Development of the Adult Vulvar Lichen Sclerosus Severity Scale—A Delphi Consensus Exercise for Item Generation

Sheinis, Michal; Selk, Amanda

doi:10.1097/lgt.0000000000000361

Cited by 30 publications

(34 citation statements)

References 70 publications

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“…Also, the initially striking results of a reduction in impact of lichen sclerosus on patients' lives can be attributed to patient bias because this was not a double-blinded study and may have involved a desire to collaborate with the doctor. Additionally, histology could also benefit the confirmation of a clinical diagnosis, but its inclusion in an adult lichen sclerosus severity scale is questionable (Sheinis and Selk, 2017). Analyzing biopsy test result changes to treatment may be objective, but whether this outcome is important to patients is unclear and likely should be used as an adjunct to other measures (Sheinis and Selk, 2017).…”

Section: Discussionmentioning

confidence: 99%

Use of Er:YAG laser in the treatment of vulvar lichen sclerosus

Gómez-Frieiro

Laynez-Herrero

2019

International Journal of Women's Dermatology

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ObjectiveThe aim of this research was to evaluate the efficacy and safety of Er:YAG lasers to improve signs and symptoms of vulvar lichen sclerosus.MethodsThe study population consisted of 28 women with symptomatic vulvar lichen sclerosus. Three nonablative, thermal-only Er:YAG laser treatment sessions (7 J/cm2, 2 Hz, 7 mm spot) were performed at 4-week intervals. Each patient was asked about the presence of symptoms, such as itching, pain, and coital pain. Clinical diagnosis was established on the basis of the presence of lesions such as hypopigmentation, ecchymosis, hyperkeratosis, excoriations, or fissures. The affected areas were divided by zones (clitoris, introitus, labia minora, labia majora, perineum, labial fusion, and effacement) and were visually evaluated. Based on the presence of symptoms, lesions, and affected zones, a scale with a maximum of 14 scores was established for use before and after treatment. The impact of lichen sclerosus on patients' lives before and after treatment was evaluated with an 11-point visual analogue scale, and treatment discomfort was assessed at each session.ResultsAfter analysis of each scoring component, individual statistically significant reductions were observed in itching, pain, ecchymosis, excoriations, and hypopigmentation.ConclusionThe Er:YAG laser is a safe, well tolerated, and effective method for the adjuvant treatment of vulvar lichen sclerosus. Three sessions with monthly intervals using the indicated parameters can quantifiably reduce the impact of lichen sclerosus on patients' lives.

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Section: Discussionmentioning

confidence: 99%

Use of Er:YAG laser in the treatment of vulvar lichen sclerosus

Gómez-Frieiro

Laynez-Herrero

2019

International Journal of Women's Dermatology

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“…We adopted the 23 items which had been defined and classified into six items of “symptoms,” 11 items of “signs” and six items of “architectural changes” by the ISSVD consensus group 10 (Table 1). Following an in‐depth, nonsystematic research on other PubMed‐listed publications on severity scales (summarized in Table S1) and based on our clinical experience, we combined the three items “pain with intercourse,” “bleeding and pain with intercourse,” and “skin tearing with intercourse” to one item “dyspareunia.” We omitted the item “elasticity (or loss of elasticity)” which may be strongly biased by menopause 12 and added the items “petechia/ecchymosis” (which is an easily assessable item of activity) and “dysuria,” as the latter is a well‐known potent irritant perpetuating and aggravating VLS in many cases.…”

Section: Methodsmentioning

confidence: 99%

“…We adopted the 23 items which had been defined and classified into six items of "symptoms," 11 items of "signs" and six items of "architectural changes" by the ISSVD consensus group 10 (Table 1). Following an in-depth, nonsystematic research on other PubMed-listed publications on severity scales (summarized in Table S1) and based on our clinical experience, we combined the three items "pain with intercourse," "bleeding and pain with intercourse," and "skin tearing with intercourse" to one item "dyspareunia."…”

