Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Topical Tacrolimus, Genital Lichen Sclerosus, and Risk of Squamous Cell Carcinoma

Topical Tacrolimus, Genital Lichen Sclerosus, and Risk of Squamous Cell Carcinoma There have been several recent reports of the apparently successful use of topical tacrolimus in the treatment of genital lichen sclerosus (LSc),1-4 2 of which have appeared in the Archives of Dermatology.1,2 Genital squamous cell carcinoma is an established risk in the context of a chronic inflammatory scarring dermatosis such as LSc.5,6 All too frequently in situ and invasive carcinoma is unsuspected, misdiagnosed, or diagnosed late, with dire consequences. Several factors contribute to this, including a low index of suspicion and a failure to recognize significant signs, often less florid than the features of the precursor dermatosis such as LSc, that are indicative of neoplastic change. It is therefore disconcerting that not one of the articles advocating the use of topical tacrolimus in LSc considers the possibility that this topical immunosuppressant might create an increased risk of squamous cell carcinoma: This theoretical concern already exists for the use of topical ultrapotent steroids in genital LSc although it does not seem to have been borne out in practice, as topical clobetasol proprionate has been used in our clinics since 1986 without a rise in the incidence of squamous cell carcinoma in genital LSc. However, the risk needs to be considered very carefully for a newer agent that has not stood the test of time and that may be used on skin or mucosae that have already been extensively treated with topical steroid. We urge that a topical ultrapotent steroid, which is very effective in the majority of cases of genital LSc, should remain the first line of medical treatment (alongside possible surgical intervention, eg, circumcision, in the male)6,7 and that topical tacrolimus should be used with caution. The authors have no relevant financial interest in this letter. Correspondence: Dr Bunker, Department of Dermatology, Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, England (cbb@hamderm.demon.co.uk). References 1. Bohm MFrieling ULuger TABonsmann G Successful treatment of anogenital lichen sclerosus with topical tacrolimus Arch Dermatol. 2003;139922- 924PubMedGoogle ScholarCrossref 2. Kunstfeld RKirnbauer RStingl GKarlhofer FM Successful treatment of vulvar lichen sclerosus with topical tacrolimus Arch Dermatol. 2003;139850- 852PubMedGoogle ScholarCrossref 3. Assmann TBecker-Wegerich PGrewe MMegahed MRuzicka T Tacrolimus ointment for the treatment of vulvar lichen sclerosus J Am Acad Dermatol. 2003;48935- 937PubMedGoogle ScholarCrossref 4. Pandher BSRustin MHKaisary AV Treatment of balanitis xerotica obliterans with topical tacrolimus J Urol. 2003;170923PubMedGoogle ScholarCrossref 5. Neill SMRidley CM Management of anogenital lichen sclerosus Clin Exp Dermatol. 2001;26637- 643PubMedGoogle ScholarCrossref 6. Bunker CB Topics in penile dermatology Clin Exp Dermatol. 2001;26469- 479PubMedGoogle ScholarCrossref 7. Neill SMTatnall FMCox NHBritish Association of Dermatologists, Guidelines for the management of lichen sclerosus Br J Dermatol. 2002;147640- 649PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Topical Tacrolimus, Genital Lichen Sclerosus, and Risk of Squamous Cell Carcinoma

Topical Tacrolimus, Genital Lichen Sclerosus, and Risk of Squamous Cell Carcinoma

Abstract

There have been several recent reports of the apparently successful use of topical tacrolimus in the treatment of genital lichen sclerosus (LSc),1-4 2 of which have appeared in the Archives of Dermatology.1,2 Genital squamous cell carcinoma is an established risk in the context of a chronic inflammatory scarring dermatosis such as LSc.5,6 All too frequently in situ and invasive carcinoma is unsuspected, misdiagnosed, or diagnosed late, with dire consequences. Several factors contribute to...
Loading next page...
 
/lp/american-medical-association/topical-tacrolimus-genital-lichen-sclerosus-and-risk-of-squamous-cell-7zTY45KEUj
Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.140.9.1169-a
Publisher site
See Article on Publisher Site

Abstract

There have been several recent reports of the apparently successful use of topical tacrolimus in the treatment of genital lichen sclerosus (LSc),1-4 2 of which have appeared in the Archives of Dermatology.1,2 Genital squamous cell carcinoma is an established risk in the context of a chronic inflammatory scarring dermatosis such as LSc.5,6 All too frequently in situ and invasive carcinoma is unsuspected, misdiagnosed, or diagnosed late, with dire consequences. Several factors contribute to this, including a low index of suspicion and a failure to recognize significant signs, often less florid than the features of the precursor dermatosis such as LSc, that are indicative of neoplastic change. It is therefore disconcerting that not one of the articles advocating the use of topical tacrolimus in LSc considers the possibility that this topical immunosuppressant might create an increased risk of squamous cell carcinoma: This theoretical concern already exists for the use of topical ultrapotent steroids in genital LSc although it does not seem to have been borne out in practice, as topical clobetasol proprionate has been used in our clinics since 1986 without a rise in the incidence of squamous cell carcinoma in genital LSc. However, the risk needs to be considered very carefully for a newer agent that has not stood the test of time and that may be used on skin or mucosae that have already been extensively treated with topical steroid. We urge that a topical ultrapotent steroid, which is very effective in the majority of cases of genital LSc, should remain the first line of medical treatment (alongside possible surgical intervention, eg, circumcision, in the male)6,7 and that topical tacrolimus should be used with caution. The authors have no relevant financial interest in this letter. Correspondence: Dr Bunker, Department of Dermatology, Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, England (cbb@hamderm.demon.co.uk). References 1. Bohm MFrieling ULuger TABonsmann G Successful treatment of anogenital lichen sclerosus with topical tacrolimus Arch Dermatol. 2003;139922- 924PubMedGoogle ScholarCrossref 2. Kunstfeld RKirnbauer RStingl GKarlhofer FM Successful treatment of vulvar lichen sclerosus with topical tacrolimus Arch Dermatol. 2003;139850- 852PubMedGoogle ScholarCrossref 3. Assmann TBecker-Wegerich PGrewe MMegahed MRuzicka T Tacrolimus ointment for the treatment of vulvar lichen sclerosus J Am Acad Dermatol. 2003;48935- 937PubMedGoogle ScholarCrossref 4. Pandher BSRustin MHKaisary AV Treatment of balanitis xerotica obliterans with topical tacrolimus J Urol. 2003;170923PubMedGoogle ScholarCrossref 5. Neill SMRidley CM Management of anogenital lichen sclerosus Clin Exp Dermatol. 2001;26637- 643PubMedGoogle ScholarCrossref 6. Bunker CB Topics in penile dermatology Clin Exp Dermatol. 2001;26469- 479PubMedGoogle ScholarCrossref 7. Neill SMTatnall FMCox NHBritish Association of Dermatologists, Guidelines for the management of lichen sclerosus Br J Dermatol. 2002;147640- 649PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Sep 1, 2004

Keywords: squamous cell carcinoma,tacrolimus,genital lichen sclerosus

References