Dr Tania Day

Lichen sclerosus – overcoming myths and misconceptions

Vulval lichen sclerosus (LS) is a common chronic T-cell-mediated inflammatory dermatosis that occurs across all age groups. Affected patients may be asymptomatic or report a range of symptoms of varied type, frequency, severity, and provoking factors. Features of LS vary widely across individuals with white color change, thinned or thickened texture, and architectural alterations being the most common findings. Clinicians often encounter comorbid conditions adjacent to or superimposed on LS, especially candidiasis, lichen planus, dermatitis, and psoriasis. Non-diagnostic biopsy should not overturn a sound clinical diagnosis of LS. Topical steroid ointment is the mainstay of LS management, with 4 main treatment goals: 1) attaining symptom relief in those who are symptomatic and improving quality of life, 2) objectively controlling disease, 3) preventing progressive anatomical alteration, and 4) reducing the risk of neoplasia. As LS is a chronic condition, initial control with topical steroids must be followed by a lifelong regular maintenance regimen. Patient-centered long-term management plans range from weekly to daily application of a low- to super-potent steroid ointment, depending on disease severity, comorbid conditions, and factors that enhance adherence and QoL. Consistent, specific, supportive communication with patients, caregivers, and other health professionals helps mitigate the negative impacts of steroid phobia and health misinformation. Attention to general vulvovaginal health facilitates LS treatment, improves symptoms, and enhances self-efficacy. The tireless work of researchers and advocates has achieved admirable progress in highlighting the public health importance of LS, raising community awareness, and establishing the need for improved provider education and knowledge translation.

Adapted from Day T, Mauskar M, Selk A, eds. Lichen sclerosus: ISSVD practical guide to diagnosis and management. ISSVD; 2024.