Section: Grading Of Symptoms Signs and Architectural Changesmentioning

confidence: 99%

“…Furthermore, the VASS lacks subjective items addressing symptoms and therefore may not capture LS in its complete manifestation. Therefore, we aimed to (a) assess the prevalence and severity of 23 items (symptoms, signs and architectural changes) proposed by the ISSVD consensus group 10 in patients referred to a tertiary center for vulvar disorders, (b) develop a new clinical severity scale (ie, “the Clinical Lichen Sclerosus Score”) for VLS based on study goal 1, and (c) test in a first attempt the interrater reliability of this novel severity score.…”

Section: Introductionmentioning

confidence: 99%

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Proposition of a severity scale for lichen sclerosus: The “Clinical Lichen Sclerosus Score”

Erni

Navarini

Huang

et al. 2021

Dermatologic Therapy

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Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin disease of the anogenitalarea leading to itch, burning, sexual dysfunction and impaired quality of life. An unmet need in the context of LS is a practical, easily assessable grading scale to classify disease severity and to allow intra-and interindividual comparisons. The objectives of this study were i) to assess the prevalence and severity of 23 items proposed by a recent Delphi consensus group in patients with adult VLS. ii) to develop a clinical severity scale and, iii) to test the interrater reliability of this novel severity scale. A retrospective assessment of the prevalence and severity of 23 items in 143 patients was performed by using patient records and photo documentation to develop a novel clinical severity scale (i.e. the "Clinical Lichen Sclerosus Score" = CLISSCO) for VLS. Thereafter, the CLISSCO was validated by 16 raters. We found that the items proposed by the consensus group vary markedly in frequency and severity. Following selection of the most relevant items, the CLISSCO was developed consisting of 3 "Symptoms", 3 "Signs" and 6 "Architectural changes" rated on a 0-4 point Likert-scale. The intraclass correlation coefficient was excellent for each item, the applicability of the CLISSCO considered user-friendly by the raters. We conclude that the CLISSCO proved to be a user-friendly, reliable tool to assess disease severity in VLS. However, further studies are needed to validate its applicability and value in daily practice and clinical research.

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“…However, the method of measurement of the signs and symptoms was not reached. Hence, further research is advised on this severity scale [13].…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review

Singh

Ghatage

2020

Obstetrics and Gynecology International

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Objective. Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. With numerous controversies as regards to the nomenclature, diagnosis and its association with neoplastic conditions, we decided to conduct a scoping review on this subject. Data Source. A review protocol was developed, and the Knowledge Resource Services website was used to do a search of articles pertaining to VLS with keywords “Vulvar,” “Vulval,” “diagnosis,” “lichen sclerosus et atrophicus,” “kraurosis,” “vulvar dystrophy,” and “Lichen Sclerosus”. Study Selection. The search was limited to published data from the last ten years, i.e., from July 2009 onwards and in the English language. A total of 338 articles pertaining to VLS were obtained. Older data were accessed if particular information was sought for. Results & Conclusion. The presentation is bimodal, i.e., one in prepubertal girls (average age: 7.6 years) and the other in peri- and postmenopausal women (average age: 52.6 years). However, many cases also present during reproductive years. Studies suggest a multifactorial origin as far as etiology is concerned, including a genetic, autoimmune, hormonal, and local infectious background. It affects the genital labial, perineal, and perianal areas and manifests as a patchy, thin, glistening, ivory-white area. Diagnosis is mainly based on clinical features. Biopsy is seldom required. It has been well established as a precursor lesion of dVIN and vulvar carcinoma.

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Development of the Adult Vulvar Lichen Sclerosus Severity Scale—A Delphi Consensus Exercise for Item Generation

Abstract: Through expert international consensus, 24 items are proposed for inclusion in a future validated adult vulvar lichen sclerosus severity scale.Supplemental digital content is available in the text.

Cited by 30 publications

References 70 publications

Use of Er:YAG laser in the treatment of vulvar lichen sclerosus

Use of Er:YAG laser in the treatment of vulvar lichen sclerosus

Proposition of a severity scale for lichen sclerosus: The “Clinical Lichen Sclerosus Score”

Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review

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