Update on treatments for erosive vulvovaginal lichen planus

Abstract

Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course of the disease and its resistance to treatment. While topical steroids have been accepted as the first-line treatment, they fail to achieve symptomatic control in approximately 40% of patients.Second-line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. This review provides an overview of the current treatments and explores the level of evidence supporting each of them.

The use of hydroxychloroquine as a systemic treatment in erosive lichen planus of the vulva and vagina

“…Previous research has shown that ELPV is a difficult to treat condition. 2,3 This study suggests that HCQ can be an effective treatment in ELPV. Overall, 60% of the patients responded to HCQ, with almost half experiencing a longterm effect.…”

“…Dear Editor , Erosive lichen planus affecting the vulva and vagina (ELPV) is a rare inflammatory skin disease, presenting with painful erosions and severe scarring 1 . The disease course is persistent and often refractory to treatment: up to 45% of patients do not experience remission with topical treatments, and evidence for systemic treatments remains scarce 2 . Hydroxychloroquine (HCQ) is frequently used in daily practice as a first choice systemic therapy 3 .…”

“…We conducted a three-round electronic Delphi (eDelphi) process with members of the International Eczema Council (IEC). 1,2 The IEC is a global nonprofit organization that aims to promote the optimal management of AD through research, education and patient/family care.…”

“… 1 The disease course is persistent and often refractory to treatment: up to 45% of patients do not experience remission with topical treatments, and evidence for systemic treatments remains scarce. 2 Hydroxychloroquine (HCQ) is frequently used in daily practice as a first choice systemic therapy. 3 However, little evidence is available on use of HCQ for ELPV.…”

“… 3 However, little evidence is available on use of HCQ for ELPV. 2 The aim of this study was to analyse the effectiveness and safety of HCQ in ELPV.…”