From the Guidelines
Vaginal estrogen cream is not the primary treatment for vaginal lichen sclerosis in a 77-year-old female, and instead, a potent topical corticosteroid such as clobetasol propionate 0.05% ointment should be considered as the first-line treatment. The British Association of Dermatologists guidelines for the management of lichen sclerosus, published in 2018 1, recommend offering all female patients with anogenital lichen sclerosus clobetasol propionate 0.05% ointment on a specific regimen for 3 months. Key points to consider in the treatment of vaginal lichen sclerosis include:
- The use of a soap substitute and a barrier preparation in conjunction with topical corticosteroid treatment
- Discussion with the patient about the amount of topical treatment to be used, the site of application, and the safe use of an ultrapotent topical steroid
- Consideration of an individualized treatment regimen of topical steroid to maintain disease control and prevent scarring in female patients with ongoing active lichen sclerosus disease
- Referral to a specialist vulval clinic in cases where the disease does not respond to topical steroid treatment or if surgical management is being considered. While vaginal estrogen cream may be beneficial in addressing concurrent vaginal atrophy and dryness, it does not directly treat the underlying inflammatory and autoimmune processes of lichen sclerosus, and its use should be considered adjunctive to corticosteroid treatment, as supported by the guidelines 1.
From the Research
Treatment Options for Vaginal Lichen Sclerosis
- The provided studies do not directly address the use of vaginal estrogen cream as a treatment for vaginal lichen sclerosis in a 77-year-old female.
- However, the studies suggest that topical steroids, such as clobetasol propionate, are effective in treating vulvar lichen sclerosus 2, 3, 4, 5, 6.
- Clobetasol propionate has been shown to be superior to other treatments, including progesterone, in improving symptoms and clinical appearance of vulvar lichen sclerosus 2, 6.
- The use of estrogen cream is not mentioned in the provided studies as a treatment for vaginal lichen sclerosis.
Considerations for Treatment
- The studies provided are focused on the treatment of vulvar lichen sclerosus, rather than vaginal lichen sclerosis.
- The effectiveness of topical steroids, such as clobetasol propionate, in treating vaginal lichen sclerosis is not directly addressed in the provided studies.
- Further research would be needed to determine the efficacy of vaginal estrogen cream as a treatment for vaginal lichen sclerosis in a 77-year-old female.