Vulvar lichen sclerosus: recent advances in understanding and management

Abstract

Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. It is one of the most common pathologies presenting to vulvar clinics. However, uncertainty continues to exist about its etiopathogenesis, diagnosis and treatment. Studies suggest a multifactorial origin as far as etiology is concerned, including a genetic, autoimmune, hormonal and local infectious background. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. Conventionally, treatment includes topical corticosteroids as a first-line therapy with alternative options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and surgical removal of affected tissues. New therapeutic approaches are coming into effect in gynecological practice due to potential risks of the above-mentioned methods. Stem cell and platelet-rich plasma therapy, energy-based modalities such as the fractional CO2 laser, photo dynamic therapy, and high intensity focused ultrasound, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional methods. Refinement of surgical techniques for restoring vulvar anatomy is leading to improved patient outcomes. This review summarizes current perspectives on the etiopathogenesis, diagnosis and treatment for vulvar lichen sclerosus.