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

Erni, Barbara; Navarini, Alexander A.; Huang, Dorothy Jane; Schoetzau, Andreas; Kind, André B.; Mueller, Simon M.

doi:10.1111/dth.14773

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…One of the most prominent symptoms of VLS is pruritus, which was also the most common symptom reported in our study [1]. In a study of 143 patients with VLS, 90% were symptomatic, with 37% reporting dyspareunia and changes in sexual function [5]. Some impact on sexual function was reported in 42% of the current sample.…”

Section: Discussionmentioning

confidence: 53%

Quality of Life and Treatment Adherence in Patients with Vulvar Lichen Sclerosus

Geisler¹,

Koptyev²,

Strunk³

et al. 2023

Dermatology

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Background: Vulvar lichen sclerosus (VLS) is a chronic, relapsing, inflammatory dermatosis that has significant impact on patients’ quality of life (QoL). While disease severity and associated QoL impact have been studied, factors associated with treatment adherence and their relation to QoL in VLS remain unexplored. Objective: To describe demographics, clinical characteristics and skin-related QoL in VLS patients, and to assess the relationship between QoL and treatment adherence. Methods: This was a cross-sectional, single institution, electronic survey study. The relationship between adherence, measured using the validated Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence) scale, and skin-related QoL, using the Dermatology Life Quality Index (DLQI) score, was assessed using Spearman correlation. Results: Of 28 survey respondents, 26 provided complete responses. Among 9 patients classified as adherent and 16 classified as non-adherent, mean DLQI total scores were 1.8 and 5.4 respectively. Spearman correlation between summary non-adherence score and DLQI total was 0.31 (95% CI -0.09, 0.63) overall, and 0.54 (95% CI 0.15-0.79) when patients who reported missing doses due to asymptomatic disease were excluded. Most frequently reported factors preventing treatment adherence included application/treatment time (43.8%) and asymptomatic or well-controlled disease (25%). Conclusions: Though Qol impairment was relatively small in both our adherent and non-adherent groups, we identified important factors preventing treatment adherence, with the most common being application/treatment time. These findings may help dermatologists and other providers generate hypotheses as to how to facilitate better treatment adherence among their patients with VLS, with the goal of optimizing QoL.

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Section: Discussionmentioning

confidence: 53%

Quality of Life and Treatment Adherence in Patients with Vulvar Lichen Sclerosus

Geisler¹,

Koptyev²,

Strunk³

et al. 2023

Dermatology

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“…Previous studies have not demonstrated a correlation between symptom severity and macroscopic anatomic changes. 6,15 Our finding here of an association between symptom severity and microscopic histopathologic changes should be investigated in a larger study. Study limitations include sample size, inclusion of patients from a single academic medical center, and consistent biopsy sampling of the same anatomic site rather than the most symptomatic site.…”

Section: Discussionmentioning

confidence: 73%

“…Although ulceration and erosion were included in the original ISSVD Delphi consensus, these signs were excluded in the final version of the CLISSCO scoring system based on this consensus. 6,7 Future iterations of VLS severity scores should consider the inclusion of these signs. Finally, those 4 patients with a severe VQLI score had trends for higher average thickness of the stratum corneum, other epidermal layers, and dermal sclerosis than those 2 patients with mild VQLI scores.…”

Section: Discussionmentioning

confidence: 99%

“…4 Given the range of clinical severity and lack of standardized reporting among VLS clinical trials, several clinical severity scales have been developed to classify disease severity, including the Clinical Lichen Sclerosus Severity Scale (CLISSCO). 5,6 CLISSCO is a 4-point Likert scale system based on the 2018 International Society for the Study of Vulvovaginal Disease (ISSVD) Delphi consensus for VLS and assesses symptoms, signs, and architectural changes. 6,7 Another tool that has been developed to capture vulvar disease quality of life across symptomatic, psychosexual, and physical aspects is the Vulvar Quality of Life Index (VQLI).…”

Section: Introductionmentioning

confidence: 99%

“…5,6 CLISSCO is a 4-point Likert scale system based on the 2018 International Society for the Study of Vulvovaginal Disease (ISSVD) Delphi consensus for VLS and assesses symptoms, signs, and architectural changes. 6,7 Another tool that has been developed to capture vulvar disease quality of life across symptomatic, psychosexual, and physical aspects is the Vulvar Quality of Life Index (VQLI). 5 The development of such clinical severity scales is important to allow for standardized assessments of baseline disease severity and improvement with treatment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series

Pyle

Evans

Vandergriff

et al. 2023

The American Journal of Dermatopathology

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Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the Study of Vulvovaginal Disease Delphi consensus VLS severity score were administered. Vulvar skin punch biopsies were obtained to measure inflammatory density, constituent inflammatory cells, thickness of the stratum corneum and other epidermal layers, dermal edema, and dermal sclerosis. Clinicopathologic correlations were assessed. Two cases demonstrated sparse inflammatory densities, 1 case demonstrated patchy and nodular inflammatory density, 1 case demonstrated dense lichenoid inflammatory density, and 2 cases demonstrated dense lichenoid and epitheliotropic inflammatory densities. Those patients who reported severe pruritus demonstrated the greatest lymphocytic inflammatory densities on histopathological examination. Both cases of ulceration or erosion were associated with severe VQLI scores. Severe VQLI scores were also associated with trends for higher average thickness of the epidermal layers and of dermal sclerosis. Altogether, histopathologic grading of biopsy sites may reflect clinical severity in patients with VLS.

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A systematic review of outcome measures evaluating treatment efficacy in vulval lichen sclerosus and evaluation of patients' priorities

Jasionowska,

Almadori,

Goble

et al. 2024

Skin Health and Disease

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Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by itching, apareunia, loss of vulval architecture and scarring. Heterogeneity in outcome reporting precludes comparison between treatments. This study aimed to systematically review outcome measures used to evaluate the efficacy of VLS treatments and present patients' treatment priorities. This review followed the PRISMA guidelines using a registered protocol (PROSPERO: CRD42022356738). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials and International Standard Randomised controlled trial (RCT) registries. All RCTs assessing any treatment for VLS were eligible for inclusion. A total of 775 patients were assessed across 21 RCTs. The assessment tools reported outcomes in the following domains: patient‐reported symptoms assessed with one validated scale in 12 studies and seven non‐validated scales in nine studies; sexual function with validated female sexual function index and female sexual distress scale in two studies and two non‐validated scales in two studies; quality of life with three validated scales in three studies and clinician‐reported objective outcomes with two validated scales in three studies and six non‐validated scales in fourteen studies. Histological changes were assessed in 10 studies and tissue biomechanics in one study. We also carried out an online survey completed by 809 women with VLS to assess their research and disease treatment priorities and identified validated outcome measures to assess these. There is high variability in assessing treatment outcomes for VLS. We identified validated assessment tools which could be implemented in VLS studies to evaluate the effectiveness of treatments.

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

Cited by 14 publications

References 28 publications

Quality of Life and Treatment Adherence in Patients with Vulvar Lichen Sclerosus

Quality of Life and Treatment Adherence in Patients with Vulvar Lichen Sclerosus

Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series

A systematic review of outcome measures evaluating treatment efficacy in vulval lichen sclerosus and evaluation of patients' priorities

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