Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy.
J Eur Acad Dermatol Venereol. 2018 Jan;32(1):96-101. doi: 10.1111/jdv.14516. Epub 2017 Sep 7.
According to the current guidelines, the aim of vulvar lichen sclerosus (VLS) treatment was to improve symptoms and signs, not to cure.
To assess (i) the rate of patients with VLS who achieved complete clearance of symptoms or objective features, or both, with a 12-week pharmacological treatment and (ii) the predictive value of therapeutic response to the demographic and clinical features.
We retrospectively included patients with VLS who had undergone any topical treatment for 12 weeks; demographics, history, VLS-related symptoms and objective features recorded at baseline and on completion of treatment were collected and elaborated. The primary study endpoint was to assess the rate of patients achieving complete clearance of global subjective score (GSS), or in global objective score (GOS), and in both scores.
One hundred and ninety-six patients were included; 24 (12.2%) were asymptomatic at baseline, and nine (4.6%) dropped out. After treatment, 78 patients (47.3%) achieved GSS = 0, 40 (21.4%) achieved GOS = 0, and 23 (13.9%) achieved complete clearance of both symptoms and signs. Lower symptom scores at baseline and shorter disease duration were associated with the achievement of symptom clearance at the end of the treatment. Earlier disease onset, diagnosis and beginning of study treatment as well as lower baseline GOS were significantly associated with complete recovery of VLS signs and clearance of both symptoms and signs.
A relevant part of patients who undergo a 12-week topical treatment is not completely cured of VLS. It may be hypothesized that these patients, in spite of a significant improvement, may still have substantial residual disease and, as a result, its effect on their quality of life.
根据目前的指南，外阴硬化性苔藓（VLS）的治疗目的是改善症状和体征，而不是治愈。
评估（i）经过 12 周药物治疗后，VLS 患者症状或客观特征完全缓解，或两者均完全缓解的比例，以及（ii）治疗反应对人口统计学和临床特征的预测价值。
我们回顾性纳入接受任何局部治疗 12 周的 VLS 患者；收集并详细记录基线和治疗结束时的人口统计学、病史、VLS 相关症状和客观特征。主要研究终点是评估达到完全缓解的患者比例，包括全球主观评分（GSS）和全球客观评分（GOS），或两者均完全缓解。
共纳入 196 例患者；24 例（12.2%）基线时无症状，9 例（4.6%）脱落。治疗后，78 例（47.3%）患者 GSS=0，40 例（21.4%）GOS=0，23 例（13.9%）同时缓解症状和体征。基线时症状评分较低和疾病持续时间较短与治疗结束时症状缓解相关。疾病更早发生、更早诊断和开始研究治疗以及基线 GOS 较低与 VLS 体征完全恢复和症状和体征均完全缓解显著相关。
接受 12 周局部治疗的患者中有相当一部分不能完全治愈 VLS。可以假设这些患者尽管有显著改善，但仍可能有大量残余疾病，因此对其生活质量有影响。
