Therapeutic target
Relief of local symptoms
Therapy recommendations
Woman
Woman:
- Careful local care of the labia majora and minora (labia) with dexpanthenol cream (also known as pantothenol, D-panthenol, or panthenol) [basic therapy].
- Estrogen-containing (estriol-containing) hydrophilic creams – in early stages in women, especially younger women.
- Shock therapy
- Topical glucocorticosteroids (TGS): clobetasol propionate 0.5% for 2-3 months (5 months); success rates of over 90% are reported; milder cortisone ointments are used thereafter
- For nonresponse to glucocorticoids: topical immunomodulators (TIM):
- Topical calcineurin antagonists (immunosuppressive/modulating) resp.
- Systemic therapy with retinoids for 3 to 4 months;
- If necessary, also cyclosporine over 3 months or low-dose methotrexate over 6 to 8 months.
- For nonresponse to glucocorticoids: topical immunomodulators (TIM):
- UVA phototherapy (see below “Further therapy“).
- Topical glucocorticosteroids (TGS): clobetasol propionate 0.5% for 2-3 months (5 months); success rates of over 90% are reported; milder cortisone ointments are used thereafter
Girls:
- Careful local care of the large and small labia with dexpanthenol cream (also known as pantothenol, D-panthenol or panthenol) [basic therapy].
- Topical glucocorticosteroids (TGS): e.g. clobetasol propionate 0.05% and mometasone furoate 0.1%.
- Topical immunomodulators (TIM): tacrolimus 0.03% or 0.1% (off-label use); dosing: initially 1 time daily, duration of 4 weeks; then 1 time every 2nd day for 4 weeks and finally 2 times weekly for 4 weeks (or longer until remission is achieved)
Man
Man:
- Testosterone ointment/gel (2-5%) (better: early circumcision/circumcision!).
Boys:
- Circumcision (remission (regression) rates of up to 100% have been described).
Extragenital lesions (skin lesions outside the genitals)
- Use of TGS as well as TIM (see above).
See also under “Further therapy”.
