Vulval lichen sclerosus: An Australasian management consensus

Abstract

Background/Objectives: Vulval lichen sclerosus (VLS) is a chronic inflammatory skin condition predominantly affecting the anogenital region in women and children. To date, there is lack of agreement amongst experts on a severity scale to aid assessment, research and treatment stratification on VLS. Furthermore, literature on best practice for long-term management of VLS is lacking. The aim of this consensus is to provide broad guidelines on the short and long-term management of VLS.Methods: An initial focus group of Australasian experts in vulval dermatology developed a draft consensus statement for the management of VLS. Based on the results of the draft statement, a consensus panel of 22 Australasian experts, comprised of the initial and additional members, participated in an anonymous four-stage eDelphi process. Round 1 involved generation and voting on statements from the draft consensus statement developed by the focus group. In Rounds 2, 3 & 4, panel members were presented formal feedback from previous rounds and asked to indicate their level of agreement. Consensus was reached if there was ≥70% agreement on the importance of an item in the 4 (agree) to 5 (strongly agree) range. Results:The expert panel, with a total of 504 collective years of experience in the field of VLS, reached consensus on a core set of 51 management statements related to diagnosis, severity, initial and long-term management, follow-up, and complications of VLS. Conclusions:This study has identified a set of management statements for VLS that may be useful in clinical practice in the Australasian population.

Lichen sclerosus: The 2023 update

“…The diagnosis of LS in adults and children is typically clinical, involving a thorough medical history and physical examination. Photographic records are also recommendable to monitor therapy efficacy or disease progression ( 121 ). The clinical scoring system in VLS is a validated useful tool to ease the diagnosis and to evaluate related symptoms and the therapy response ( Table 1 ) ( 122 , 123 ).…”

Management of severe vulval lichen sclerosus with adalimumab

“…There is some evidence to suggest that TNF‐α contributes to the autoimmune and inflammatory mechanisms which lead to fibrosis 2 . There are no existing guidelines for the management of VLS in Australia; however, an Australasian management consensus statement has been recently published 3 . Potent to ultrapotent topical corticosteroids (TCS) are the first‐line treatment, 3 there is limited evidence to support a choice in second‐line therapy.…”

“…2 There are no existing guidelines for the management of VLS in Australia; however, an Australasian management consensus statement has been recently published. 3 Potent to ultrapotent topical corticosteroids (TCS) are the first-line treatment, 3 there is limited evidence to support a choice in second-line therapy. Management of severe, recalcitrant disease remains challenging.…”

Attitudes Toward Proactive Topical Corticosteroid Use Among Women With Vulval Lichen Sclerosus

“…[4][5][6][7] First-line treatment for VLS is ultrapotent topical corticosteroids (TCSs) which, in most cases, relieves symptoms and reverses skin color to normal. 1,2,8 However, the best way to manage VLS beyond the acute period after diagnosis is a subject of research and debate. Approaches can be categorized broadly into "reactive" and "proactive."…”