Treatment and prevention of recurrent genital lichen sclerosus in women

Objective: To compare the eff icacy of topical glucocorticoids (GCs) monotherapy and combined hormonal therapy with low molecular weight hyaluronic acid in the treatment of genital lichen sclerosus (GLS) in women. Materials and methods: 66 women with GLS were divided into Group 1 (n=20) and Group 2 (n=46). Group 1 patients were treated with topical GCs (mometasone) for 3 months. Group 2patients additionally received vaginal and vulvar Estrogial cream and gel for 6 months. The efficacy was assessed at 2, 6, 12 weeks and 6 months after the start of treatment by changes in symptoms and the severity of the most frequent (itching, atrophy and paleness of the vulva). Results: In Group 1, many symptoms had regressed by the 3rd month of treatment (p<0.001), but by the 6th month most symptoms relapsed. Group 2, on the other hand, showed an improvement in all GLS symptoms during the treatment course (p<0.001) and no relapse. The most pronounced effect by the 6th month of follow-up was noted between the groups regarding atrophy, paleness, burning, and sclerosis. Analysis of the severity of the leading GLS symptoms showed a significant reduction in the severity of all symptoms at month 6 of follow-up in Group 2 patients compared to Group 1 and at all time points of atrophy and paleness except for baseline (p<0.01). The greatest effect size was observed at the end of 6 months of follow-up for atrophy with between-group median difference between groups of 3.0 (-3.0-0), p<0.001. Conclusion: The use of vaginal and vulvar Estrogial cream and gel as part of complex therapy with topical GCs led to better treatment results and lower recurrence rate, compared to GCs monotherapy. Estrogial cream and gel for local application can be considered an addition to the baseline GLS therapy.

lichen sclerosus, hyaluronic acid, glucocorticoids, Estrogial