The most common regimen is to apply it thoroughly over lesion two times daily for three months . Clobetasol propionate cream (0.05%) significantly reduces symptoms and improves skin characteristics . The gold standard treatment for VLS consists of high-potency topical corticosteroids (TCS), such as clobetasol dipropionate. ![]() The various modalities of treatment of VLS are summarized in Table 1. ![]() Therapeutic options for vulvar lichen sclerosus The data was summarized in the form of a descriptive review. This review did not seek individual data sources, and a narrative analysis was done. All the articles were retrieved in full text. There are not any papers available regarding testosterone usage owing to its severe unpropitious effects. In some cases, relevant older data was also included such as role of testosterone in the management of VLS. Inclusion of original articles and review articles was done on priority basis. All of these articles were screened 276 articles were excluded because of the following reasons: not correlated to the objective of this review, i.e., management of VLS, or they were not original articles. After a comprehensive search, 338 articles concerning to VLS were retrieved. Keywords used for search were: “Vulvar,” “Vulval,” “lichen sclerosus et atrophicus,” “kraurosis,” “dystrophy,” “VIN,” “Cancer,” and “lichen sclerosus.” The published data from July 1999 in English language were accessed. Various databases were searched: MEDLINE (Ovid), Evidence-Based Medicine (EBM) Reviews, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, and Excerpta Medica Database (EMBASE). PubMed was explored for the literature search related to VLS with the assistance of Knowledge Resource Services website. Additionally, the focus will also be on the difference in management of adult and juvenile VLS.Ī review protocol was framed. 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. With numerous controversies, we decided to conduct a scoping review on this subject. Follow-up and maintenance therapies are also not clearly defined. Testosterone was found ineffective in root canal treatment (RCTs) and has unacceptable side effects . As far as the treatment strategy is concerned, testosterone was the mainstay of treatment in the past, whereas high-potency steroids are now considered the standard therapy. ![]() The clinical features suffice diagnosis, and biopsy is rarely done . The labia, perineum, and perianal areas get affected and present as a patchy, thin, glistening, and ivory-white area. It has multitude of causative factors such as autoimmune pathologies, hormones, and infections. Some cases may present in reproductive group (18-40) females. VLS has bimodal presentation, both in pre-pubertal girls and postmenopausal women. Presently, this disease is included in non-neoplastic 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 . 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. A study reported that incidence rate of lichen sclerosus increased from 7.4 to 14.6 per 100,000 woman-years between 1991 to 2011 . Vulvar lichen sclerosus (VLS), also known as vulvar dystrophy in the past, is one of the most common pathologies presenting to vulvar clinics. Monitoring young patients yearly is recommended as there are chances of recurrence. Long-term follow-up in specialist clinics is recommended for women who have persistent complaints, thickened skin, or history of neoplastic lesion. 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. Effective treatments such as high-potency topical steroids are now the standard of care and first-line treatment. Out of this, 62 were original articles related to management of VLS. A total of 338 articles pertaining to VLS were obtained. 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. ![]() 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. Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages.
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