Major clinical, nutrological and immunological considerations and treatments of vulvar lichen sclerosus: an integrative systematic review

Introduction: Vulvar Lichen Sclerosus (VLS) is characterized by being a chronic progressive inflammatory skin disease, mediated by lymphocytes, which mainly affects the anogenital area. Its prevalence is higher in the female population (10:1), especially in postmenopausal women, and is associated with autoimmune diseases, although it can affect both sexes. It is one of the diseases that most causes structural damage to the vulva and consequent physical and mental suffering. The diagnosis of vulvar lichen sclerosus is clinical. Biopsy is indicated only in cases of non-typical lesions. Objective: This was to conduct an integrative systematic review to present the main clinical, nutrological, and immunological considerations of vulvar lichen sclerosus, as well as the treatment challenges. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from September to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. 38 articles were fully evaluated and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=90.7%>50%. It was concluded that the exact cause of VLS is not fully understood. Still, it is believed that nutritional factors, dysbiosis of the intestinal microbiota, genetics, autoimmunity, and hormonal imbalance may play an important role in its development. The main risk factor for vulvar cancer associated with VLS is delayed diagnosis, so controlling symptoms and preventing complications is crucial, and regular follow-up is necessary to monitor response to treatment and disease recurrence.