Lichen sclerosus in men: improving diagnostic and treatment methods

Abstract

Objective of the study.To evaluate the effectiveness of systemic interferon alpha‑2b in the complex therapy of lichen scleroatrophic of the penis.Material and methods. The study involved 26 male patients with a verified diagnosis: lichen scleroatrophic of the penis. The main group was 19 people, the comparison group was 7 men. The duration of the disease in men was from 9 to 12 months. To estimate the area of lesion as well as to estimate their dynamic changes were developed: Scleroatrophic Lichen Area Index (LS-S in men) and Scleroatrophic Lichen Activity Index (LS-A). Treatment in the main group: topical corticosteroid momentasone cream two times a day for 21 days, as well as interferon alpha‑2b suppositories in a dose of 3 million ME two times a day, daily for 10 days, then three times a week for 2 months with subsequent external application of 1–2 times a day for 2 months of ointment with interferon alpha‑2b. In patients with balanopostitis the cream was used in combination with momentazone, economazole, gentamycin and dexpanthenol. Patients from the comparison group received momentazone cream for 21 days, and in case of recurrence of symptoms – the prescription of topical calcineurin inhibitors. Patients of both groups received vitamin E of 200 mg per day for 2 months. The end point of observation for patients of both groups was 3 months after the end of therapy.Results. Against the background of treatment, improvement was achieved in all patients in the main group within 21 days. Subsequent cancellation of topical corticosteroid and continuation of therapy with suppositories and ointment of the interferon alpha‑2b allowed to maintain positive dynamics of the skin process during the whole period of observation. The control group also achieved a positive effect from therapy with topical corticosteroids (cream with momentazone), but after its cancellation, in the period from 4 to 6 weeks, symptoms were recurrent, which required the continuation of therapy with topical calcinerin inhibitors – tacrolimus ointment 0.1% 1–2 times a day for 4 weeks. The use of the LS-A Index showed that the indices of skin manifestations were the fastest to regress than those of the LS-S index assessing the area of lesion.Conclusions. 1. The use of system therapy with interferon alpha‑2b, along with topical GCSs, in the complex treatment can reduce the severity of clinical manifestations of GSAL without resorting to prolonged use of topical GCSs. 2. The use of interferon alpha‑2b in the complex treatment of the genital lichen sclerosus has demonstrated its effectiveness in a small group of patients. 3. Application of the developed Lesion Area Index and Lichen Sclerosus Activity Index in men allow to objectively assess the effectiveness of treatment. 4. Lichen sclerosus assessment indices allow to develop an individual plan of rehabilitation measures. 5. It is expedient to continue studies on pathogenetic mechanisms of influence of alpha‑2b interferon in genital lichen sclerosus.