From the Guidelines
The first-line treatment for lichen sclerosis lesions is an ultrapotent topical corticosteroid, as recommended by the British Association of Dermatologists' guidelines 1. This approach is based on the most recent and highest quality evidence available, which suggests that ultrapotent topical corticosteroids are effective in reducing inflammation, decreasing itching, and preventing further scarring and skin changes in patients with lichen sclerosis lesions. The typical regimen involves applying a thin layer of the ointment to affected areas once or twice daily for 4-12 weeks, then gradually tapering to maintenance therapy of 1-3 times weekly for long-term management, as supported by the guidelines 1. Some key points to consider when treating lichen sclerosis lesions include:
- Asymptomatic patients with evidence of clinically active LS, such as ecchymosis, hyperkeratosis, and progressing atrophy, should be treated 1.
- Long-term follow-up in a specialized clinic is unnecessary for uncomplicated disease that is well controlled clinically using small amounts of a topical corticosteroid, and follow-up should be reserved for patients with complicated LS that is unresponsive to treatment and those patients who have persistent disease with a history of a previous SCC 1.
- Surgical intervention is indicated only for the complications of scarring or the development of malignancy 1.
- Any psychosexual issues should be addressed if appropriate, and referral made to practitioners experienced in this field if indicated 1.
From the Research
Treatment Options for Lichen Sclerosis Lesions
- The first line treatment for lichen sclerosis lesions is ultra-potent and potent corticosteroids, administered for 12 weeks 2.
- Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are effective and safe alternatives to corticosteroids 2, 3.
- Maintenance treatment mostly consists of topical corticosteroids, administered on an "as needed" basis, on a continuative regimen, or on a low-dose, intermittent regimen 2.
Specific Treatment Regimens
- A treatment regimen involving clobetasol to induce remission, then tacrolimus to maintain remission, can be used to treat lichen sclerosis in pediatric females 4.
- The use of clobetasol and tacrolimus can minimize side effects associated with long-term, high-potency corticosteroid use and reduce the risk of changes to genital architecture secondary to lichen sclerosis 4.
Other Considerations
- Lichen sclerosis is a chronic, inflammatory disorder that can cause significant symptoms and quality of life impairment 5.
- The role of calcineurin inhibitors in the management of lichen sclerosis is still being studied, and concerns remain regarding their malignant potential with long-term use 3.
- Antibiotics, such as penicillin and cephalosporins, have been studied as a potential treatment for lichen sclerosis, but their use is not widely recommended as a first-line treatment 6.