SHORT-TERM EFFECTS OF TOPICAL TESTOSTERONE IN VULVAR LICHEN-SCLEROSUS

Objective: To evaluate the systemic and therapeutic effect of topical testosterone treatment in vulvar lichen sclerosus. Methods: This prosp ective clinical, single-arm study included ten postmenopausal women wi th vulvar lichen sclerosus. Testosterone propionate (0.04 g daily) was administered topically for 4 weeks. Serum androgens (testosterone, fr ee testosterone, androstenedione, dehydroepiandrosterone sulfate) were determined before and after 4 weeks of treatment, and; vulvodynia was evaluated by a horizontal visual analogue scale. Results: Serum level s of total testosterone increased in all patients (P < .01) and exceed ed normal range in eight of ten women. Vulvodynia improved in nine of ten patients (paired t test: P < .01). Four of ten patients showed cli nical signs of hyperandrogenism (enlargement of the clitoris, alterati ons of the voice, increase in libido) after 4 weeks of treatment. The only patient without subjective improvement had elevated basal serum a ndrogen levels and showed clinical signs of hyperandrogenism before th erapy. Conclusion: Topical testosterone is effective in normoandrogeni c women with lichen sclerosus. Androgen status should be evaluated bef ore treatment, and dosage should be individualized to avoid virilizati on and metabolic side effects. Because there is a marked systemic effe ct, clinical controls and a follow-up with evaluation of serum testost erone levels are recommended. Other steroids should be included in the rapeutic decisions. Copyright (C) 1997 by The American College of Obst etricians and Gynecologists.