A dopamine agonist successfully treats a case of chronic lichen sclerosus

The dermatological inflammatory disorder known as lichen sclerosus (LS) frequently involves the vulva. The most common therapy are very potent glucocorticoids e.g., clobetasol, although recently laser therapy has been evaluated with some success. However, in general, the standard therapies have not been overly impressive with their results. Dopamine agonists, e.g., dextroamphetamine sulfate (DS), have been very successful in ameliorating pelvic pain, vulvovaginitis, and different types of dermatological conditions that were refractory to standard therapy. A case is presented of a patient with dysmenorrhea and vulvar LS. The LS worsened progressing to painful fissures despite treatment with three different types of potent topical glucocorticoids. Her dysmenorrhea and LS went into total remission after a short time of treatment with DS. The remission has lasted 1.5 years while remaining on DS therapy. The hypothesized mechanism of action of DS is to release more dopamine. This biogenic amine probably corrects these inflammatory defects by the effect of dopamine on decreasing cellular permeability thus precluding the abrogation of the mucosal barrier thus preventing infiltration of unwanted irritants into various tissues causing inflammation by cellular immune cells, including, but not limited to, the vulvar region.