Skip to main content
SpringerLink
Log in

Significant Improvement in Extensive Lichen Sclerosus with Tacrolimus Ointment and PUVA

  • Case Reports
  • Tacrolimus and PUVA for Extensive Lichen Sclerosus
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Lichen sclerosus is an uncommon, chronic inflammatory skin disorder of unknown origin. It is clinically characterized by sclerotic, whitish, atrophic-type lesions. The most frequent site of the lesions is generally the genital region, with about 15–20% having additional extragenital involvement. We present the case of a 62-year-old woman with a very extensive extragenital lichen sclerosus who showed great clinical and subjective improvement with 0.1% tacrolimus ointment and psoralen plus UVA (PUVA), without any topical or systemic adverse effects. Combined treatment of 0.1% tacrolimus ointment and PUVA may be a good option in extensive cases of lichen sclerosus or when other treatment options have failed, and has a good tolerability and safety profile.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Meffert J, Davis BM, Grimwood RE. Lichen sclerosus. J Am Acad Dermatol 1995 32: 393–416

    Article  PubMed  CAS  Google Scholar 

  2. Neill SM, Tatnall FM, Cox NH. Guidelines for the management of lichen sclerosus. Br J Dermatol 2002 147: 640–9

    Article  PubMed  CAS  Google Scholar 

  3. Hallopeau H. Le¸ cons cliniques sur les malad´ cutan´ et syphiliques. Union Med Can 1887 43: 472

    Google Scholar 

  4. Helm KF, Gibson LE, Muller SA. Lichen sclerosus et atrophicus in children and young adults. Pediatr Dermatol 1991 8: 97–101

    Article  PubMed  CAS  Google Scholar 

  5. Vildosola VS, Gonz´ ME, Campo Virgili ME. Liquen escleroso y atr´ alez ofico extragenital en una niá préepuber. Actas Dermosifiliogr 1996 87: 418–20

    Google Scholar 

  6. Monteagudo B, Leon E, Lavandeira J. Lichen sclerosus with genital and extragenital lesions. Pediatr Ann 2006 64: 397–8

    Article  Google Scholar 

  7. R¨ocken M, Ghoreschi K. Morfea y liquen escleroso. In: Bolognia L, Jorizzo JL, Rapini RP, editors Dermatolog´ia Madrid: Elsevier

  8. Di Silverio A, Serri F. Generalized bullous and haemorrhagic lichen sclerosus et atrophicus. Br J Dermatol 1975 93: 215–7

    Article  PubMed  Google Scholar 

  9. Wakelin SH, James MP. Extensive lichen sclerosus et atrophicus with bullae and ulceration: improvement with hydroxychloroquine. Clin Exp Dermatol 1994 19: 332–4

    Article  PubMed  CAS  Google Scholar 

  10. Ronnen M, Suster S, Kahana M. Bilateral Koebner phenomenon in lichen sclerosus et atrophicus. Int J Dermatol 1987 26: 117–8

    Article  PubMed  CAS  Google Scholar 

  11. Choi SW, Yang JE, Park HJ. A case of extragenital lichen sclerosus following Blaschko’s lines. J Am Acad Dermatol 2000 43: 903–4

    Article  PubMed  CAS  Google Scholar 

  12. Foulds IS. Lichen sclerosus et atrophicus of the scalp. Br J Dermatol 1980 103: 197–200

    Article  PubMed  CAS  Google Scholar 

  13. Purres J, Krull EA. Lichen sclerosus et atrophicus involving the palms. Arch Dermatol 1971 104: 68–9

    Article  PubMed  CAS  Google Scholar 

  14. Kartamaa M, Reitamo S. Treatment of lichen sclerosus with carbon dioxide laser vaporization. Br J Dermatol 1997 136: 356–9

    Article  PubMed  CAS  Google Scholar 

  15. Kreuter A, Jansen T, Stucker M. Low-dose ultraviolet-A1 phototherapy for lichen sclerosus et atrophicus. Clin Exp Dermatol 2001 26 (1): 30–2

    Article  PubMed  CAS  Google Scholar 

  16. Tan SH, Derrick E, McKee PH. Altered p53 expression and epidermal cell proliferation is seen in vulval lichen sclerosus. J Cutan Pathol 1994 21: 316–23

    Article  PubMed  CAS  Google Scholar 

  17. Kreuter A, Gambichler T, Avermaete A. Low-dose ultraviolet-A1 phototherapy for extragenital lichen sclerosus: results of a preliminary study. J Am Acad Dermatol 2002 46: 251–5

    Article  PubMed  Google Scholar 

  18. Marini A, Blecken S, Ruzicka T. Lichen sclerosus: new aspects of pathogenesis and treatment. Hautarzt 2005 56: 550–5

    Article  PubMed  CAS  Google Scholar 

  19. Meyrick RH, Ridley CM, McGibbon DH. Lichen sclerosus et atrophicus and autoimmunity: a study of 350 women. Br J Dermatol 1988 118: 41–6

    Article  Google Scholar 

  20. Clifton MM, Garner IB, Kohler S. Immunohistochemical evaluation of androgen receptors in genital and extragenital lichen sclerosus: evidence for loss of androgen receptors in lesional epidermis. J Am Acad Dermatol 1999 41: 43–6

    Article  PubMed  CAS  Google Scholar 

  21. Weedon D. Disorders of collagen. In: Weedon D Skin pathology edition Edin-burgh: Churchill Livingstone

  22. Friedrich EG. Topical testosterone for benign vulvar dystrophy. Obstet Gynecol 1971 37: 677–86

    PubMed  Google Scholar 

  23. Sideri M, Origoni M, Spinaci L. Topical testosterone in the treatment of vulvar lichen sclerosus. Int J Gynaecol Obstet 1994 46: 53–6

