Use Clobetasol on Lichen Sclerosus, Then Biopsy.

SOUTH LAKE TAHOE, NEV, -- If a patient presents with what appears to be lichen sclerosus of the vulva, it is often a good idea to treat her with clobetasol propionate before attempting to biopsy any lesions unless an obvious carcinoma is present, Dr. C. Paul Morrow recommended.

Of the inflammatory dermatoses of the vulva, lichen sclerosus is the most common and has the highest potential for malignancy. It therefore needs to be diagnosed and treated with special diligence, he said at an obstetrics and gynecology conference sponsored by the University of California, Davis.

Lichen sclerosus--symmetrical, confluent skin involvement--is usually confined to the glabrous, non-hair-bearing skin. The skin typically has a very white, parchmentlike look, said Dr. Morrow, a professor in the division of gynecologic oncology at the University of Southern California, Los Angeles.

However, since the hallmark of the disease is pruritus, when patients first present with severe cases they often have been scratching excessively, leading to heavily keratinized and ulcerated areas. In these cases, it can be difficult to decide whether what you are seeing is carcinoma or lichen sclerosus, and it can be hard to know where to biopsy to make either diagnosis, Dr. Morrow said.

Therefore, he often first treats suspected cases of lichen sclerosus empirically, with clobetasol propionate 0.05% cream, twice daily for a week. That is usually enough time for the scratching damage to begin to resolve and it is then easier to see where to biopsy In these patients, Dr. Morrow usually takes four or more biopsies.

Generally, he has ...