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Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases.
J Reprod Med. 2004 Oct; 49(10):778-80.JR

Abstract

BACKGROUND

Lichen sclerosus is a chronic cutaneous disorder with a predilection for the vulva. The etiology is unknown. Superpotent topical corticosteroids are the most effective treatment. Dermal atrophy, however, is a well-known complication associated with changes of lichen sclerosus superpotent topical corticosteroids. In addition, some women do not respond adequately to topical steroids. Therefore, a treatment regimen that does not rely on corticosteroids may be beneficial. As lichen sclerosus is a T-lymphocyte-mediated disorder, it has been suggested that a topical macrolide immunosuppressant, such as pimecrolimus, may be a safe and effective alternative treatment for lichen sclerosus. Since pimecrolimus does not affect collagen synthesis, it does not cause thinning of the dermis.

CASES

Four patients with biopsy-proven lichen sclerosus were treated with 1% pimecrolimus cream twice daily. At the end of 3 months of treatment, 3 of the 4 patients reported complete resolution of their symptoms of vulvar itching and burning. Two patients had repeat vulvar biopsies at the end of treatment that showed reversal of the histologic changes of lichen sclerosus.

CONCLUSION

In this small series, pimecrolimus appeared to be a safe and effective treatment of vulvar lichen sclerosus. A randomized, controlled trial comparing pimecrolimus and clobetasol propionate should be performed to determine which is the safer and more effective medication for the long-term treatment of lichen sclerosus.

Authors+Show Affiliations

Goldstein AT
Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. obstetrics@yahoo.com
Marinoff SC
No affiliation info available
Christopher K
No affiliation info available

MeSH

Administration, TopicalAdultBiopsy, NeedleChildDose-Response Relationship, DrugDrug Administration ScheduleFemaleFollow-Up StudiesHumansImmunohistochemistryImmunosuppressive AgentsLichen Sclerosus et AtrophicusMiddle AgedSampling StudiesSeverity of Illness IndexTacrolimusTreatment OutcomeVulvar Diseases

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15568399

Clinical Trial Links

Clobetasol Versus Pimecrolimus for Vulvar Lichen Sclerosus

Citation

Goldstein, Andrew T., et al. "Pimecrolimus for the Treatment of Vulvar Lichen Sclerosus: a Report of 4 Cases." The Journal of Reproductive Medicine, vol. 49, no. 10, 2004, pp. 778-80.
Goldstein AT, Marinoff SC, Christopher K. Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases. J Reprod Med. 2004;49(10):778-80.
Goldstein, A. T., Marinoff, S. C., & Christopher, K. (2004). Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases. The Journal of Reproductive Medicine, 49(10), 778-80.
Goldstein AT, Marinoff SC, Christopher K. Pimecrolimus for the Treatment of Vulvar Lichen Sclerosus: a Report of 4 Cases. J Reprod Med. 2004;49(10):778-80. PubMed PMID: 15568399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases. AU - Goldstein,Andrew T, AU - Marinoff,Stanley C, AU - Christopher,Kurt, PY - 2004/12/1/pubmed PY - 2005/2/18/medline PY - 2004/12/1/entrez SP - 778 EP - 80 JF - The Journal of reproductive medicine JO - J Reprod Med VL - 49 IS - 10 N2 - BACKGROUND: Lichen sclerosus is a chronic cutaneous disorder with a predilection for the vulva. The etiology is unknown. Superpotent topical corticosteroids are the most effective treatment. Dermal atrophy, however, is a well-known complication associated with changes of lichen sclerosus superpotent topical corticosteroids. In addition, some women do not respond adequately to topical steroids. Therefore, a treatment regimen that does not rely on corticosteroids may be beneficial. As lichen sclerosus is a T-lymphocyte-mediated disorder, it has been suggested that a topical macrolide immunosuppressant, such as pimecrolimus, may be a safe and effective alternative treatment for lichen sclerosus. Since pimecrolimus does not affect collagen synthesis, it does not cause thinning of the dermis. CASES: Four patients with biopsy-proven lichen sclerosus were treated with 1% pimecrolimus cream twice daily. At the end of 3 months of treatment, 3 of the 4 patients reported complete resolution of their symptoms of vulvar itching and burning. Two patients had repeat vulvar biopsies at the end of treatment that showed reversal of the histologic changes of lichen sclerosus. CONCLUSION: In this small series, pimecrolimus appeared to be a safe and effective treatment of vulvar lichen sclerosus. A randomized, controlled trial comparing pimecrolimus and clobetasol propionate should be performed to determine which is the safer and more effective medication for the long-term treatment of lichen sclerosus. SN - 0024-7758 UR - https://www.unboundmedicine.com/medline/citation/15568399/Pimecrolimus_for_the_treatment_of_vulvar_lichen_sclerosus:_a_report_of_4_cases_ DB - PRIME DP - Unbound Medicine ER -