Treatment of lichen sclerosus with antibiotics.

Current therapy for lichen sclerosus centers on topical steroids, particularly clobetasol propionate. As some evidence suggests an infectious etiology owing to Borrelia, we studied the effect of penicillin and cephalosporin therapy on patients with lichen sclerosus who had responded poorly to treatment with potent topical corticosteroids. Fifteen patients with lichen sclerosus were treated for 3-21 months with either penicillin or cephalosporins in an observational study. Thirteen patients (nine women, four men) received penicillin, including intramuscular penicillin G benzathine suspension and/or oral penicillin V potassium, amoxicillin, or amoxicillin/clavulanate potassium. Two additional men received cephalosporins, either intramuscular ceftriaxone sodium or oral cefadroxil monohydrate. All patients showed a significant response, evident within a few weeks. Most striking was the rapid relief of pain, pruritus and burning. Four patients cleared completely, four experienced marked improvement, and the remaining seven had a favorable improvement of symptoms with incomplete clearing of lesions. We recommend treatment of lichen sclerosus with either intramuscular ceftriaxone every 3 weeks or intramuscular penicillin every 2-3 weeks. The addition of oral penicillin or cephalosporin presumably helps maintain antibiotic blood levels and may be a sufficient treatment in some cases.

Disseminated blastomycosis.

A 26-year-old veiled Saudi-Arabian woman presented with hemoptysis, and multiple nodules and abscesses. A skin biopsy specimen revealed yeast forms consistent with Blastomyces dermatitidis. Fungal cultures from bronchoscopy and skin specimens also grew B dermatitidis. She was treated with oral itraconazole (200 mg twice a day). Both lung and skin lesions showed improvement within 6 weeks.