    Article  PubMed  CAS  Google Scholar 

  24. Bousema MT, Romppanen U, Geizer JM. 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 

  25. Penneys NS. Treatment of lichen sclerosus with potassium paraaminobenzoate. J Am Acad Dermatol 1984 10: 1039–42

    Article  PubMed  CAS  Google Scholar 

  26. Brzezinska-Weislo LA, Szeremeta-Bazylewicz GT, Pierzchala EK. Lichen sclerosus et atrophicus: diagnostic and therapeutic difficulties. Wiad Lek 2001 9-10: 484–91

    Google Scholar 

  27. Kreuter A, Gambichler T, Sauermann K. Extragenital lichen sclerosus successfully treated with topical calcipotriol: evaluation by in vivo confocal laser scanning microscopy. Br J Dermatol 2002 146: 332–3

    Article  PubMed  CAS  Google Scholar 

  28. August PJ, Milward TM. Cryosurgery in the treatment of lichen sclerosus et atrophicus of the vulva. Br J Dermatol 1980 103: 667–70

    Article  PubMed  CAS  Google Scholar 

  29. Hillemans P, Untch M, Prove F. Photodynamic therapy of vulvar lichen sclerosus with 5-aminolevulinic acid. Obstet Gynecol 1999 93: 71–4

    Article  Google Scholar 

  30. Greve B, Hartschuh W, Raulin C. Extragenital lichen sclerosus et atrophicus: treatment with pulsed dye laser. Hautarzt 1999 50: 805–8

    Article  PubMed  CAS  Google Scholar 

  31. Boms S, Gambichler T, Freitag M. Pimecrolimus 1% cream for anogenital lichen sclerosus in childhood. BMC Dermatol 2004 4: 14–7

    Article  PubMed  Google Scholar 

  32. Goldstein AT, Marinoff SC, Christopher K. Pimecrolimus for the treatment of vulvar lichen sclerosus in a premenarchal girl. J Pediatr Adolesc Gynecol 2004 17: 35–7

    Article  PubMed  Google Scholar 

  33. Bohm M, Frieling U, Luger TA. Successful treatment of anogenital lichen sclerosus with topical tacrolimus. Arch Dermatol 2003 139: 922–4

    Article  PubMed  Google Scholar 

  34. Kunstfels R, Kirnbauer R, Stingl G. Successful treatment of vulvar lichen sclerosus with topical tacrolimus. Arch Dermatol 2003 139: 850–2

    Article  Google Scholar 

  35. Assmann T, Becker-Wegerich P, Grewe M. Tacrolimus ointment for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol 2003 48: 935–7

    Article  PubMed  Google Scholar 

  36. Ginarte M, Toribio J. Vulvar lichen sclerosus successfully treated with topical tacrolimus. Eur J Obstet Gynecol Reprod Biol 2005 123: 123–4

    Article  PubMed  Google Scholar 

  37. Goldstein AT, Marinoff SC, Christopher K. Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases. J Reprod Med 2004 49: 778–80

    PubMed  Google Scholar 

  38. Arican O, Ciralik H, Sasmaz S. Unsuccessful treatment of extragenital lichen sclerosus with topical 1% pimecrolimus cream. J Dermatol 2004 31: 1014–7

    PubMed  Google Scholar 

  39. Valdivielso-Ramos M, Bueno C. Generalized lichen sclerosus successfully treated with tacrolimus ointment 0. [poster no PO3 14th EADV Congress; 2005 Oct 12-16

  40. Breuckmann F, Gambichler T, Altmeyer P. UVA/UVA1 phototherapy and PUVA photochemotherapy in connective tissue diseases and related disorders: a research based review. BMC Dermatol 2004 20: 4–11

    Google Scholar 

  41. Dalmau J, Baselga E, Roe E. Psoralen UVA treatment for generalized prepubertal extragenital lichen sclerosus et atrophicus. J Am Acad Dermatol 2006 55: S56–8

    Article  Google Scholar 

  42. Beattie PE, Dawe RS, Ferguson J. UVA-1 phototherapy for genital lichen sclerosus. Clin Exp Dermatol 2006 31: 343–7

    Article  PubMed  CAS  Google Scholar 

  43. Jubran RF, Dinndorf PA. Successful therapy of refractory graft versus host disease with tacrolimus and psoralen plus ultraviolet light. Ther Drug Monit 1998 20: 236–9

    Article  PubMed  CAS  Google Scholar 

  44. Mehrabi D, Pandya AG. A randomized, placebo-controlled, double-blind trial comparing narrowband UV-B plus 0. acrolimus ointment with narrowband UV-B plus placebo in the treatment of generalized vitiligo Arch Dermatol 2006 142: 927–9

    PubMed  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this case report. The authors have no conflicts of interest that are directly relevant to the content of this case report.

Author information

Authors and Affiliations

  1. Servicio de Dermatología, Hospital Virgen de la Torre, Puerto Lumbreras, 5, 28031, Madrid, Spain

    Marta Valdivielso-Ramos

  2. Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Celso Bueno & Josée Manuel Hernanz

Authors
  1. Marta Valdivielso-Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Celso Bueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josée Manuel Hernanz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marta Valdivielso-Ramos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Valdivielso-Ramos, M., Bueno, C. & Hernanz, J.M. Significant Improvement in Extensive Lichen Sclerosus with Tacrolimus Ointment and PUVA. Am J Clin Dermatol 9, 175–179 (2008). https://doi.org/10.2165/00128071-200809030-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128071-200809030-00006

Keywords

Search

Navigation