Case Reports
Tacrolimus ointment for the treatment of vulvar lichen sclerosus,☆☆,,★★

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Abstract

The treatment of vulvar lichen sclerosus is generally considered difficult. Ultrapotent corticosteroids represent the most effective topical treatment, but carry the risk of side effects such as skin atrophy. We describe a 71-year-old woman with long-standing vulvar lichen sclerosus refractory to conventional treatment. After 6 consecutive weeks of treatment with tacrolimus ointment 0.1% (Protopic) twice daily, signs and symptoms of lichen sclerosus resolved. To our knowledge, this is the first report of the use of topical tacrolimus, which does not induce skin atrophy, in the treatment of vulvar lichen sclerosus. (J Am Acad Dermatol 2003;48:935-7.)

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Case report

A 71-year-old white woman presented with white atrophic plaques with a waxy surface in the vulvar and perineal region (Fig 1, A).

. Patient (age 71 years) with vulvar lichen sclerosus before treatment (A) and after 6 weeks of topical treatment with tacrolimus ointment twice daily (B).

The patient had a history of recalcitrant lichen sclerosus for more than 10 years with intractable pruritus and pain. Histology showed typical characteristics of lichen sclerosus: a hydropic degeneration of the basal

Discussion

Topical glucocorticosteroids represent the mainstay in the treatment of vulvar lichen sclerosus, however, they induce skin atrophy. Therefore, the use of nonsteroidal drugs is desirable. The immunomodulatory macrolide tacrolimus acts by inhibition of calcineurin, leading to an inhibition of nuclear gene transcription of interleukin 2 and several other proinflammatory cytokines.5, 6 Consequently, activation and differentiation of T cells and other inflammatory cells are suppressed.7, 8, 9

References (16)

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Cited by (86)

  • A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus

    2014, Journal of the American Academy of Dermatology
    Citation Excerpt :

    Safety of long-term use was not studied and still needs further investigation. Local side effects have been reported with tacrolimus1-14,22; this could have led the investigators to suspect which topical regimen participants were using. Therefore, the potential risk for unblinding is present.

  • Pruritus ani: Diagnosis and treatment

    2013, Gastroenterology Clinics of North America
    Citation Excerpt :

    Short term (6–8 weeks) treatment with a potent topical steroid, such as clobetasol, is highly effective in reducing symptoms.20 Retinoids, testosterone creams, and tacrolimus ointment have also been described.22–24 Because of the risk of squamous cell carcinoma, nonresponding patients should have a skin biopsy to rule out malignancy.5

  • The Course of Lichen Sclerosus Diagnosed Prior to Puberty

    2013, Journal of Pediatric and Adolescent Gynecology
    Citation Excerpt :

    Treatment duration of LS in our study varied, but 3-4 months appears to be adequate for most patients. More recently, tacrolimus is increasingly being used as it does not induce skin atrophy (a typical side effect of long-term topical corticosteroid use) and may be useful in refractory cases of LS.20 More research is needed to evaluate the effectiveness and long-term safety of these calcineurin inhibitors vs topical steroids.21

  • Innovative use of topical calcineurin inhibitors

    2010, Dermatologic Clinics
    Citation Excerpt :

    Favorable results were also seen in smaller open studies in patients with vulvar lichen sclerosus102,103 and lichen sclerosus of the penis.104 Several case reports have also shown favorable results in vulvar lichen sclerosus,105–108 anogenital lichen sclerosus,109 and extragenital lichen sclerosus110 including lichen sclerosus of the lip.111 Several open studies112–114 and 1 case report115 showed favorable results of topical pimecrolimus in vulvar lichen sclerosus.

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Funding sources: None.

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Conflict of interest: None identified.

Reprint requests: Thomas Ruzicka, MD, Department of Dermatology, Heinrich-Heine-University, Moorenstr. 5, D-40225 Duesseldorf, Germany. E-mail: [email protected].

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0190-9622/2003/$30.00 + 0

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