Clobetasol propionate in the treatment of premenarchal vulvar lichen sclerosus

OBJECTIVE: To assess the effectiveness of treating premenarchal vulvar lich en sclerosus with clobetasol propionate. METHODS: A retrospective chart review was performed of girls presenting to the University of Michigan Pediatric and Adolescent Gynecology Clinic from January, 1995, to July, 2000, with premenarchal lichen sclerosus. Subjects in the study were treated with topical clobetasol propionate ointment 0.05% for 2-4 weeks, and then tapered to a less potent steroid. Information was extracted concerning age at onset, symptoms, vulvar examination, previous t reatments, effectiveness of clobetasol follow-up, and complications. The pa rents were contacted for a follow-up telephone survey. RESULTS: Fifteen girls averaging 5.7 years at the start of symptoms met cri teria. The diagnosis of lichen sclerosus was made visually in I I and by bi opsy in four. Follow-up ranged from 2 months to 6 years. Fourteen girls had good improvement within 4-7 weeks. One girl developed a yeast superinfecti on and one developed transient erythema. At least I year of follow-up by cl inic visit or telephone interview was available in 11 girls. Of these 11, t wo girls had no further vulvar symptoms after the initial treatment, five h ad one or two total flares, three reported three to eight flares per year, and one girl continues to be unresponsive to therapy. CONCLUSION: Clobetasol propionate was an effective treatment of premenarcha l vulvar lichen sclerosus in this small group; however, recurrences were co mmon and required additional steroid treatment. Furthermore, complications of treatment were infrequent, minor, and easily treatable. (C) 2001 by the American College of Obstetricians and Gynecologists.