Long-term Management of Adult Vulvar Lichen Sclerosus

Abstract

This prospective, single-center, longitudinal cohort study of adult patients with VLS suggests that individualized preventive TCS regimens that achieve objective normality of skin color and texture and are used by compliant patients who attend regular long-term follow-up visits may modify the course of the disease. There was a significant difference in symptom control, scarring, and occurrence of vulvar carcinoma between compliant and partially compliant patients. The adverse effects of TCSs were minimal.

Vulvar Lichen Sclerosus and Neoplastic Transformation

“…Neoplasia incidence risk in this study was 3.5%, which is comparable with the mean incidence risk reported in previous follow-up studies published since 1975, [11][12][13][14][15][16][17][18][19][20] when ISSVD introduced clear clinical and histological criteria for diagnosis of VLS. 4 The smallest of these studies, with only 32 patients, reports the highest neoplasia incidence risk (31.3%) in the literature.…”

“…However, a recent prospective cohort study indicates that long-term topical corticosteroid treatment could prevent the progression of VLS and the development of vulvar cancer, and thus, long-term treatment for VLS should be the norm. 20 …”

“…4 In the studies after 1975, the mean incidence risk of developing neoplasia in women with VLS is 2.8%. [11][12][13][14][15][16][17][18][19][20] However, there is a high variability in incidence risk reported, ranging from 0% 17 to 31.3%, 14 and therefore, the exact risk of neoplastic transformation of VLS is uncertain.…”

Superficially invasive stage IA vulvar squamous cell carcinoma—therapy and prognosis

“…In a recent prospective study, 507 women with vulvar LS were treated with topical corticosteroids over the long term. During a follow-up period of 4.7 years none of the compliant patients developed VSCC, whereas 4.7% (n=7) of the non-compliant patients developed VSCC or VIN 21. Consequently, the skin of vulvar LS patients should be treated with maintenance therapy and examined at least yearly, with biopsy of suspicious lesions 22…”

“…Affected patients might therefore benefit from intensified surveillance and adequate maintenance therapy in specialized centers. There is prospective evidence that topical corticosteroids lower both the risk of VSCC as well as local recurrences 21. However, the number of cases is too small to make evidence-based recommendations.…”