Renaud-Vilmer Catherine, Cavelier-Balloy Bénédicte, Porcher Raphaël, Dubertret Louis
Department of Dermatology, Centre anticancereux Rene Huguenin, St Cloud, France.
Arch Dermatol. 2004 Jun;140(6):709-12. doi: 10.1001/archderm.140.6.709.
Lichen sclerosus is an inflammatory disease of unknown etiology affecting the anogenital skin and associated with the development of squamous cell carcinoma. It is not known whether long-term topical treatment with a potent steroid can cure this disease and thus prevent malignant evolution.
To analyze the rates of remission, recurrence, and chronic evolution of vulvar lichen sclerosus (VLS) treated with 0.05% clobetasol propionate ointment and determine whether this treatment can decrease the risk of malignant evolution.
Prospective study, conducted between 1981 and 2001, of 83 women with VLS who were treated until complete clinical and histologic remission and followed up for evidence of clinical and histologic recurrence (median follow-up, 4.7 years).
Dermatology department of a large urban teaching hospital.
Complete remission was obtained in 45 patients (54%). The probability of remission was significantly associated with age (P<.001). The estimated incidence of remission at 3 years was 72% in women younger than 50 years, 23% in women aged between 50 and 70 years, and 0% in women older than 70 years. The incidence of relapse was estimated to be 50% at 16 months (95% confidence interval, 30%-64%) and 84% at 4 years (95% confidence interval, 57%-94%). Age had no effect on relapse prevalence. The 8 observed vulvar squamous cell carcinomas (9.6%) occurred in previously untreated or irregularly treated VLS lesions.
Treatment with a potent steroid cream can improve but does not cure VLS in women older than 70 years, probably because of a long disease evolution. In younger patients who achieve complete remission, it seems to have only a temporary effect. Although a protective effect from malignant evolution is suggested (carcinoma developed only in nontreated or irregularly treated VLS lesions), the number of seemingly protected patients was too small to be statistically significant.
硬化性苔藓是一种病因不明的炎症性疾病，累及肛门生殖器皮肤，并与鳞状细胞癌的发生有关。目前尚不清楚长期外用强效类固醇能否治愈该病，从而预防恶性进展。
分析外用0.05%丙酸氯倍他索软膏治疗外阴硬化性苔藓（VLS）的缓解率、复发率和慢性进展情况，并确定该治疗能否降低恶性进展的风险。
1981年至2001年间进行的一项前瞻性研究，纳入83例VLS女性患者，治疗至临床和组织学完全缓解，并随访临床和组织学复发证据（中位随访时间4.7年）。
一家大型城市教学医院的皮肤科。
45例患者（54%）获得完全缓解。缓解概率与年龄显著相关（P<0.001）。年龄小于50岁的女性3年缓解估计发生率为72%，50至70岁女性为23%，70岁以上女性为0%。复发率估计在16个月时为50%（95%置信区间，30，30%-64%），4年时为84%（95%置信区间，57%-94%）。年龄对复发率无影响。观察到的8例外阴鳞状细胞癌（9.6%）发生在既往未治疗或治疗不规律的VLS病变中。
外用强效类固醇乳膏可改善70岁以上女性的VLS，但不能治愈，可能是因为病程较长。在获得完全缓解的年轻患者中，似乎只有暂时的效果。虽然提示有预防恶性进展的作用（仅在未治疗或治疗不规律的VLS病变中发生癌变），但似乎得到保护的患者数量太少，无统计学意义。
