From the Guidelines
A combination of vaginal estrogen cream and clobetasol can be effective for a 77-year-old female with both vaginal atrophy and lichen sclerosus, as evidenced by recent guidelines and studies 1.
Treatment Approach
For vaginal atrophy, a low-dose estrogen cream such as Premarin or Estrace applied vaginally 2-3 times weekly can help restore vaginal tissue health, as supported by the NCCN guidelines 1.
- Vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals 1.
- A study in 76 postmenopausal survivors of hormone receptor (HR)–positive breast cancer receiving aromatase inhibitor (AI) therapy found that intravaginal testosterone cream or an estradiol-releasing vaginal ring were safe and improved vaginal atrophy and sexual function 1.
Lichen Sclerosus Management
For lichen sclerosus, clobetasol propionate 0.05% ointment is typically applied thinly to affected areas once daily for 2-4 weeks, then tapered to 2-3 times weekly for maintenance, as recommended by the British Association of Dermatologists guidelines 1.
- The guidelines suggest offering all female patients with anogenital LS clobetasol propionate (CP) 0.05% ointment on a regimen for 3 months, combined with a soap substitute and a barrier preparation 1.
- Regular follow-up is important to monitor response and adjust treatment as needed, with examinations every 6-12 months to check for any skin changes that might require biopsy, as lichen sclerosus carries a small risk of malignant transformation.
Key Considerations
These conditions often coexist in older women and require different treatments as they have different underlying causes.
- Vaginal atrophy results from estrogen deficiency, while lichen sclerosus is an inflammatory condition.
- The patient should apply the medications separately, with estrogen cream inserted vaginally and clobetasol applied to external genital areas affected by lichen sclerosus.
From the Research
Treatment Options for Vaginal Atrophy and Lichen Sclerosus
- Vaginal atrophy is a common condition among post-menopausal women, characterized by symptoms such as vaginal dryness, pruritus, and irritation 2.
- Lichen sclerosus is a chronic inflammatory dermatitis that can cause scarring and distortion of the anogenital area, and is often associated with vaginal atrophy 3.
- The gold standard treatment for lichen sclerosus is ultra-potent topical steroids, such as clobetasol propionate 3, 4.
- Estrogen-based treatments, such as vaginal estrogen cream, are effective for vaginal atrophy, but may not be sufficient to treat lichen sclerosus 5, 2.
Combination Therapy for Vaginal Atrophy and Lichen Sclerosus
- A combination of vaginal estrogen cream and clobetasol propionate may be effective in treating both vaginal atrophy and lichen sclerosus, as estrogen can help to improve vaginal health and clobetasol can help to reduce inflammation and scarring associated with lichen sclerosus 3, 2.
- A study found that treatment with clobetasol propionate for six months on a regular basis was more effective than treatment for three months in reducing symptoms and signs of lichen sclerosus in post-menopausal women 4.
- Another study found that lipofilling with platelet-rich plasma (PRP) can be effective in relieving symptoms of vaginal atrophy and lichen sclerosus, and can also improve the appearance of the genital area 5.
Considerations for Treatment
- Treatment of lichen sclerosus and vaginal atrophy should be individualized and may involve a combination of topical steroids, estrogen-based treatments, and other therapies 3, 2.
- Patients with lichen sclerosus should be monitored closely for malignancy, as they are at increased risk of developing vulvar squamous cell carcinoma 3, 2.
- Long-term treatment and follow-up are necessary to manage chronic conditions such as lichen sclerosus and vaginal atrophy 3, 6.