From the Guidelines
Diltiazem is not recommended as a first-line treatment for lichen sclerosus, and instead, a potent topical corticosteroid, such as clobetasol propionate 0.05% ointment, should be used as the primary treatment. The standard treatment for lichen sclerosus is based on guidelines from reputable sources, including the British Association of Dermatologists 1. For lichen sclerosus, the recommended regimen is:
- Apply clobetasol propionate 0.05% ointment once daily for 4 weeks
- Then reduce to every other day for 4 weeks
- Finally, maintain with twice weekly applications long-term Diltiazem, a calcium channel blocker, has been studied for lichen sclerosus in limited cases, primarily for its potential to improve blood flow and reduce inflammation. However, its efficacy is not well-established, and it should only be considered as an alternative or adjunct therapy under specialist guidance 1. If considering diltiazem, it would typically be used as a 2% topical preparation, applied twice daily. However, patients should be aware that this is an off-label use and may not be as effective as standard corticosteroid treatment. The primary goal in treating lichen sclerosus is to control symptoms, prevent scarring, and reduce the risk of malignant transformation, and topical corticosteroids remain the most effective way to achieve these goals based on current evidence 1.
From the Research
Treatment Options for Lichen Sclerosus
- The primary treatment for lichen sclerosus is topical high potency corticosteroids, as recommended by 2 and 3.
- Second- and third-line treatments include topical calcineurin inhibitors and topical retinoids, respectively, as suggested by 2 and 4.
- Surgical treatment is considered for male genital lichen sclerosus with persistent phimosis not responsive to medical treatment, as stated by 2 and 3.
Effectiveness of Diltiazem for Lichen Sclerosus
- There is no mention of Diltiazem as a treatment option for lichen sclerosus in the provided studies 2, 3, 4, 5, 6.
- The studies focus on the effectiveness of topical corticosteroids, calcineurin inhibitors, and other treatments, but do not discuss Diltiazem as a potential treatment for lichen sclerosus.
Alternative Treatment Options
- Photodynamic therapy, as discussed in 5, may be a novel option for the treatment of anogenital lichen sclerosus.
- Other alternative treatments, such as avocado and soya beans extracts, may be considered for mild cases, as reported by 5.
- Systemic therapies, including corticosteroids, retinoids, and biologics, may be considered for cutaneous lichen planus, as reviewed by 6, but their effectiveness for lichen sclerosus is not discussed.