Ultrapotent topical corticosteroid treatment of childhood genital lichen sclerosus

Objective: To observe the clinical effects of short-term application of ultrapotent topical corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients. Design: Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent topical corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years. Setting: Pediatric dermatology clinic (referral center). Patients: Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus. Intervention: Topical ultrapotent corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks. Main Outcome Measure: Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms. Results: All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent topical corticosteroid. No significant adverse effects were noted after the initial 6- to 8-week course of therapy or during the 6-month to 3-year follow-up period. Conclusion: A 6- to 8-week course of ultrapotent topical corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.