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There have been several recent reports of the apparently successful use of topical tacrolimus in the treatment of genital lichen sclerosus (LSc),1 - 4 2 of which have appeared in the Archives of Dermatology.1 - 2
Genital squamous cell carcinoma is an established risk in the context of a chronic inflammatory scarring dermatosis such as LSc.5 - 6 All too frequently in situ and invasive carcinoma is unsuspected, misdiagnosed, or diagnosed late, with dire consequences. Several factors contribute to this, including a low index of suspicion and a failure to recognize significant signs, often less florid than the features of the precursor dermatosis such as LSc, that are indicative of neoplastic change.
It is therefore disconcerting that not one of the articles advocating the use of topical tacrolimus in LSc considers the possibility that this topical immunosuppressant might create an increased risk of squamous cell carcinoma: This theoretical concern already exists for the use of topical ultrapotent steroids in genital LSc although it does not seem to have been borne out in practice, as topical clobetasol proprionate has been used in our clinics since 1986 without a rise in the incidence of squamous cell carcinoma in genital LSc. However, the risk needs to be considered very carefully for a newer agent that has not stood the test of time and that may be used on skin or mucosae that have already been extensively treated with topical steroid.
We urge that a topical ultrapotent steroid, which is very effective in the majority of cases of genital LSc, should remain the first line of medical treatment (alongside possible surgical intervention, eg, circumcision, in the male)6 - 7 and that topical tacrolimus should be used with caution.
The authors have no relevant financial interest in this letter.
Correspondence: Dr Bunker, Department of Dermatology, Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, England (cbb@hamderm.demon.co.uk).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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