Vulval lichen sclerosus: An Australasian management consensus.

BACKGROUND/OBJECTIVES: Vulval lichen sclerosus (VLS) is a chronic inflammatory skin condition predominantly affecting the anogenital region in women and children. To date, there is lack of agreement amongst experts on a severity scale to aid assessment, research and treatment stratification on VLS. Furthermore, literature on best practice for long-term management of VLS is lacking. The aim of this consensus is to provide broad guidelines on the short and long-term management of VLS. METHODS: An initial focus group of Australasian experts in vulval dermatology developed a draft consensus statement for the management of VLS. Based on the results of the draft statement, a consensus panel of 22 Australasian experts, comprised of the initial and additional members, participated in an anonymous four-stage eDelphi process. Round 1 involved generation and voting on statements from the draft consensus statement developed by the focus group. In Rounds 2, 3 & 4, panel members were presented formal feedback from previous rounds and asked to indicate their level of agreement. Consensus was reached if there was ≥70% agreement on the importance of an item in the 4 (agree) to 5 (strongly agree) range. RESULTS: The expert panel, with a total of 504 collective years of experience in the field of VLS, reached consensus on a core set of 51 management statements related to diagnosis, severity, initial and long-term management, follow-up, and complications of VLS. CONCLUSIONS: This study has identified a set of management statements for VLS that may be useful in clinical practice in the Australasian population.

Proactive maintenance therapy with a topical corticosteroid for vulvar lichen sclerosus: preliminary results of a randomized study.

BACKGROUND: The chronic and relapsing nature of vulvar lichen sclerosus (VLS) represents a challenge for its long-term management after an effective treatment with topical corticosteroids. OBJECTIVES: To assess the effectiveness of proactive, twice-weekly application of mometasone furoate 0·1% ointment, compared with daily topical vitamin E or cold cream, in keeping VLS in remission and reducing the risk of relapse after 3 months of treatment with topical corticosteroid. METHODS: In total, 27 patients affected with VLS were enrolled into a 12-week active treatment phase (AP) with topical mometasone furoate 0·1% ointment once daily. Those who achieved disease remission entered a 52-week maintenance phase (MP) in which patients were randomized to apply either mometasone furoate 0·1% ointment twice weekly, a cold cream once daily or topical vitamin E once daily. The primary efficacy parameters were the relapse rate and the mean time to relapse. RESULTS: Twenty-five patients considered to have been completely or almost completely healed after the AP entered the MP. By the end of the 52-week MP, 10 patients (40%) experienced a relapse: five in the vitamin E group (56%) and five in the cold cream group (62%), while no patient in the mometasone furoate 0·1% ointment group had a relapse. The occurrence of VLS relapse for patients in therapy with both vitamin E and cold cream was significantly higher than for those in proactive therapy with topical corticosteroid. The median time to relapse was the same (21·6 weeks) for the vitamin E and the emollient groups. CONCLUSIONS: Once VLS has been stabilized with topical corticosteroids, twice-weekly proactive application of mometasone furoate 0·1% ointment over 56 weeks was found to be an effective and safe therapy option in maintaining VLS remission and in preventing the occurrence of relapse.

[Selected vulvar dermatoses]. / Wybrane dermatozy sromu.

Numerous cutaneous lesions are located in the region of the female genital organs, occasionally presenting a diagnostic and therapeutic challenge. The most common cases include: eczema vulvae, lichen simplex chronius, lichen sclerosus et atrophicus or lichen planus. Clinical presentation of these lesions is not always characteristic for certain dermatoses. Thus, it is important to conduct proper tests, including histopathological or contact allergy examination. Only thorough diagnostics allows to implement correct therapy. This paper shows a detailed description of dermal lesions located in the region of the female genital organs of the allergic and lichenoid origin, together with the literature review on diagnosis and treatment.

Treatment of genital lichen sclerosus in women--review.

Lichen sclerosus is a chronic inflammatory skin disorder that belongs to a group of autoimmune connective tissue diseases, localized within the skin and mucous membrane of the anogenital area. In the latter location, the focal atrophy of the mucosa is the most visible sign. Lesions may be accompanied by symptoms such as itching, pain, burning. The disease occurs more often in females. The etiology is not fully understood. Genetic, infectious, hormonal factors and autoimmune mechanisms are taken into consideration. Early diagnosis and appropriate treatment is important to avoid further complications. This review aims to analyze available literature on the treatment of this disease entity

Vulvar lichen sclerosus: effect of maintenance treatment with a moisturizer on the course of the disease.

OBJECTIVES: Vulvar lichen sclerosus (LS) is an inflammatory disease of unknown etiology that may result in significant discomfort and psychological distress in postmenopausal women. One of the most troublesome features of LS is its chronically relapsing nature. The aim of this study was to investigate the effect of maintenance therapy with a moisturizer in preventing the risk of relapse and progression of vulvar LS in postmenopausal women. DESIGN: Between January 1995 and January 2006, 34 postmenopausal women with vulvar LS were included in a prospective open trial. The participants were treated with a topical corticosteroid cream (0.1% betamethasone valerate) once daily for 1 month and then with maintenance therapy with a moisturizing cream alone once daily. Follow-up visits were scheduled after 1 month and then twice per year (median follow-up, 58 mo). RESULTS: Overall the symptoms of all women improved after therapy with a topical steroid. Twenty-four women (71%) became symptom free, and 10 (29%) experienced partial response. Eighteen of the 24 women (75%) who became symptom free and 6 of the 10 women (60%) who exhibited a partial response reported no worsening of their symptoms while on therapy with a cold cream alone. Total resolution of the clinical signs occurred in 6 of the 19 women with mild vulvar architectural changes. Partial resolution of clinical signs was observed in 22 women (64%). No change was noticed in six (18%) women. None of the participants experienced worsening of vulvar scarring. None of the participants developed vulvar intraepithelial neoplasia or squamous cell carcinoma during the follow-up period. There were no side effects. CONCLUSION: Long-term maintenance therapy of vulvar LS with a moisturizing cream can maintain the symptom relief induced by topical corticosteroids in women with vulvar LS while being safe and inexpensive. This treatment may also be associated with a reduction in topical corticosteroid use because more than half of the women could eliminate corticosteroids altogether.