Vulvar Lichen Sclerosus

Vulvar lichen sclerosus (VLS) is an often underrecognized idiopathic T-cell-mediated inflammatory dermatosis that affects approximately 0.5-3% of the female population. Symptoms may include itching, burning, irritation, and dyspareunia; however, a significant proportion of patients are asymptomatic. Typical signs include hypopigmentation of the tissues, hyperkeratosis, erosions, fissuring, thinning of the skin, ecchymosis, and erythema. Anatomic changes that may develop include fusion of the clitoral hood, regression of the labia minora, and scarring and stenosis of the vaginal introitus. These signs and symptoms can have a significant effect on patients' quality of life and sexual health. Vulvar lichen sclerosus can develop at any point, from childhood to the postmenopausal period, and the effects of pregnancy on this condition may be of importance to women of reproductive age. The diagnosis of VLS is primarily clinical; however, a biopsy may be indicated in cases of unclear diagnosis, concern for neoplastic change, and failure to respond to therapy. Ultra-high-potency topical steroids are the gold standard therapy for treatment. The risk of malignancy with VLS is approximately 5-7% when untreated; however, this risk is reduced with adequate disease control. There is good evidence that maintenance therapy may also reduce the risk of anatomic change progression, even in asymptomatic patients. Anatomic changes do not improve with medical therapy and may require surgical intervention.