Exact use of prescribed topical steroids may be most beneficial in vulvar lichen sclerosus
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Women who used topical steroids exactly as prescribed for vulvar lichen sclerosus experienced improved symptoms compared with women who failed to use steroids appropriately, according to a study.
“Our objective was to investigate the relationship between patient compliance with topical steroids and patients’ perceived symptoms, progression of physical exam changes and sexual function,” Jaden R. Kohn, MD, MPH, of Baylor College of Medicine and department of gynecology and obstetrics, Johns Hopkins Hospital, and colleagues wrote.
Kohn and colleagues described vulvar lichen sclerosus (VLS) as a progressive dermatitis marked by itching, pain and sexual dysfunction. In the retrospective cohort study, they evaluated how dermatology, gynecology and vulvovaginal specialty clinics used topical steroids in this patient population from 2012 to 2017.
The analysis included data for 333 women and 1,525 doctor visits (median six visits per patient; range, 1 to 24 visits).
At 66% of these visits, patients used steroids exactly as prescribed. However, at 26% of visits, patients used less steroids than prescribed, while 8% reported not using steroids at all.
Compared with patients who failed to use steroids, exact use yielded significant improvement in symptoms (OR = 4.6; 95% CI, 2.2-9.6). Exact use also bested no use in terms of physical exam results (OR = 6.9; 95% CI, 2.7-17.6).
By comparison, infrequent steroid use demonstrated smaller improvements over no use in terms of symptoms (OR = 2.5; 95% CI, 1.2-5.4) and physical exam (OR = 4.2; 95% CI, 1.6-11.0).
While 93% of vulvovaginal doctor visits included a note on sexual activity status, just 29% of gynecology visits and 0% of dermatology visits included this information.
Baseline data showed that 42% of patients were not sexually active due to pain of VLS. Among this group, sexual activity resumed as a result of steroid treatment.
No association was reported between steroid adherence and change in sexual activity.
Just 69% of follow-up visits included patients reporting on steroid use.
Further findings showed that ultra-high-potency steroids were used in 75% of visits that reported this information, while high-potency steroids were used in 14% of visits, moderate-potency steroids in 3% and low-potency steroids in 8%.
“Women with vulvar lichen sclerosus are more likely to improve clinically in both their reported symptoms and physical exam when topical steroids are used exactly as prescribed,” the researchers said. “However, some degree of improvement may occur when topical corticosteroids are used less than prescribed in either frequency or amount.”
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