Materials and Methods
A retrospective cohort study including all the women followed in the
Lower Genital Tract Disease Unit of Centro Hospitalar Universitário São
João during a period of eleven years (January 2008-December 2018), with
the diagnosis of vulvar LP was performed. Patients were referred by the
primary care providers, emergency room or from other consultations. The
diagnosis of LP was made based on clinical features and/or on histology,
according to the ISSVD recommendations.9–12
Data were collected through consultation of the electronic files of each
patient, where all the information is recorded. We retrieved information
on the age at diagnosis, smoking habits, menopause status and the use of
menopause hormone therapy. Presenting symptoms and anatomical changes
observed in physical examination that contributed to the diagnosis of LP
were also evaluated. Follow-up was made, at least, annually. Shorter
interval visits were performed whenever deemed necessary: either due to
poor control of symptoms or presence of suspicious lesions. Data on the
treatments performed, both topical and systemic and the need to escalate
therapy for uncontrolled disease were also evaluated. We usually
advocate a scheme of application of clobetasol propionate (CP) once a
day for 4 weeks, followed by once every other day for another 4 weeks,
and finally twice a week for another 4 weeks, completing 3 months of
initial treatment. Manutention therapy is usually recommended; patients
are advised to use up to 60 g of CP/year.
Whenever a suspicious lesion was found during follow-up or when first
line treatments were not effective in controlling the disease, vulvar
biopsies were performed. The results of all biopsies performed were
retrieved and analyzed.
Descriptive and inferential analysis were performed using IBM SPSS
Statistics Version 21. We performed a descriptive analysis, with
continuous variables summarized as means with standard deviations and
categorical variables as percentages of patients in each category.
The study was approved by the ethics committee of the institution
(nº182/19).