Treatment of Vulvovaginal Erosive and Stenosing Lichen Planus by Surgical Dilatation and Methotrexate

October 2007 in “ Obstetrical & Gynecological Survey ”

Outi Kortekangas-Savolainen, Pentti Kiilholma

methotrexate tacrolimus steroid creams emollients local estrogen

TLDR Low-dose methotrexate, combined with surgical and local treatments, effectively treats severe vulvovaginal lichen planus.

The study reported on the treatment of 5 women with severe vulvovaginal erosive and stenosing lichen planus (LP) using surgical dilatation and methotrexate, alongside local treatments like tacrolimus and potent steroid creams. Methotrexate, administered weekly at 7.5 mg, was effective in reducing stenotic changes and benefiting oral lesions, with only one patient experiencing hair loss as a side effect. The treatment regimen also included washing with emollients and local estrogen to prevent vaginal atrophy. The findings supported the use of low-dose methotrexate for severe cases, especially when surgical and local treatments were insufficient, and highlighted the need for close follow-up due to the risk of malignant transformation.

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