**3.3 Progesterone**

*Depigmentation*

VIN:

to diagnose just VIN I lesion.

tion is more difficult.

**3.1 Clobetazole (Butavate\*)**

controlled is administered.

*2.3.4 Biological behavior and prognosis VIN and CIN*

• increased incidence in last two decades

• the recession is twice as likely as invasion.

*2.3.5 Clinical finding and diagnose of VIN and CIN*

whereas invasive cancer mainly in the fifth decade [32, 34, 40].

CIN: lesions frequently cited in the transformation zone

believed that it affects Ki67 as well as promotes p53 expression.

disappear, but atrophy and color change still remain.

**3.2 Testosterone and other hormones**

relapses and should continue to receive treatment [72–75]. An alternative option is triamcinolone ointments.

• average age of development 30 years

In most VIN cases, instead of CIN, the damage is high risk. It is also uncommon

• risk of progression to invasive cancer increased in women of the fifth decade (20%)

It is more common in women of 20–30 years, while VIN III in the fourth decade

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 evalua-

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

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

Treatment of choice is the topical administration of clobetazole, which blocks mitosis and induces synthesis of proteins reducing inflammatory response. It is also

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

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

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

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

**42**

It is referred to be extremely effective. It is prepared by mixing 400 mg progesterone oil with 4 oz Aqua-for. It is prescribed twice a day.
