The authors declare no conflict of interest.Dr J. Bradford and Dr G. Fischer equally contributed to the construction, analysis and writing of this study.
Long-term management of vulval lichen sclerosus in adult women
Article first published online: 1 APR 2010
© 2010 The Authors. Journal compilation © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 50, Issue 2, pages 148–152, April 2010
How to Cite
BRADFORD, J. and FISCHER, G. (2010), Long-term management of vulval lichen sclerosus in adult women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50: 148–152. doi: 10.1111/j.1479-828X.2010.01142.x
- Issue published online: 13 APR 2010
- Article first published online: 1 APR 2010
- Received 5 December 2009; accepted 11 January 2010.
- lichen sclerosus;
- skin diseases;
- vulvar cancer
Background: Adult vulval lichen sclerosus (VLS) is usually a lifelong disease with an estimated remission rate after treatment of only 16% [Arch Dermatol 2004; 140 (6): 709]. Although superpotent topical corticosteroid (TCS) is the validated gold standard treatment to induce remission, little data are available on how remission should be maintained.
Aims: We present a retrospective chart review of 129 adult patients with VLS who have been under surveillance by the authors for a minimum duration of three years.
Methods: Remission was maintained in most patients with low-to-moderate potency TCS. All subjects’ symptoms, signs, treatment regimes and response to treatment including compliance, symptom remission, disease progression with scarring, squamous cell carcinoma and side effects were recorded. Data were compared for the compliant and non-compliant groups. Fischer’s exact test was used to identify significant differences.
Results: The mean age at presentation was 53.6 years and mean duration of follow-up was 6.2 years. Compliance was excellent: 84 (65%) of patients’ self-reporting as being fully compliant. Symptom remission was achieved in 98% of compliant and 75% of non-compliant patients (P = 0.001) Progression of disease with scarring was not encountered in any of the compliant patients, but was seen in 35% of non-compliant patients (P = 0.0001). One patient had squamous cell carcinoma on first presentation. Carcinoma subsequently occurred in none of the compliant patients, and in five partly compliant patients (P = 0.004). Mild, reversible corticosteroid side effects were encountered in 7% of patients.
Conclusions: Long-term treatment of adult VLS with individualised regimes using moderate potency TCS is safe and effective. Patients require long-term follow-up.