Insights to current and emerging treatment strategies for vulvar lichen sclerosus (LS), a chronic and inflammatory skin disorder associated with risk for vulva scarring and sexual dysfunction, were offered in a review paper published in the International Journal of Women’s Health.

The estimated prevalence of LS is currently unknown, but it is suggested that approximately 1 in 70 women who present to specialized practitioners in a general gynecology practice have the condition. Etiology of LS is also unclear, but data suggest the condition is an autoimmune disorder with a genetic component. Patients with vulvar LS have an approximately 4% to 6.7% risk of squamous cell carcinoma of the vulva. Compliance with topical corticosteroids may reduce this risk.

Although no cure for LS exists, several treatment options may help patients achieve remission and prevent disease progression. The gold standard of therapy is ultrapotent topical corticosteroids, such as clobetasol propionate ointment. Randomized controlled trials have found a 0.05% concentration of clobetasol propionate ointment to be the most effective option for treating vulvar LS, and this evidence provided basis for recommendations made in the British Association of Dermatologists Guidelines for the management of anogenital LS.

Topical calcineurin inhibitors are additional therapies considered to be alternatives to corticosteroids in the setting of LS. Newer topical calcineurin inhibitors do not inhibit collagen synthesis, which reduces the risk for dermal atrophy. Some evidence suggests that clobetasol is superior to pimecrolimus and tacrolimus for decreasing underlying inflammation. Platelet-rich plasma, another treatment option for vulvar LS, may help stimulate the release of cytokines and growth factors, which may promote tissue healing. Only case reports and small studies have been performed with PRP.

Energy-based modalities, including photodynamic therapy, high-intensity focused ultrasound, and fractional CO2 lasers, have some promising evidence to suggest their benefit in LS. Limitations of studies that support these modalities, however, warrant additional larger randomized cohorts over a long-term follow-up period to identify more robust efficacy and safety data of the techniques.

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The authors wrote that advancements “in disease formation and progression hold promise for improved diagnosis of LS, bringing us one step closer to minimally invasive testing or screening options that could facilitate detection of early disease.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. lease see the original reference for a full list of authors’ disclosures.

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Reference

Krapf JM, Mitchell L, Holton MA, Goldstein AT, et al. Vulvar lichen sclerosus: current perspectives [published online January 15, 2020]. Dovepress. doi: 10.2147/IJWH.S191200