Long‐term management of vulval lichen sclerosus in adult women

Bradford, Jennifer; Fischer, Gayle

doi:10.1111/j.1479-828x.2010.01142.x

Cited by 60 publications

(51 citation statements)

References 20 publications

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“…Neoplasia incidence risk in this study was 3.5%, which is comparable with the mean incidence risk reported in previous follow-up studies published since 1975, [11][12][13][14][15][16][17][18][19][20] when ISSVD introduced clear clinical and histological criteria for diagnosis of VLS. 4 The smallest of these studies, with only 32 patients, reports the highest neoplasia incidence risk (31.3%) in the literature.…”

Section: Discussionsupporting

confidence: 91%

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Vulvar Lichen Sclerosus and Neoplastic Transformation

Micheletti

Preti

Radici

et al. 2016

Journal of Lower Genital Tract Disease

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Section: Discussionsupporting

confidence: 91%

“…4 In the studies after 1975, the mean incidence risk of developing neoplasia in women with VLS is 2.8%. [11][12][13][14][15][16][17][18][19][20] However, there is a high variability in incidence risk reported, ranging from 0% 17 to 31.3%, 14 and therefore, the exact risk of neoplastic transformation of VLS is uncertain.…”

mentioning

confidence: 99%

Vulvar Lichen Sclerosus and Neoplastic Transformation

Micheletti

Preti

Radici

et al. 2016

Journal of Lower Genital Tract Disease

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“…The risk of cancer in the partially compliant group is close to the risk of 5% to 6% of untreated women in previous studies. 3,6,13,20 This finding suggests that as-required treatment that controls symptoms only may not reduce the risk of developing cancer and supports a previous study 11 suggesting that compliance with treatment could potentially reduce the incidence of cancer. It seems that, in compliant patients who maintain normal skin color and texture, the risk of VSN is greatly reduced.…”

Section: Discussionsupporting

confidence: 83%

“…It is a basic premise in dermatological practice that chronic inflammatory skin diseases frequently require ongoing suppression. This fact, in addition to the high rates of relapse in patients who stop using TCSs after achieving remission, 6,11 has been the basis for our recommendation to continue maintenance treatment even when patients are asymptomatic. To our knowledge, the largest previous long-term study of TCS-treated women with VLS to date was a retrospective cohort study of 253 women with a mean follow-up of 5.5 years.…”

Section: Discussionmentioning

confidence: 94%

Long-term Management of Adult Vulvar Lichen Sclerosus

2015

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This prospective, single-center, longitudinal cohort study of adult patients with VLS suggests that individualized preventive TCS regimens that achieve objective normality of skin color and texture and are used by compliant patients who attend regular long-term follow-up visits may modify the course of the disease. There was a significant difference in symptom control, scarring, and occurrence of vulvar carcinoma between compliant and partially compliant patients. The adverse effects of TCSs were minimal.

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“…Women and girls with genital lichen sclerosus (GLS) present with postinfl ammatory scarring which may Vulval lichen sclerosus is associated with a signifi cant risk for squamous cell carcinoma (SCC) of the vulva (3).…”

Section: Genital Lichen Sclerosusmentioning

confidence: 99%

Genital Lichen Sclerosus – Has Th ere Been any Progress in Treatment?

Karadaglić¹

2014

Serbian Journal of Dermatology and Venereology

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cause fusion of the labia minora, narrowing of the vaginal introitus, and burying of the clitoris, resulting in dyspareunia, sexual dysfunction, and anal or genital bleeding (Figures 1, 2, 3a-b) (1).GLS in children is uncommon, so diff erential diagnosis in any pre-pubertal child presenting with chronic vulval symptoms is of great importance. Th e long-term prognosis is unknown, but assumptions that the condition will resolve at puberty may be incorrect (2). AbstractLichen sclerosus (LS) is a chronic infl ammatory dermatosis localized mainly in the anogenital region, accompanied by itching, atrophy and sclerosis. Progressive destructive scarring in genital lichen sclerosus (GLS) may result in burying of the clitoris in females and phimosis in males. Affected persons have an increased risk of genital cancers. It is often unrecognized in everyday clinical practice due to undiagnosed squamous cell carcinoma at the site of lesions. Remissions are rare and the estimated remission rate is only 16%. GLS is a lifelong, incurable condition, but signifi cant improvement can be achieved. Numerous therapeutic modalities have been used in GLS; unfortunately, the number of controlled studies is small and the results are mostly related to the management of symptoms, not the progression of the disease and destructive scarring. A systemic meta analysis of seven randomized controlled trials on local therapy of GLS was performed. It included a total of 249 patients treated with six topical agents: clobetasol propionate, mometasone furoate, testosterone, dihydrotestosterone, progesterone and pimecrolimus. Topical corticosteroids, clobetasol propionate 0.05% (highly potent) and mometasone furoate 0.05% (potent), showed to be signifi cantly more effi cient compared to placebo. Pimecrolimus 1% cream and clobetasol propionate 0.05% showed similar effi cacy. Both agents have proven effective in the treatment of GLS: there was no statistically signifi cant difference in relieving symptoms of pruritus and burning/pain. Tacrolimus 0.1% ointment also proved to be effective in the treatment of GLS. Topical androgens and progesterone did not show signifi cant effi cacy. Topical tretinoin and calcipotriol have been used with limited success, but they may induce irritation, so they are rarely used in the treatment of GLS. Other therapeutic options for GLS include ultraviolet A1 (UVA-1) phototherapy, methotrexate, retinoids, cyclosporine, stanozolol, hydroxychloroquine, calcitriol, laser and photodynamic therapy, but the number of patients is small to allow for conclusive assessment. Surgery is not a standard therapeutic option for GLS. In conclusion, treatment of GLS should be carried out in two phases: introduction of remission and maintenance of remission; topical therapy should include highly potent corticosteroids once daily during three months, followed by twice per week, or twice daily during 4 to 6 weeks, and then twice per week. There are different opinions regarding maintenance therapy: application of super potent or potent topical cort...

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Long‐term management of vulval lichen sclerosus in adult women

Abstract: Long-term treatment of adult VLS with individualised regimes using moderate potency TCS is safe and effective. Patients require long-term follow-up.

Cited by 60 publications

References 20 publications

Vulvar Lichen Sclerosus and Neoplastic Transformation

Vulvar Lichen Sclerosus and Neoplastic Transformation

Long-term Management of Adult Vulvar Lichen Sclerosus

Genital Lichen Sclerosus – Has Th ere Been any Progress in Treatment?

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