Abstract

Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. The aim of this review is to focus on first-line, second-line, and maintenance therapies as well as follow-up of women with VLS. With numerous controversies, we decided to conduct a scoping review on this subject. A review protocol was developed, and the Knowledge Resource Services website was used to run a search of articles pertaining to VLS with keywords “Vulvar,” “Vulval,” and “Lichen Sclerosus.” The search was limited to published data from the last 10 years, i.e., July 2009 onward, and researches published in English language. A total of 338 articles pertaining to VLS were obtained. Out of this, 62 were original articles related to management of VLS. Effective treatments such as high-potency topical steroids are now the standard of care and first-line treatment. Follow-up may be done every three to six months for the first two years and then at least yearly to ensure adequacy of treatment and encourage compliance. Long-term follow-up in specialist clinics is recommended for women who have persistent complaints, thickened skin, or history of neoplastic lesion. Monitoring young patients yearly is recommended as there are chances of recurrence.

Highlights

  • Vulvar lichen sclerosus (VLS), known as vulvar dystrophy in the past, is one of the most common pathologies presenting to vulvar clinics

  • The vague terminologies like leukoplakia, kraurosis, and dystrophy of vulva were prevalent before International Society for the Study of Vulvovaginal Disease (ISSVD) 1975 classification system

  • Relevant older data was included such as role of testosterone in the management of VLS

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Summary

Introduction

Vulvar lichen sclerosus (VLS), known as vulvar dystrophy in the past, is one of the most common pathologies presenting to vulvar clinics. The vague terminologies like leukoplakia, kraurosis, and dystrophy of vulva were prevalent before International Society for the Study of Vulvovaginal Disease (ISSVD) 1975 classification system. This disease is included in nonneoplastic and non-infectious entities; vulvar dermatoses in ISSVD classification includes this disease entity with vulvar dermatoses, which are non-neoplastic and non-infectious in nature [2]. The focus of this review is on the first-line, second-line, and maintenance therapies as well as on the follow-up of women with VLS. The focus will be on the difference in management of adult and juvenile VLS

Methods
Steroid Therapy
Intra-lesional Steroid Therapy
Topical Calcineurin Inhibitors
Topical Androgens and Progesterone
Other Local Pharmacologic Agents
Role of Emollients
Laser Therapy
Phototherapy
Photodynamic Therapy
10. Cryotherapy
11. Fat Grafting
12. Role of Adipose-Derived Stem Cells and Platelet-Rich Plasma Therapy
13. Herbal Therapies
14. Systemic Therapy
15. Role of Dietary Modification
16. Surgical Intervention
17. Maintenance Therapy
18. Treatment of Juvenile Lichen Sclerosus
Conclusions
Findings
Disclosures

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