Open-label trial of cyclosporine for vulvar lichen sclerosus Emel Bulbul Baskan, MD, Hakan Turan, MD, Sukran Tunali, MD, Semra Cikman Toker, MD, and Hayriye Saricaoglu, MD Bursa, Turkey Background: Lichen sclerosus (LS) is a chronic inflammatory disease of skin and mucosal surfaces which is generally difficult to treat. Objective: We evaluated the efficacy of oral cyclosporine in refractory vulvar LS. Methods: Five patients with refractory vulvar LS were treated with oral cyclosporine (3-4 mg/kg/d) for 3 months. They were followed up on a monthly basis. Results: At the end of the treatment, the mean total symptom score regressed significantly and clinical findings such as erythema and erosion showed marked improvement. Mild adverse effects were seen in 3 patients. Limitations: The patients did not give consent to rebiopsy at the end of the treatment. Conclusion: Moderate dose of oral cyclosporine could be an effective alternative in the treatment of refractory vulvar LS. ( J Am Acad Dermatol 2007;57:276-8.) L ichen sclerosus (LS) is a chronic inflammatory disease of the skin and mucosal surfaces and is most commonly seen on the female genital skin. Although any age group may be affected, it is seen more often in elderly women. 1 Estimates of prevalence are difficult but recently Powell et al 2 calculated a prevalence of 1 in 660 women. Although various factors such as hormonal, infectious, auto- immune, genetic, and cell-mediated immune re- sponse are thought to be responsible for the disease, the exact origin of LS is unknown. It can cause severe discomfort as a result of persisting pruritus, burning, and pain, and substantial dysfunc- tion of intercourse, urination, and defecation, be- cause of sclerosis and scarring in late stages. 3,4 Therefore, several treatment regimens such as top- ical treatments including ultrapotent corticosteroids, testosterone, tacrolimus, pimecrolimus, calcipotriol, progesterone, estrogen, and cyclosporine; systemic treatments including retinoids, corticosteroids, and potassium para-aminobenzoate; and surgical treat- ments including vulvectomy, laser surgery, and cry- osurgery have been tried. We aimed to present the clinical results of oral cyclosporine therapy used for 5 cases with severe vulvar LS refractory to conven- tional treatments. METHODS Five patients with histologically proven and se- vere vulvar LS who referred to our clinic between June 2004 and March 2006 were included in this retrospective study. Their ages ranged from 48 to 65 years (mean, 53 years). The patients had a history of recalcitrant LS with severe pruritus, burning, and stinging. The duration of the symptoms ranged from 2 to 12 years. Dermatologic examination revealed white sclerotic, eroded, fissured, and infiltrated plaques only localized to the vulvar region (Fig 1). The patients had used several treatment regimens including ultrapotent corticosteroids, testosterone, estrogen, pimecrolimus cream, and systemic corti- costeroids to date (Table I). Initially, these treatments From the Uludag University Medical Faculty, Department of Dermatology. Funding sources: None. Conflicts of interest: None declared. Accepted for publication March 11, 2007. Reprint requests: Emel Bulbul Baskan, Uludag University Medical Faculty, Department of Dermatology, Gorukle 16059, Bursa, Turkey. E-mail: bbemel@uludag.edu.tr. Published online April 19, 2007. 0190-9622/$32.00 ª 2007 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2007.03.006 276