Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies

Authors

Theodora T. Mautz, The Centers for Vulvovaginal Disorders, New York, NY, USA. Electronic address: tmautz.cvvd@gmail.com.
Jill M. Krapf, The Centers for Vulvovaginal Disorders, New York, NY, USA; The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, DC, USA.
Andrew T. Goldstein, The Centers for Vulvovaginal Disorders, New York, NY, USA; The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, DC, USA.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

Sexual medicine reviews

Volume

10

Issue

1

DOI

10.1016/j.sxmr.2021.03.006

Keywords

Corticosteroids; Pharmacokinetics: Vulvar lichen sclerosus; Vulva

Abstract

Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short- and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2022;10:42-52.

APA Citation

Mautz, Theodora T.; Krapf, Jill M.; and Goldstein, Andrew T., "Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies" (2022). GW Authored Works. Paper 492.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/492

Department

Obstetrics and Gynecology