Intralesional Corticosteroid Therapy for Refractory Hyperkeratotic Vulvar Lichen Sclerosus: A Case Series

Objective: To describe clinical response and safety of intralesional corticosteroid therapy for adult patients with persistent or refractory hyperkeratotic vulvar lichen sclerosus after histologic exclusion of neoplasia. Methods: This was a descriptive case series of 3 adult women with vulvar lichen sclerosus and persistent hyperkeratotic plaques despite topical corticosteroid therapy. All patients underwent vulvar biopsy before intervention to exclude human papillomavirus-associated vulvar intraepithelial neoplasia, human papillomavirus-independent vulvar intraepithelial neoplasia, or squamous cell carcinoma. A single session used 0.25 mL triamcinolone acetonide 40 mg/mL diluted 1:1 with 0.25 mL 2% lidocaine (final concentration, 20 mg/mL; total dose, 10 mg) delivered through 4 to 6 points with a 0.5-mL insulin syringe and 0.30×8-mm needle. There was no comparator. Outcomes were clinical resolution, symptoms, Vulvar Quality of Life Index (VQLI) score, photographs, and adverse events. No statistical analysis was performed because of the descriptive design and small sample size. Results: All patients showed complete clinical resolution at 4 months and no repeat infiltration. VQLI scores decreased from 35 to 12, 31 to 8, and 22 to 10, respectively. At March 2026 follow-up (median: 11 mo; range: 10 to 12), no clinical recurrence or local/systemic adverse events were observed or reported. The main limitations were the small number of cases, lack of a control group, descriptive design, and short follow-up. Conclusions: Intralesional triamcinolone may be a useful rescue therapy for selected patients with persistent or refractory hyperkeratotic vulvar lichen sclerosus, provided that neoplasia is excluded and long-term surveillance is maintained.