Simonart Thierry, Lahaye Marc, Simonart Jean-Marie
Department of Dermatology, Erasme University Hospital, Brussels, Belgium.
Menopause. 2008 Jan-Feb;15(1):74-7. doi: 10.1097/gme.0b013e3180616689.
Vulvar lichen sclerosus (LS) is an inflammatory disease of unknown etiology that may result in significant discomfort and psychological distress in postmenopausal women. One of the most troublesome features of LS is its chronically relapsing nature. The aim of this study was to investigate the effect of maintenance therapy with a moisturizer in preventing the risk of relapse and progression of vulvar LS in postmenopausal women.
Between January 1995 and January 2006, 34 postmenopausal women with vulvar LS were included in a prospective open trial. The participants were treated with a topical corticosteroid cream (0.1% betamethasone valerate) once daily for 1 month and then with maintenance therapy with a moisturizing cream alone once daily. Follow-up visits were scheduled after 1 month and then twice per year (median follow-up, 58 mo).
Overall the symptoms of all women improved after therapy with a topical steroid. Twenty-four women (71%) became symptom free, and 10 (29%) experienced partial response. Eighteen of the 24 women (75%) who became symptom free and 6 of the 10 women (60%) who exhibited a partial response reported no worsening of their symptoms while on therapy with a cold cream alone. Total resolution of the clinical signs occurred in 6 of the 19 women with mild vulvar architectural changes. Partial resolution of clinical signs was observed in 22 women (64%). No change was noticed in six (18%) women. None of the participants experienced worsening of vulvar scarring. None of the participants developed vulvar intraepithelial neoplasia or squamous cell carcinoma during the follow-up period. There were no side effects.
Long-term maintenance therapy of vulvar LS with a moisturizing cream can maintain the symptom relief induced by topical corticosteroids in women with vulvar LS while being safe and inexpensive. This treatment may also be associated with a reduction in topical corticosteroid use because more than half of the women could eliminate corticosteroids altogether.
外阴硬化性苔藓（LS）是一种病因不明的炎症性疾病，可给绝经后女性带来极大不适和心理困扰。LS最棘手的特征之一是其慢性复发性。本研究旨在探讨使用保湿剂进行维持治疗对预防绝经后女性外阴LS复发和进展风险的效果。
1995年1月至2006年1月期间，34名患有外阴LS的绝经后女性被纳入一项前瞻性开放试验。参与者每天外用一次皮质类固醇乳膏（0.1%戊酸倍他米松），持续1个月，然后仅每天使用一次保湿霜进行维持治疗。在1个月后安排随访，之后每年随访两次（中位随访时间为58个月）。
总体而言，所有女性经外用类固醇治疗后症状均有改善。24名女性（71%）症状消失，10名（29%）有部分缓解。在24名症状消失的女性中，有18名（75%），在10名有部分缓解的女性中，有6名（60%）报告在仅使用冷霜治疗期间症状未加重。19名有轻度外阴结构改变的女性中有6名临床体征完全消退。22名女性（64%）观察到临床体征部分消退。6名（18%）女性未见变化。所有参与者的外阴瘢痕均未加重。在随访期间，没有参与者发生外阴上皮内瘤变或鳞状细胞癌。没有副作用。
对外阴LS使用保湿霜进行长期维持治疗，可在安全且廉价的同时，维持外用皮质类固醇诱导的外阴LS女性的症状缓解。这种治疗还可能与减少外用皮质类固醇的使用有关，因为超过一半的女性可以完全停用皮质类固醇。
