Bradford J, Fischer G
Department of Obstetrics and Gynaecology, Blacktown Hospital, University of Western Sydney, Campbelltown, NSW, Australia.
Aust N Z J Obstet Gynaecol. 2010 Apr;50(2):148-52. doi: 10.1111/j.1479-828X.2010.01142.x.
Adult vulval lichen sclerosus (VLS) is usually a lifelong disease with an estimated remission rate after treatment of only 16% [Arch Dermatol 2004; 140 (6): 709]. Although superpotent topical corticosteroid (TCS) is the validated gold standard treatment to induce remission, little data are available on how remission should be maintained.
We present a retrospective chart review of 129 adult patients with VLS who have been under surveillance by the authors for a minimum duration of three years.
Remission was maintained in most patients with low-to-moderate potency TCS. All subjects' symptoms, signs, treatment regimes and response to treatment including compliance, symptom remission, disease progression with scarring, squamous cell carcinoma and side effects were recorded. Data were compared for the compliant and non-compliant groups. Fischer's exact test was used to identify significant differences.
The mean age at presentation was 53.6 years and mean duration of follow-up was 6.2 years. Compliance was excellent: 84 (65%) of patients' self-reporting as being fully compliant. Symptom remission was achieved in 98% of compliant and 75% of non-compliant patients (P = 0.001) Progression of disease with scarring was not encountered in any of the compliant patients, but was seen in 35% of non-compliant patients (P = 0.0001). One patient had squamous cell carcinoma on first presentation. Carcinoma subsequently occurred in none of the compliant patients, and in five partly compliant patients (P = 0.004). Mild, reversible corticosteroid side effects were encountered in 7% of patients.
Long-term treatment of adult VLS with individualised regimes using moderate potency TCS is safe and effective. Patients require long-term follow-up.
成人外阴硬化性苔藓（VLS）通常是一种终身性疾病，治疗后的缓解率估计仅为16%[《皮肤病学文献》2004年；140(6):709]。尽管超强效外用糖皮质激素（TCS）是诱导缓解的有效金标准治疗方法，但关于如何维持缓解的数据却很少。
我们对129例成年VLS患者进行了一项回顾性病历审查，这些患者由作者进行了至少三年的监测。
大多数中低效力TCS患者的缓解得以维持。记录了所有受试者的症状、体征、治疗方案以及对治疗的反应，包括依从性、症状缓解、伴有瘢痕形成的疾病进展、鳞状细胞癌和副作用。对依从组和不依从组的数据进行了比较。采用Fisher精确检验来确定显著差异。
就诊时的平均年龄为53.6岁，平均随访时间为6.2年。依从性良好：84例（65%）患者自我报告完全依从。98%的依从患者和75%的不依从患者实现了症状缓解（P = 0.001）。依从患者中未出现伴有瘢痕形成的疾病进展，但在35%的不依从患者中出现了这种情况（P = 0.0001）。1例患者初诊时患有鳞状细胞癌。随后，依从患者中无1例发生癌变，部分依从的5例患者发生了癌变（P = 0.004）。7%的患者出现了轻度、可逆的糖皮质激素副作用。
使用中效力TCS进行个体化方案的成人VLS长期治疗是安全有效的。患者需要长期随访。
