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Outcomes of Treatment With Hydroxychloroquine in Patients With Lichen Sclerosus
TAKE-HOME MESSAGE
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This retrospective study assessed data from 70 patients with lichen sclerosus who were treated with hydroxychloroquine. The hydroxychloroquine treatment response rate for anogenital lichen sclerosus was 84.6% compared with only 50.0% for extragenital lichen sclerosus. The adverse effects were predominantly mild and were noted in 14.3% of the patients.
- This study suggests that hydroxychloroquine is a treatment option for patients with anogenital lichen sclerosus, given the disease improvements and few adverse effects.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
There is a dearth of studies investigating the efficacy of hydroxychloroquine in the treatment of either anogenital lichen sclerosus or extragenital lichen sclerosus, a condition that, if left untreated, could lead to a greater degree of scarring and malignant transformation.
OBJECTIVE
This study aims to analyze the demographic characteristics, clinicopathological features, treatment response, and outcomes of patients diagnosed with either anogenital or extragenital lichen sclerosus who received hydroxychloroquine therapy.
METHODS
A retrospective analysis was conducted involving 70 patients diagnosed with lichen sclerosus who underwent treatment with hydroxychloroquine at our institution between 2018 and 2023.
RESULTS
Among the cohort, 67 patients were female, and 3 were male. Extragenital lichen sclerosus was diagnosed in 23 patients, with 16 exhibiting concomitant morphea overlap. Itching was the predominant clinical presentation (67%). A notable proportion of patients (36%) had a connective tissue disorder, prompting hydroxychloroquine therapy. Among the 30 patients treated solely for lichen sclerosus, 21 demonstrated response and 9 had no response. From a broader comparison of response to hydroxychloroquine, the overall anogenital response rate was 84.6% as opposed to 50% in extragenital lichen sclerosus. The median time to initial response was 4 months. Adverse effects, predominantly mild, were observed in 10 (14.3%) patients.
LIMITATION
This study is constrained by its retrospective nature and reliance on data from a single center, resulting in a limited sample size.
CONCLUSION
Hydroxychloroquine demonstrates promise as a therapeutic option for anogenital lichen sclerosus because of its favorable response rates and low incidence of adverse effects. However, further investigations, including larger-scale or prospective studies, are imperative to ascertain its definitive efficacy.
Additional Info
Disclosure statements are available on the authors' profiles:
Treatment of lichen sclerosus with hydroxychloroquine: a Mayo Clinic experience
Int. J. Dermatol 2024 Jul 19;[EPub Ahead of Print], CO Akpala, B Tekin, RR Torgerson, DA Wetter, GH NguyenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Patients and physicians are itching for new medications to treat lichen sclerosus. Super-potent topical steroids have been the mainstay of therapy since the early 1990s when they were found superior to 2% topical testosterone. Although widely accessible and inexpensive, patients remain frustrated with topical agents and are discouraged from applying them regularly on genital skin by non-dermatologists.
This retrospective study highlights the outcomes of treatment with hydroxychloroquine in 70 patients with anogenital and/or extragenital lichen sclerosus. A majority of the patients were prescribed hydroxychloroquine for morphea or other connective tissue diseases, but 30 were started on therapy for their lichen sclerosus. I found it interesting that whitening or epidermal atrophy was not listed in the clinical presentation for lichen sclerosus; in fact, 10% of the patients did not have a clinical examination documented. Patients with anogenital disease were noted to have a higher rate of response to therapy than those with extragenital disease. Unfortunately, there were subjective outcome measures, and all but 2 patients with lichen sclerosus were continued on topical steroids, making it difficult to conclude that the improvement was from hydroxychloroquine alone.
Despite these limitations, this intriguing study highlights the use of a well-tolerated medication for a condition that affects 1% of the population. Given the response rate of more than 80% among patients with anogenital disease, rest assured that multi-institutional randomized controlled trials comparing hydroxychloroquine with first-line topical steroids are on the horizon.