Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study

• Published in: Sexually transmitted infections Vol. 77; no. 1; pp. 53 - 57
• Main Authors: Nyirjesy, Paul, Sobel, Jack D, Weitz, M Velma, Leaman, Deborah J, Small, Maria J, Gelone, Steven P
• Format: Journal Article
• Language: English
• Published: London BMJ 01-02-2001; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Antigens; Biological and medical sciences; Chronic Disease; Chronic illnesses; Cromolyn sodium; Cromolyn Sodium - therapeutic use; Disease; Double-Blind Method; Drug therapy; Evaluation; Family medical history; Female; Humans; Infections; Mast Cells - drug effects; Medical sciences; Microscopy; Middle Aged; Original; Pain; Pharmacology. Drug treatments; Prospective Studies; Skin, nail, hair, dermoskeleton; Standard deviation; Studies; Treatment Failure; Vulvar diseases; Vulvitis - drug therapy; Vulvitis - immunology; Womens health; Human; Local administration; Chemotherapy; Treatment; Vestibulitis; Vulvitis; Vulvar diseases; Female genital diseases
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sti.77.1.53

Objective: Patients with chronic idiopathic vulvar vestibulitis have increased mast cells when biopsied, and cromolyn has been suggested as a treatment. The purpose of this study was to assess the efficacy of 4% cromolyn cream in women with vulvar vestibulitis. Methods: A prospective, double blind, randomised, placebo controlled study was initiated at two centres. Patients with vulvar vestibulitis were assigned to apply cromolyn or placebo cream to the vestibule. Symptoms (burning, irritation) and signs (erythema, extent of erythema, tenderness) were recorded on a 0–3 scale. In the sexually active patient subgroup, dyspareunia was also evaluated. Results: 13 of the 26 evaluable patients received cromolyn. Patients in the cromolyn arm were more likely to have failed therapy with amitriptyline (p = 0.05), but the two groups were otherwise similar upon study entry. Overall, scores decreased from a median of 9 to 5 (p = 0.001) during the study, but the level of improvement was similar between both groups. Improvement was unrelated to duration of symptoms, fluconazole use, or sexual activity. Five patients (38%) taking cromolyn and six (46%) taking placebo felt they had a 50% or greater reduction in symptoms. In the 21 sexually active patients, the total score decreased from a mean of 12 to 8 (p = 0.005), but there was no statistically significant difference between study arms. Conclusions: Cromolyn cream did not confer a significant benefit in patients with vulvar vestibulitis. The large placebo response suggests the need for large well controlled studies of other treatment modalities.