Comorbid Vulvar Lichen Sclerosus and High-Grade Squamous Intraepithelial Lesions: A Management Conundrum. Issue 4 (15th October 2022)

• Record Type: Journal Article
• Authors: Janke, Monica J.; DeBlanc, Jennie; Kobernik, Emily K.; Skala, Stephanie L.; Hiles, Guadalupe Lorenzatti; Kelly, Rebeca; Welch, Kathryn C.
• Is Part Of: Journal of lower genital tract disease. Volume 26:Issue 4(2022)
• Page Start: 319
• Page End: 322
• Publication Date: 2022-10-15
• Subjects: lichen sclerosus et atrophicus -- vulvar lichen sclerosus -- squamous intraepithelial lesions -- vulvar intraepithelial neoplasia -- human papillomavirus-dependent vulvar intraepithelial neoplasia -- human papillomavirus-independent vulvar intraepithelial neoplasia -- usual-type vulvar intraepithelial lesion -- differentiated vulvar intraepithelial neoplasia -- topical corticosteroids; Generative organs, Female -- Diseases -- Periodicals; Cervix uteri -- Diseases -- Periodicals; Generative organs -- Diseases -- Periodicals; Sexually transmitted diseases -- Periodicals; 618.1
• DOI: 10.1097/LGT.0000000000000690
• Languages: English
• ISSNs: 1089-2591

Abstract

Abstract : Patients with comorbid lichen sclerosus and high-grade squamous intraepithelial lesion treated with topical corticosteroids do not have an increased risk of high-grade squamous intraepithelial lesion recurrence. Abstract : Objective: This study aimed to determine if treating lichen sclerosus (LS) with high-potency topical corticosteroids (TCS) increases the risk of high-grade squamous intraepithelial lesion (HSIL) recurrence in patients with comorbid vulvar LS and HSIL. Methods: This is a retrospective study of patients with comorbid vulvar LS and HSIL treated with TCS between 2015 and 2020. Patients with clinically diagnosed or biopsy-proven LS and biopsy-proven HSIL of the vulva were included. Clinical data included demographics, tobacco use, immune-modifying conditions, specimen pathology, treatment types, and HSIL recurrence. Bivariate analysis was performed to compare demographic and clinical characteristics between patients with and without HSIL recurrence. Results: Twenty-six patients with comorbid LS and HSIL were identified. The median age was 66.0 years and median time in treatment for LS was 5.5 years. Thirteen (50%) had recurrence of HSIL and 13 (50%) did not have recurrence. Exposure to high-potency TCS was present in 20 (77%) patients, with 17 (65%) having use of more than 1-year duration and 9 (35%) having use at the time of HSIL diagnosis. When comparing the groups with and without HSIL recurrence, there was no significant difference in high-potency TCS exposure, duration of use, or use at time of HSIL diagnosis. Conclusions: High-potency TCS use for the treatment of LS did not seem to increase the risk of HSIL recurrence in patients with comorbid vulvar LS and HSIL. This suggests that high-potency TCS can be appropriately used for the treatment of LS even when HPV-associated disease is present.