Remission of genital and generalised extragenital lichen sclerosus et atrophicus under pulse therapy with intravenous steroids

• Published in: BMJ case reports Vol. 14; no. 4; p. e241900
• Main Authors: Plachouri, Kerasia-Maria, Mulita, Francesk, Grafanaki, Katerina, Georgiou, Sophia
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 30.04.2021; BMJ Publishing Group
• Subjects: Abdomen; Breasts; Case reports; Causality; Genitalia; Humans; Images In; Inflammatory diseases; Lichen Sclerosus et Atrophicus - drug therapy; Patients; Remission (Medicine); Skin; Skin diseases; Steroids; Urogenital system; Vagina; skin; dermatology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-241900

LSA is a chronic condition that affects mostly the anogenital region, but can also manifest in extragenital areas and can prove refractory to many topical and systemic treatments.3 4 Large scale studies on generalised extragenital disease are rather scarce, with case series and case reports being the source of information concerning the therapeutic approach in this case.1–4 Kreuter et al describe a prospective study of seven patients that showed sufficient response under a regimen with pulsed intravenous high-dose corticosteroids combined with orally administered low-dose methotrexate therapy (15 mg weekly).3 A limited number of small studies and case series describe the administration of methotrexate as monotherapy.1 2 4 However, no studies concerning the use of high pulse intravenous steroids combined with topical potent steroids are reported. The fact that our patient was overweight discouraged us from considering methotrexate as a treatment option, since patients with increased body mass index tend to be more susceptible to methotrexate-associated liver toxicity.5 The application of potent topical steroids in our case was limited to the genital lesions, as described above. [...]a pulse therapy with high-dose corticosteroids is a useful option for cases where other therapeutic regimes, such as potent topical steroids or methotrexate monotherapy, are either insufficient to achieve disease control, or contraindicated.