LICHEN SCLEROSUS ET ATROPHICUS (LSA)
and CLOBETASOL PROPIONATE
RS. Please note : My criticism of these studies is that parents
should not be advised to experiment with steroids on children, until
conclusive, scientific, unbiased, and uncontradictory studies have
been performed, and the methods tried and tested, - preferably on adults.
Individual adults or parents who ecstatically praise steroids as the
new wonder cure will not change my attitude.
Betamethasone is occasionally
claimed to cure LSA
RS criticism of LINDHAGEN:
First we will consider an excellent scientific study, noting over previous
studies "However neither of these studies considered the possibility
that the outcome was attributable to anything but the steroid.".
Histological (i.e. the cellular strructure, by which LSA etc, is diagnosed)
examinations were performed.
Topical clobetasol propionate compared with placebo in the treatment
of unretractable foreskin.
Eur J Surg 1996 Dec;162(12):969-72
ABSTRACT: Objective: To assess whether it is the steroid
alone or the gentle physical retraction combined with ointment that
is responsible for the excellent results observed with topical steroid
treatment of unretractable foreskin. Design: Prospective, randomised,
double-blind study. Setting: University hospital, Sweden. Subjects:
30 Boys randomised to be treated with clobetasol propionate (n = 15)
or placebo (n = 15). Interventions: The boys were examined 1,
2 and 6 months, respectively, after treatment. Main Outcome Measures: Comparison between the effects of clobetasol propionate and placebo. Results: Two patients in the steroid group and one in the placebo
group withdrew from the study. 10 Boys in the steroid group showed
an improvement within 2 months. The remaining 3 boys had no effect
and were circumcised. Histopathological examination showed lichen sclerosus
et atrophicus. Seven boys in the placebo group improved. The 7 non-
responders were prescribed clobetasol propionate ointment, and all
7 improved. Conclusion: 17 of 27 boys referred with "phimosis"
were successfully treated with an ointment and gentle traction. When
clobetasol propionate was given the non-responders success rate was
increased to 24/27 (89%).
" .. clobetasol propionate 0.05% (Dermovate, Glaxco UK). Instructions
were to retract the foreskin as much as possible without causing pain
and then apply a thin layer of the ointment into the prepuce from the
corona gkandis to the distal margin once daily. After one week of treatment,
gentle attempts to retract the foreskin should be made.
The problem remains, however, to differentiate and operate on the cases
with lichen schlerosus et atrophicus, a distinct histopathological
diagnosis which leads to fibrotic scarring of the distal prepuce with
true phimosis, and which may develop into squamous cell carcinoma.
In recent years topical steroid ointments have been successfully used
to treat phimosis. Jørgensen and Svensson reported a 70% rate
of success using clobetasol propionate 0.05% cream, while Kirikos et.
al. had an overall success rate of 81% with different regimens including
betamethasone and hydrocortisone creams. However neither of these studies
considered the possibility that the outcome was attributable to anything
but the steroid."
The dilemma facing the family practitioner and the paediatrician is
one of differential diagnosis, and identifying the cases of lichen
sclerosus et atrophicus. The development of phimosis in previously
retractable foreskin has been suggested as a criterion ... A good practice
could be to circumcise patients with more than two recurrencese after
treatment with topical steroid.
In conclusion, the non-invasive treatment of phimosis with an ointment
and gentle traction resolves half the cases, and this increases to
almost 90% with the addition of a potent topical steroid, thereby significantly
reducing the "need" for circumcision."
RS criticism of DAHLMAN-GHOZLAND:
An excellent study, (both this and the previous come from Sweden).
clobetasol propionate needs further study - because both studies are
completely contradictory - the first says clobetasol propionate does
not relieve LSA, the second says it does, and both are 100% conclusive.
(above: 3 circumcised had LSA - below: "All histologic LSA criteria
were significantly (P < .01 to .05) reduced after treatment.")
K DAHLMAN-GHOZLAND, Hedblad MA, von Krogh G
Penile lichen sclerosus et atrophicus treated with clobetasol dipropionate
0.05% cream: a retrospective clinical and histopathological study.
Department of Dermatovenereology, Karolinska Hospital, Stockholm,
J Am Acad Dermatol 1999 Mar;40(3):451-7
Abstract: BACKGROUND: Treatment with clobetasol propionate
0.05% cream is effective against lichen sclerosus et atrophicus (LSA)
of the vulva. OBJECTIVE: The purpose of this study was to retrospectively
evaluate whether clinical and histologic responses to topical clobetasol
can be accomplished in penile LSA. METHODS: A self-assessment questionnaire
was obtained from 22 men with LSA, and a clinical examination was performed
in 21 of them. Biopsy specimens from 15 cases were compared before
and after treatment. RESULTS: Itching, burning, pain, dyspareunia,
phimosis, and dysuria decreased significantly (P < .001 to .05) after
1 to 2 daily applications, for a mean of 7.1 weeks (2-16 weeks). Additional
operation for phimosis was required in 6 of the 22 men. All histologic
LSA criteria were significantly (P < .01 to .05) reduced after treatment.
CONCLUSION: Topical treatment of penile LSA with clobetasol propionate
represents a safe and effective therapy with no risk of epidermal atrophy
but with some potential for triggering latent infections, most importantly