*2.3.3 Risk factors*


#### *2.3.4 Biological behavior and prognosis VIN and CIN*

In most VIN cases, instead of CIN, the damage is high risk. It is also uncommon to diagnose just VIN I lesion.

VIN:


It is more common in women of 20–30 years, while VIN III in the fourth decade whereas invasive cancer mainly in the fifth decade [32, 34, 40].

#### *2.3.5 Clinical finding and diagnose of VIN and CIN*

VIN instead of CIN is not appeared during colposcopy with abnormal vasculation and mosaicism, but in the form of subtracted white or red plaques with clear borders.

Due to keratinization of the surface layer, in case of VIN, the cytological evaluation is more difficult.

VIΝ: itching, burning sensation, pain, single, or multifocal lesions (40%) CIN: there are usually no symptoms or findings, single, or multifocal lesions VIN: lesions often situated in the inner lips of vagina and the perineum CIN: lesions frequently cited in the transformation zone

#### **3 Basic principles in treatment of depigmentation disorders of the vulva**

#### **3.1 Clobetazole (Butavate\*)**

Treatment of choice is the topical administration of clobetazole, which blocks mitosis and induces synthesis of proteins reducing inflammatory response. It is also believed that it affects Ki67 as well as promotes p53 expression.

For those cases that diagnosed for the first time, it is recommended to apply once daily for 4 weeks, then every second day for 4 more weeks and during the third month of treatment, twice a week (once a day is based on pharmacokinetic studies). If symptoms reappear, the minimal clobetazole dose in which disease was controlled is administered.

A 30 g tube should be used for 12 weeks, and then, the original is reconsidered. If treatment is effective, hyperkeratosis, bruising, erosions, and stretch marks will disappear, but atrophy and color change still remain.

Clobetazole is continued as needed. Most patients usually need 30–60 g per year. If therapy is complete, no further treatment is needed, but other patients will have relapses and should continue to receive treatment [72–75].

An alternative option is triamcinolone ointments.

#### **3.2 Testosterone and other hormones**

Nowadays, estrogens or testosterone creams have no place in the LS treatment. Also recent studies have shown that testosterone is less effective than clobetazole

**43**

*Depigmentation's Disorders of the Vulva, Clinical Management*

terone oil with 4 oz Aqua-for. It is prescribed twice a day.

and has same effectiveness with petrolatum, the excipient used to make testoster-

It is referred to be extremely effective. It is prepared by mixing 400 mg proges-

They are mainly used in the complicated LS on failure of corticoid treatment. It

Acitrecine (Nco-Tigason\*) 25 or 50 mg/24 h per os in a single dose until symptom remission and continue 25–50 mg/24 hours go per os. The treatment stops

Isotretinoin (Roaccutan\*, Accurane\*) synthetic 13 is isomer of tretinoin. It reduces sebaceous gland size and sebum production and inhibits abnormal keratinization. The

Topical administration of retinoids is not recommended due to the local irrita-

Close attention should be paid to per os administration of retinoids to adolescents due to the teratogenicity they cause and is recommended avoidance of pregnancy for 2 months (isotretinoin) and 3 years (acitretin) at the end of the treatment [72–75].

Positive results from the administration of potassium para-aminobenzoate, as well as psoralen with UVA therapy, stanozolol, antimalarials, antihistamines (e.g. oxatomide), and various antibiotics (possible cause or infection by Borrelia), were also observed.

In uncomplicated forms of LS, there is no evidence of removal of vulvar tissue. Surgical treatment should be applied exclusively in case of malignant transforma-

When there is a narrowing of the opening of vagina, perineoplasty is performed, which improves dyspareunia in 90% of cases and improves the quality of sexual life

Simple vulvectomy should not be preferred because the symptoms do not always

Positive results are reported with LASER ablation treatment, which is applied with LASER CO, 1–2 mm deep with complete healing 6 weeks after surgery and low relapse rates. It is considered a method of nonresponse to other forms of treatment.

disappear, the signs reappear, and the likelihood of malignant transformation

persists. Also, the operation creates many psychosocial problems.

is considered that they reduce the degradation of the connective tissue.

dose is 0.5–1 mg/kg/24 hours, and the duration of treatment is 4–6 months.

*DOI: http://dx.doi.org/10.5772/intechopen.83595*

one ointment.

**3.4 Retinoids**

*3.4.1 Acitrecine (Nco-Tigason\*)*

when the lesions fall back.

tion they cause.

**3.5 Other medications**

**3.6 Surgical treatment**

tion and recurrent forms.

**3.7 Alternative treatment**

in 86% of cases.

*3.4.2 Isotretinoin (Roaccutan\*, Accurane\*)*

**3.3 Progesterone**

and has same effectiveness with petrolatum, the excipient used to make testosterone ointment.
