Vulval erosive lichen planus: a qualitative investigation of U.K. clinician views and principles of management

Simpson, Rosalind; Kim, Thomas; Murphy, Ruth

doi:10.1111/bjd.12373

Cited by 11 publications

(6 citation statements)

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“…To provide an evidence base for the consensus exercise, a review of the literature was undertaken to summarize diagnostic criteria that have been used in previous studies of ELPV. In addition, items perceived important by 25 clinicians were elicited through a set of structured interviews . The results from these two exercises were collated to form a structured questionnaire that contained a list of 12 potential diagnostic criteria required for the diagnosis of ELPV.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, items perceived important by 25 clinicians were elicited through a set of structured interviews. 13 The results from these two exercises were collated to form a structured questionnaire that contained a list of 12 potential diagnostic criteria required for the diagnosis of ELPV. The study protocol was finalized in September 2012.…”

Section: Study Proceduresmentioning

confidence: 99%

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Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise

et al. 2013

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Background There is no defined set of criteria for diagnosing erosive lichen planus affecting the vulva (ELPV) and there is geographical variation in management.Objectives To reach consensus on clinicopathological diagnostic criteria for ELPV.Methods This was a three-stage international electronic-Delphi exercise with a subsequent formal feedback process. In the first two rounds participants were asked to rate the importance of a list of clinicopathological criteria. Responses from round 1 were summarized and presented in round 2, along with additional criteria suggested by participants. In round 3, participants were asked to rate the items that had reached consensus as ‘essential’ or ‘supportive’ features in diagnosing ELPV. Consensus was defined as being reached if 75% of participants agreed on the importance of an item.Results A total of 73 experts representing dermatology, gynaecology, histopathology and genitourinary medicine participated; 69 (95%) completed all three rounds. Consensus was achieved for the following ‘supportive’ diagnostic criteria: (i) well-demarcated erosions/erythematous areas at the vaginal introitus; (ii) presence of a hyperkeratotic border to lesions and/or Wickham striae in surrounding skin; (iii) symptoms of pain/burning; (iv) scarring/loss of normal architecture; (v) presence of vaginal inflammation; (vi) involvement of other mucosal surfaces; (vii) presence of a well-defined inflammatory band involving the dermoepidermo junction; (viii) presence of an inflammatory band consisting predominantly of lymphocytes; and (ix) signs of basal layer degeneration. It was suggested that at least three supportive features should be present to make a diagnosis of ELPV, although this number is subject to further discussion.Conclusions This study has identified a diagnostic dataset for ELPV that can be adopted into clinical practice and clinical trials.

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Section: Methodsmentioning

confidence: 99%

Section: Study Proceduresmentioning

confidence: 99%

Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise

et al. 2013

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“…Bradford and Ficher required both syptomatic control and clinical resolution of inflammatory changes but acknowledged that preceding studies use symptoms alone as a guide for therapy. It is ours and other UK physicians' experience that improvement in clinical signs lag considerably behind symptomatic recovery [2]. It is therefore clear that a set of outcomes relevant and acceptable to both patients and clinicians needs to be agreed upon for future work in this area.…”

Section: To the Editormentioning

confidence: 97%

Comment on “Management of Vulvovaginal Lichen Planus

Simpson

Kim

Murphy

2014

Journal of Lower Genital Tract Disease

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“…Erosive vulval LP (EVLP) is a chronic inflammatory condition [6] which may cause severe scarring and tissue destruction resulting in urinary and sexual impairment. Although the pathogenesis of LP remains unclear, there is some evidence supporting a T-lymphocyte response to autoantigens [7]. This in turn results in apoptosis of epithelial cells and chronic inflammation.…”

Section: Introductionmentioning

confidence: 99%

Management of Vulval Lichen Planus

2016

ARC Journal of Dermatology

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Background: Vulval lichen planus (VLP) is a debilitating, often treatment resistant condition, for which there is limited evidence-based guidance on assessment and management. Aim: To describe current management of women with VLP in the multidisciplinary vulval dermatology clinic at the Royal Women's Hospital (RWH), Melbourne, to compare this with reported practices in the literature and provide focus for future research needs. Methods: A retrospective case note review was undertaken of all women with VLP attending the vulval clinic between 2009 and 2012. Data was collected regarding age of onset, symptoms, examination findings and treatments utilized. Results: Eighty women with VLP were identified between 2009-2012. The mean age of onset was 59.8 years. Very potent topical steroids were the most commonly used first line therapy (71.3%). The most commonly utilized agent was betamethasone diproprionate optimized-vehicle ointment (46.3% of patients) with improvement in 16 (43.2%). This was followed by Clobetasol propionate ointment 0.05% which was used in 8 patients (10.0%), with improvement in 6 (75.0%). The most frequently used systemic monotherapy was methotrexate, used in 16 patients either first or second line with improvement seen in 7 (43.8%) with a greater proportion responding to higher doses of 10mg per week. Prednisolone was used in 7 patients, with a response noted in 3. Responders had all been commenced on a higher dose of 50mg. No consistent disease severity measures were used, clinician or patient reported. Conclusion: This case note review describes the current practice of Dermatologists working at a subspecialty vulval dermatology unit at a tertiary referral centre. Topical corticosteroids are utilized as first line therapy, with methotrexate the most commonly used systemic agent for refractory cases. Our study also highlights the need for validated disease severity and quality of life measures. The therapeutic regimes are partially in line with published data from the UK, the Netherlands and Iowa but differ from another large Australian centre. Future research should focus on developing disease severity measures and conducting pragmatic trials comparing commonly used treatment regimes such as with Clobetasol proprionate.

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Vulval erosive lichen planus: a qualitative investigation of U.K. clinician views and principles of management

Cited by 11 publications

References 4 publications

Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise

Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise

Comment on “Management of Vulvovaginal Lichen Planus

Management of Vulval Lichen Planus

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