Vulvar Lichen Sclerosus: Current Perspectives

Abstract

Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO₂ laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.

Keywords:

• lichen sclerosus
• clitoral phimosis
• vulvar granuloma fissuratum
• corticosteroids
• fractional CO₂ laser
• lysis of vulvar adhesions

Disclosure

Dr Andrew T Goldstein reports grants from Elen, Cellular Medicine Association, Gynecologic Cancers Research Foundation, during the conduct of the study; personal fees from Amag, grants, personal fees from Ipsen, grants from endoceutics, grants, personal fees from SST, outside the submitted work; and Dr Goldstein is the founder and president of the Gynecologic Cancers Research Foundation, a 501c3. The authors report no other conflicts of interest in this work.