Topical immunosuppressants, genital lichen sclerosus and the risk of squamous cell carcinoma: a case report.

BACKGROUND: Squamous cell carcinoma (SCC) has a recognized association with lichen sclerosus (LS) of the vulva. Several recent reports have indicated the usefulness of the new macrolide immunosuppressant agents pimecrolimus and tacrolimus in the treatment of LS, emphasizing the advantage over topical corticosteroids of lack of atophogenicity. Despite this there may be risks involved that could outweigh this benefit. The potential of these medications to potentiate the risk of SCC in LS in the short and long-term is unknown. Once lichen sclerosus is well controlled, there is often no need for ongoing use of superpotent corticosteroids, and there may be no reason to use immunosuppressants when moderate-strength corticosteroids provide adequate control.

CASE: A 73-year-old woman with a 10-year history of hypertrophic LS and genital psoriasis presented with intractable superimposed inflammatory vulvitis. She was treated with topical pimecrolimus 1% cream on the assumption that she was either allergic to or intolerant of topical corticosteroids. One month after commencing therapy, she suddenly developed a rapidly growing vulvar tumor. This was excised and proved to be a well-differentiated squamous cell carcinoma.

CONCLUSION: It may be safest to restrict the use of topical immunosuppressives to patients with LS who are unable to use topical corticosteroids because of the risk of potentiating SCC.