Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study.

BACKGROUND: Promising results have been reported from treatment with oral retinoids in patients with severe lichen sclerosus et atrophicus (LSA) of the vulva. OBJECTIVE: The aim of our study was to determine the efficacy of acitretin (20 to 30 mg/day) for 16 weeks in LSA. METHODS: Seventy-eight patients were enrolled into a multicenter, randomized, placebo-controlled, double-blind trial. The primary measure of efficacy was the "responder" rate based on the assessment of characteristic clinical features of LSA of the vulva (pruritus, burning, atrophy, hyperkeratosis, and secondary features such as erosions, ulcers, edema, or lichenification) and on the extent of the lesions. RESULTS: From the 46 patients eligible for efficacy analysis, a significantly higher number of responders was observed in the acitretin-treatment group (14 of 22 patients) as compared with the placebo-treatment group (6 of 24 patients). Typical retinoid adverse reactions were observed in all patients receiving active drug. CONCLUSION: Acitretin is effective in treating women with severe LSA of the vulva.

Depletion of Langerhans cells in cervical HPV infection is associated with replication of the virus.

We studied the quantity of Langerhans cells in 36 patients with cervical human papillomavirus (HPV) infection. Significantly fewer Langerhans cells (p < 0.05) were found in patients with compared to those without DNA tetraploidy. Similarly, patients positive for HPV 16/18 DNA by in situ hybridization or antipeptide IgA antibodies to HPV 18 tended to have fewer Langerhans cells than those negative for HPV 16/18 DNA or IgA antibodies. Our results suggest that depletion of Langerhans cells is associated with productive HPV 16/18 infection in the cervical epithelium.

Immunoblotting analysis of class-specific antibody response in patients with primary HSV infection.

Class-specific immune response in acute herpes simplex virus (HSV) infections to individual virus specified polypeptide antigens was analysed by immunoblotting. The HSV specified glycoproteins B (gB), C (gC), and D (gD) were detected. IgG-antibody response was shown to develop to various other virus specific polypeptides as well. The IgM- and IgA-antibody responses remained restricted to only a few HSV specific proteins, namely VP 13 (80 kD), VP 20 (52 kD), and VP 23 (40 kD) and to the low molecular weight polypeptides.

Serum levels of vitamin A, E, and selenium in women with lichen sclerosus of the vulva treated with etretinate.

Forty-six patients with Lichen sclerosus (Ls) of the vulva were treated with peroral etretinate for 3 months. The pretreatment serum levels of vitamins A and E, and selenium were measured. Etretinate therapy proved to be effective in the treatment of Ls; however, it did not affect the vitamin A status of the Ls patients. Vitamin E and selenium levels did not differ from the control values, nor did they have any prognostic value.

Light- and electron-microscopic findings in lichen sclerosus of the vulva during etretinate treatment.

Fifteen women with lichen sclerosus (LS) of the vulva were treated for 3 months with 0.6 mg/kg of etretinate. The clinical response was good in 11/15 of the patients and, in agreement with this, light microscopy showed decreasing atrophy and hyperkeratosis together with subsiding inflammatory changes. However, orcein staining demonstrated that even after etretinate treatment, elastic fibers were still absent in the upper dermis with only few fibers being detectable in some specimens. Conventional electron microscopy and immunoelectron microscopy were used to examine these changes more in detail. Antiserum to the microfibrillar part of the elastic fibers confirmed that only remnants of microfibrillar coat persisted in the upper dermis and that deeper in the dermis, elastic fibers were porous and fragmented. These findings demonstrate that despite the normalization of clinical and certain histological parameters during etretinate treatment, the initial elastic fiber damage persists both at the light- and electronmicroscopic levels.

[Oral treatment of vulvar dystrophy with an aromatic retinoid, etretinate]. / Orale Behandlung der Dystrophie der Vulva mit einem aromatischen Retinoid, Etretinat.

Twenty patients with vulvar dystrophy (19 Lichen sclerosus, 1 Lichen ruber planus) were treated for 3 months with etretinate (Tigason) with an initial dose 0.54 mg/kg/day, maintenance dosage 0.26 mg/kg/day. All the patients had been unsuccessfully treated previously with topical oestrogen and corticosteroids. The therapeutic effect of etretinate on the subjective and objective symptoms of the disease was excellent. In most of the patients the pruritus and burning symptoms diminished within 2 weeks of treatment, and after 3 months the grade of symptoms was lower in 95% of cases. Clinically, a decrease in severity was achieved in 93% of cases among the group with severe vulvar dystrophy. The therapeutic effect of etretinate is strongly anti-inflammatory and it has a powerful effect on the epidermal tissues. According to the latest studies, etretinate also has a strong immuno-modifying effect on the epidermal cells. The secondary inflammatory changes, such as excoriatia, fissures and superinfections disappeared. In the histopathological follow-up hyperkeratosis in the stroma diminished and the inflamed cells and connective tissue normalised after 3 months of treatment. Side effects included cheilitis, dryness of mucous membranes and slight loss of hair. It must be taken into account that etretinate may cause liquid metabolism disturbances, particularly among risk factor patients (diabetes, obesity etc.). In our experience the best results to date in the treatment of vulvar dystrophy can be achieved with etretinate. Due to the teratogenic effect of etretinate, a reliable method of contraception must be used by fertile women of childbearing age.

Serum vitamin A and E levels in patients with lichen sclerosus and carcinoma of the vulva--effect of oral etretinate treatment.

Serum vitamin A and E concentrations were determined in six patients with vulvar epithelial carcinoma and in 25 patients with lichen sclerosus and atrophicus (LSA) of the vulva. No difference could be found in these levels between the two groups. LSA patients received oral etretinate for two months at least; improvement was observed in 93% of the patients. Etretinate therapy had no effect on the serum levels of vitamins A or E.