Androgens in the topical treatment of lichen sclerosus

Background. Testosterone propionate has been shown repeatedly to be effective in the treatment of vulvar lichen sclerosus, yet studies of androgens in serum of women with untreated vulvar lichen sclerosus suggested an abnormal activity of 5-alpha reductase in these patients. If impairment of 5-alpha reductase in women with untreated vulvar lichen sclerosus is a proximate cause of this disease, then dihydrotestosterone should be more effective than testosterone propionate in the treatment of the condition. Methods. To test this hypothesis, five women with vulvar lichen sclerosus received topically either dihydrotestosterone or testosterone propionate in a double-blind crossover study. Results, These androgens appear to be equally effective in inducing objective improvement of the vulvar lichen sclerosus by both gross and microscopic criteria. Conclusions. Impairment of 5-alpha reductase may not be germane to the pathogenesis of vulvar lichen sclerosus.