What is the diagnosis and treatment for Lichen sclerosis?

From the Guidelines

Lichen sclerosus should be treated with clobetasol propionate 0.05% ointment applied once daily for a month, alternative days for a month, and twice weekly for a month, as this regimen has been shown to be effective in managing symptoms and preventing complications 1.

Key Points

• The treatment of lichen sclerosus involves the use of potent topical corticosteroids, with clobetasol propionate 0.05% ointment being the recommended first-line treatment 1.
• The recommended regimen for clobetasol propionate 0.05% ointment is once daily for a month, alternative days for a month, and twice weekly for a month, with continued use as needed to maintain disease control and prevent scarring 1.
• Patients should be educated on proper genital hygiene, avoiding irritants, using gentle moisturizers, and wearing loose-fitting cotton underwear to help manage symptoms and prevent complications 1.
• Regular follow-up is essential to monitor for signs of malignancy and to adjust treatment as needed, with long-term follow-up recommended for patients with complicated or persistent disease 1.
• Alternative treatments, such as calcineurin inhibitors like tacrolimus 0.1% ointment, may be considered for patients who do not respond to or cannot tolerate steroids [@Example@].

Treatment Considerations

• The use of clobetasol propionate 0.05% ointment has been shown to be safe and effective in the long-term management of lichen sclerosus, with no significant increase in the risk of steroid damage or malignancy 1.
• Patients with ongoing active disease despite good compliance with treatment may require an individualized treatment regimen, with consideration given to the use of intralesional triamcinolone for hyperkeratotic areas 1.
• Referral to a specialist vulval clinic may be necessary for patients with complicated or persistent disease, or for those who require surgical management 1.

From the Research

Definition and Symptoms of Lichen Sclerosus

• Lichen sclerosus (LS) is a chronic, inflammatory condition of the skin, primarily affecting the anogenital region, potentially leading to changes in vaginal architecture and vulvar squamous cell carcinoma 2, 3.
• LS is a debilitating disease, causing itch, pain, dysuria, restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men 3.

Treatment of Lichen Sclerosus

• Current recommended treatment for LS is high-potency corticosteroids, such as clobetasol propionate 2, 4.
• Calcineurin inhibitors, such as tacrolimus, may also have a role in the treatment of LS, particularly in patients who have failed therapy with ultrapotent corticosteroids or have a contraindication for the use of corticosteroids 2, 3, 5.
• Topical and systemic retinoids may be useful in selected cases, and phototherapy or photodynamic therapy may be therapeutic options in rare cases refractory to other treatments 3.
• Surgery is restricted to scarring processes leading to functional impairment, and in men, circumcision is effective in the majority of cases, but recurrences are well described 3, 6.

Prevention of Disease Progression

• Early aggressive treatment of LS may prevent disease progression and significant morbidity, particularly in patients undergoing treatment for urethral strictures 6.
• Aggressive topical therapy with clobetasol and/or minor procedures may prevent the progression of LS in patients who present with limited disease involving the skin and meatus 6.