THERAPY OF LICHEN SCLEROSUS ET ATROPHICUS IN WOMEN
N.V. Shperling (1, 2), N.B. Voronina (3), I.A. Shperling (2)
1 Medical University “ReaViZ”, St. Petersburg, Russia;
2 State Research Experimental Institute of Military Medicine, St. Petersburg, Russia;
3 Lomonosov Moscow State University, Russia
Background. Lichen sclerosus et atrophicus (LSA) – a chronic inflammatory lesion of the skin and mucous layers, most often found in the anogenital region and manifested by itching, soreness, atrophy and scar deformation of tissues. The problem of LSA in genitals in women of different age is not currently solved due to the lack of standard methods of treatment. To prevent atrophic processes in stratified squamous epithelium of the genitals and recurrence of the disease, prolonged local therapy with glucocorticoids is carried out. However, long-term local use of strong glucocorticoids (according to the European classification Miller & Munro) cause epithelial atrophy and worsen the course of the disease. In this regard, it is advisable to use glucocorticoids with the absence of this side effect, including the cases of conjunction with drugs of other pharmacological groups. The appearance on the market of topical corticosteroids containing emollients (fats and fat-like substances that can create a protective lipid layer on the surface of the skin), as well as drugs with anti-inflammatory action, proved the development of a scheme for their effective use in LSA. Objective. To evaluate the effectiveness of topical corticosteroids of Methylprednisolone aceponate with ceramides (Komphoderm K) and topical calcineurin inhibitor Tacrolimus (Tacropic 0,03%) in the treatment of LSA in women at different age periods. Methods. 60 women with LSA voluntarily participated in the study. The first group consisted of 22 patients aged 18–45 years (reproductive period), the second – 46–75 years (menopausal transition, menopause and postmenopause). All patients were prescribed complex therapy: application of the cream containing topical GCS/ceramides (weak activity class), once a day for 2 weeks; after – 2 times a week for 4 weeks; from the 15th day after the start of treatment – application of topical calcineurin inhibitor (tacrolimus 0.03%) 2 times a day for 6 months were carried out. The effectiveness of treatment was evaluated at 2, 6, 12 weeks and 6 months after the start of treatment by the dynamics of the presence/absence of symptoms, as well as the severity of the most frequent of them (itching, atrophy and pallor of the vulva), revealed by the results of the pre-treatment examination.
Results. The most labile symptoms of SAL, mostly occurring within 6 months after the start of treatment, were: in patients of all age groups (18–75 years) – itching, scaling, burning and lichenification of the vulva; In addition, in women of reproductive age (18–45 years) –
dyspareunia, sclerosis, atrophy, hemorrhage and rigidity. Symptoms, relatively resistant to the therapy, were characteristic of older women and included dyspareunia, sclerosis, pallor, atrophy and vulva rigidity. The severity of the most significant symptoms of SAL (itching, atrophy, pallor) in the first 2 weeks after the start of treatment was significantly reduced, which indicates the early effectiveness of the therapy. Conclusion. Complex application of topical drug Komfoderm K (unhalogenized topical corticosteroid of a weak class of activity with a high level of safety, capable of long-term stay in the affected tissues, with the addition of humectants in the form of ceramides with emollient functions) and a topical inhibitor of calcineurin (Tacropic 0,03%) showed a high effectiveness in the treatment and prevention of recurrence of LSA in women in different age periods.
About the Autors
Corresponding author: N.V. Shperling – MD, Prof. at the Department of Clinical Medicine, Medical University «ReaViZ», Senior Scientist at the State Research Experimental Institute of Military Medicine, St. Petersburg, Russia; e-mail: email@example.com,