What is the first line treatment for vaginal lichen sclerosus?

From the Guidelines

The first line treatment for vaginal lichen sclerosus is clobetasol propionate 0.05% ointment, applied once daily for a month, alternative days for a month, and twice weekly for a month, as recommended by the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1.

Key Points to Consider

• The treatment regimen should be combined with a soap substitute and a barrier preparation to minimize irritation and promote healing.
• Patients should be instructed on the safe use of ultrapotent topical steroids and the importance of using only a small amount (about the size of a pea) for each application to minimize side effects.
• Long-term maintenance therapy is often necessary to prevent recurrence and complications, and treatment should be titrated to maintain symptoms and resolution of skin thickening and ecchymosis.
• Regular follow-up appointments are important to monitor response to treatment and assess for potential side effects such as skin thinning.
• Patients should also be advised to avoid irritants in the genital area, including harsh soaps, and to use gentle, fragrance-free moisturizers as needed for comfort.

Important Considerations

• The British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1 provide the most recent and highest quality evidence for the treatment of vaginal lichen sclerosus.
• Other studies, such as the British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010 1 and the guidelines for the management of lichen sclerosus 2002 1, provide additional support for the use of clobetasol propionate 0.05% ointment as the first line treatment.
• The British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1 also emphasize the importance of follow-up and self-monitoring for patients with vaginal lichen sclerosus.

From the Research

Vaginal Lichen Sclerosus Treatment

• The first line treatment for vaginal lichen sclerosus is superpotent topical corticosteroids, such as clobetasol propionate 2, 3, 4, 5.
• These corticosteroids are effective in treating the symptoms of lichen sclerosus, but may cause dermal atrophy as a side effect 2, 3.
• Alternative treatments, such as pimecrolimus and tacrolimus, have been suggested as safe and effective options for patients who do not respond to corticosteroids or experience side effects 2, 3, 6.
• Pimecrolimus, a topical macrolide immunosuppressant, has been shown to be effective in treating vulvar lichen sclerosus in small studies 2, 3.
• Tacrolimus ointment has also been reported to be effective in treating vulvar lichen sclerosus, with no skin atrophy observed 6.
• Long-term use of clobetasol propionate 0.05% has been shown to be safe and effective in treating severe lesions of vulvar lichen sclerosus in postmenopausal women 4.
• Ultrapotent topical corticosteroids have been shown to be safe and effective in treating genital lichen sclerosus in pediatric patients, with no significant adverse effects noted 5.