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. 2024 Oct;63(10):e240-e243.
doi: 10.1111/ijd.17394. Epub 2024 Jul 19.

Treatment of lichen sclerosus with hydroxychloroquine: a Mayo Clinic experience

Christeebella O Akpala  1 , Burak Tekin  2 , Rochelle R Torgerson  3 , David A Wetter  4 , Giang Huong Nguyen  4
Affiliations

Treatment of lichen sclerosus with hydroxychloroquine: a Mayo Clinic experience

Christeebella O Akpala et al. Int J Dermatol. 2024 Oct.

Abstract

Background: 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.

Keywords: GLS; HCQ; LS; anogenital lichen sclerosus; antimalarial; hydroxychloroquine; lichen sclerosus; systemic autoimmune diseases.

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