Lichen sclerosus is a chronic skin disorder that commonly affects adult women. However, in 10 to 15 percent of cases, the genital area of children, primarily girls, is affected. Associated symptoms, including pruritis, pain, dysuria and constipation, may be chronic and disruptive. Because of its location and the presenting symptoms in children, lichen sclerosus may be misdiagnosed as child abuse or genital infection. These diagnoses should not be ruled out without thorough examination. Approximately 18 percent of affected children experience long-term sequelae, including scarring, adhesions and atrophy. Treatment of lichen sclerosus in children with mild-potency topical corticosteroids has been largely unsatisfactory. However, high-potency corticosteroids have been effective in treating women with this condition. Garzon and Paller evaluated the effectiveness of short-term, ultrapotent topical corticosteroids for symptomatic genital lesions associated with lichen sclerosus in children.
Prepubertal girls with typical clinical features of genital and perianal lichen sclerosus, including whitening, atrophy, erythema and erosions were eligible for the study. The duration of their symptoms before the study ranged from several weeks to more than seven years and included pruritis, chronic discomfort, dysuria and pain with defecation. Previous treatment with hydrocortisone or other topical medications was ineffective. Patients were given one of four topical, ultra-potent corticosteroid ointments (0.05 percent clobetasol, 0.05 percent diflorasone diacetate, 0.05 percent betamethasone dipropionate or betamethasone dipropionate without propylene glycol) to apply sparingly on affected areas twice daily for six weeks. Patients were reexamined after the initial treatment, and long-term follow-up care was given to evaluate for adverse effects for up to three years. The principal outcome measures were improvement of erythema, whitening, erosions and atrophy, and subjective improvement of symptoms.
Ten girls enrolled in the study, and all showed clinical improvement of symptoms and skin lesions on initial follow-up examination. Four girls showed clinical improvement but were not clear after six weeks of treatment. They showed further improvement after treatment for an additional two weeks. Four girls reported irritation, burning and an overall worsening of their condition with application of the corticosteroid. One of these patients was examined five weeks after therapy was initiated. Her treatment was discontinued at this time because the skin was almost clear despite the burning sensation. The corticosteroid was changed in the other three patients, and the second corticosteroid was tolerated well by two of them. The third patient tolerated the nonpropylene glycol preparation. Despite the fact that all of the patients reported overall significant improvement, six had mild recurrences that responded to a brief course of ultrapotent topical corticosteroids. No steroid-induced atrophy or telangiectasias were noted on follow-up examinations.
The authors conclude that an ultrapotent topical corticosteroid applied twice daily to the genital area for six to eight weeks is a safe, effective treatment for vulvar and perianal lichen sclerosus in prepubertal girls. Periodic observation every six to 12 months is important to monitor for recurrence.