Topical Cyclosporine in the Treatment of Vulvar Lichen Sclerosus: Clinical, Histologic, and Immunohistochemical Findings

To the Editor.—  The topical application of cyclosporine could avoid the systemic side effects of the drug, making possible its use for localized immunomediated dermatoses. The sitespecific immunologic effects of topical cyclosporine have been demonstrated in animal models¹; good effects in the treatment of mucosal lichen planus with topical cyclosporine have been reported by some authors.²Vulvar lichen sclerosus (LS) is a chronic dermatosis affecting a considerable percentage of women applying to centers for vulvar disease. Patients complain of pruritus, dryness, and dyspareunia; sclerofibrotic evolution is common, with different degrees of severity affecting the labia minora and atrophy of the clitoris. Although the pathogenesis of this disease is not completely known, the involvement of the skin immune system (SIS) in vulvar lesions of LS has been recently hypothesized by means of in situ immunologic studies³ showing activated T cells in the dermis and a persistent increase of