Clobetasol dipropionate 0.05% versus testosterone propionate 2% topical application for severe vulvar lichen sclerosus

OBJECTIVE: Our goal was to evaluate short-term (3 months) and long-term (I year) treatment of vulvar lichen sclerosus, by comparing topical application of testosterone propionate 2% in petrolatum with the corticosteroid clobetasol dipropionate 0.05%. STUDY DESIGN: There were 20 women in each treatment group. The patients' symptoms and the gynecologist's examination findings were recorded before treatment, at 3 months, and at 1 year after initiation of therapy. RESULTS: The symptomatic (subjective) effect of clobetasol treatment was similar to that of testosterone at the 3-month follow-up (p less than or equal to 0.34), although objectively the signs of lichen sclerosus had improved more in the clobetasol group (p less than or equal to 0.033). Both symptoms and signs were significantly more improved in the clobetasol-treated group at the I-year follow-up examination (p less than or equal to 0.02). Seventy percent of women treated by testosterone discontinued treatment because of a lack of response, whereas only 10% of the women treated with clobetasol stopped the treatment for that reason (p less than or equal to 0.00042). CONCLUSION: Clobetasol is more effective than testosterone in the treatment of women with lichen sclerosus,especially in the long term.