Treatment of Vulvovaginal Lichen Planus With Vaginal Hydrocortisone Suppositories

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Successful treatment of vulvovaginal lichen planus has been elusive. Unchecked, the condition can seriously damage the epithelium and lead to vaginal stenosis and severe vaginal erosion. This study was conducted to investigate the use of hydrocortisone vaginal suppositories in the management of lichen planus of the vulva and vagina. Study subjects were 60 patients (mean age, 58 years; range, 30-84 years) from a private clinic who had been diagnosed with lichen planus between 1986 and 2000. Most women in this study were white (87%), 8% were Hispanic, and 2% were Asian. Patients were generally referred by other physicians after futile treatment for chronic vulvar symptoms, which included burning, pruritus, dyspareunia, and vaginal discharge. Diagnosis was confirmed with biopsy, physical exam, and symptomatic review. Initially 25-mg hydrocortisone vaginal suppositories were used twice a day until symptoms subsided. Treatment was gradually decreased to the lowest dose that provided relief from symptoms. Nine of 16 patients with vaginal stenosis were treated with vaginal dilators. Five women used estrogen cream or lidocaine jelly in addition to the suppositories. Erythema was present in nearly all subjects. Vaginal lesions were seen in 49 (82%) women, and vulvar lesions in 47 (78%) women. Forty percent of patients had oral lesions, and 7% had other areas of skin involvement. Complete pre-and posttreatment data were available for two thirds of the 60 subjects, so analysis was restricted to those 43 patients. The distribution of their symptoms did not differ from the total group. Results were based on patients' reports and on physical findings. There was a significant decrease in symptoms in the posttreatment group. The percentage of women who reported burning symptoms decreased from 72% before treatment to 16% after treatment (P <.001). Symptoms of pruritus and dyspareunia decreased from 26% to 5% (P =.004) and from 65% to 23% (P =.006), respectively. Vaginal discharge was experienced by 49% of patients before treatment and 7% after treatment (P <.001). There was no change in vaginal stenosis. Eighty-one percent of patients reported improved or somewhat improved symptoms, and physical examination found improved or somewhat improved symptoms in 84%. The majority of these patients were not sexually active, but those who were reported no change in their sexual activity. No differences were seen between those whose treatment was successful and those who did not have significant improvement. The mean duration of treatment in this series was 28 months (range, 1-144 months).