%) experienced a response; 35.3% and 17.6% of patients achieved an improvement of at least 75% in subjective and objective scores, respectively. Mean scores of itching, leukoderma (pallor) and hyperkeratosis decreased significantly in the study patients, and none presented itching-related excoriations. Erythema increased compared with baseline. Six patients (35.29%) experienced some side effects related to tretinoin, mainly mild erythema and burning. None of the subjects discontinued the treatment because of side effects.

Conclusions

Tretinoin 0.025% cream applied for 24 weeks may represent a useful alternative option to corticosteroids in the treatment of active VLS, acting particularly on hyperkeratosis and pallor.

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References

  1. Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol 2013; 14: 27–47.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777–83.

    Article  PubMed  CAS  Google Scholar 

  3. Smith YR, Haefner HK. Vulvar lichen sclerosus. Pathophysiology and treatment. Am J Clin Dermatol 2004; 5: 105–25.

    Article  PubMed  Google Scholar 

  4. Tasker GL, Wojnarowska F. Lichen sclerosus. Clin Exp Dermatol 2003; 28: 128–33.

    Article  PubMed  CAS  Google Scholar 

  5. Neill SM, Lewis FM, Tatnall FM, Cox NH. British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol 2010; 163: 672–82.

    Article  PubMed  CAS  Google Scholar 

  6. Chi CC, Kirtschig G, Baldo M, et al. Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev 2011; 12: CD008240.

    PubMed  Google Scholar 

  7. Pérez-López FR, Ceausu I, Depypere H, et al. EMAS clinical guide: Vulvar lichen sclerosus in peri and postmenopausal women. Maturitas 2013; 74: 279–82.

    Article  PubMed  Google Scholar 

  8. Virgili A, Borghi A, Toni G, Minghetti S, Corazza M. First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability. Br J Dermatol 2014; 171: 388–96.

    Article  PubMed  CAS  Google Scholar 

  9. Murina F, Rehman S, Di Francesco S, et al. Vulvar lichen sclerosus: a comparison of the short-term topical application of clobetasol dipropionate 0.05% versus mometasone furoate 0.1%. J Lower Gen Tract Dis 2014 [in press].

    Google Scholar 

  10. Goldstein AT, Creasey A, Pfau R, et al. A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J Am Acad Dermatol 2011; 64: e99–104.

    Article  PubMed  CAS  Google Scholar 

  11. Virgili A, Minghetti S, Borghi A, Corazza M. Long-term maintenance therapy for vulvar lichen sclerosus: the results of a randomized study comparing topical vitamin E with an emollient. Eur J Dermatol 2013; 23: 189–94.

    PubMed  CAS  Google Scholar 

  12. Hillemanns P, Untch M, Pröve F, et al. Photodynamic therapy of vulvar lichen sclerosus with 5-aminolevulinic acid. Obstetrics and Gynecology 1999; 93: 71–4.

    Article  PubMed  CAS  Google Scholar 

  13. Virgili A, Corazza M, Bianchi A, Mollica G, Califano A. Open study of topical 0.025% tretinoin in the treatment of vulvar lichen sclerosus. One year of therapy. J Reprod Med 1995; 40: 614–8.

    PubMed  CAS  Google Scholar 

  14. Mork N-J, Jensen P, Hoel PS. Vulval lichen sclerosus treated with etretinate (Tigason). Acta Derm Venereol (Stockh) 1986; 66: 363–5.

    CAS  Google Scholar 

  15. Bousema MT, Romppanen U, Geiger J-M, et al. Acitretin in the treatment of lichen sclerosus et atrophicus of the vulva: a double blind placebo controlled study. J Am Acad Dermatol 1994; 30: 225–31.

    Article  PubMed  CAS  Google Scholar 

  16. Virgili A, Minghetti S, Borghi A, Corazza M. Proactive maintenance therapy with a topical corticosteroid for vulvar lichen sclerosus: preliminary results of a randomized study. Br J Dermatol 2013; 168: 1316–24.

    Article  PubMed  CAS  Google Scholar 

  17. Borghi A, Corazza M, Minghetti S, Toni G, Virgili A. Avocado and soybean extracts as active principles in the treatment of mild-tomoderate vulvar lichen sclerosus: results of efficacy and tolerability. J Eur Acad Dermatol Venereol 2015; 29: 1225–30.

    Article  PubMed  CAS  Google Scholar 

  18. Virgili A, Borghi A, Toni G, Minghetti S, Corazza M. Prospective clinical and epidemiologic study of vulvar lichen sclerosus: analysis of prevalence and severity of clinical features, together with historical and demographic associations. Dermatology 2014; 228: 145–51.

    Article  PubMed  Google Scholar 

  19. Van de Nieuwenhof HP, Meeuwis KA, Nieboer TE, et al. The effect of vulvar lichen sclerosus on quality of life and sexual functioning. J Psychosom Obstet Gynaecol 2010; 31: 279–84.

    Article  PubMed  Google Scholar 

  20. Davidovici BB, Tüzün Y, Wolf R. Retinoid receptors. Dermatol Clin 2007; 25: 525–30.

    Article  PubMed  CAS  Google Scholar 

  21. Berger J, Telser A, Widschwendter M, et al. Expression of retinoic acid receptors in non-neoplastic epithelial disorders of the vulva and normal vulvar skin. Int J Gynecol Pathol 2000; 19: 95–102.

    Article  PubMed  CAS  Google Scholar 

  22. Kaya G, Saurat JH. Restored epidermal CD44 expression in lichen sclerosus et atrophicus and clinical improvement with topical application of retinaldehyde. Br J Dermatol 2005; 152: 570–2.

    Article  PubMed  CAS  Google Scholar 

  23. Kaya G, Augsburger E, Stamenkovic I, Saurat JH. Decrease in epidermal CD44 expression as a potential mechanism for abnormal hyaluronate accumulation in superficial dermis in lichen sclerosus et atrophicus. J Invest Dermatol 2000; 115: 1054–8.

    Article  PubMed  CAS  Google Scholar 

  24. Virgili A, Corazza M, Minghetti S, Borghi A. Growing evidence for topical mometasone fuoroate in the treatment of Vulvar Lichen Sclerosus. Maturitas 2015; 80: 113–5.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Via Savonarola 9, 44121, Ferrara, Italy

    Alessandro Borghi, Monica Corazza, Sara Minghetti & Annarosa Virgili

Authors
  1. Alessandro Borghi
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  2. Monica Corazza
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  3. Sara Minghetti
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  4. Annarosa Virgili
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Correspondence to Alessandro Borghi.

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Borghi, A., Corazza, M., Minghetti, S. et al. Topical tretinoin in the treatment of vulvar lichen sclerosus: an advisable option?. Eur J Dermatol 25, 404–409 (2015). https://doi.org/10.1684/ejd.2015.2595

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  • DOI: https://doi.org/10.1684/ejd.2015.2595

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