Vulvar Lichen Sclerosus: Diagnosis and Management
Vulvar Lichen Sclerosus: Diagnosis and Management
In addition to pharmacologic treatment, patients must receive education regarding the importance of avoiding skin irritants and using comfort measures. These nonpharmacologic interventions can improve symptom management and improve quality of life. Avoidance of potential skin irritants such as soaps, sanitary pads, excessive scratching, and tight clothing can decrease local inflammation. Comfort measures that are nonirritating to the skin such as the application of cool gel packs, use of sitz baths, and daily application of petroleum jelly may provide temporary symptom relief. Skin moisturizers not containing common allergens such as a propylene glycol and lanolin may also minimize local inflammation.
When used daily and applied liberally, petroleum jelly and other moisturizers are effective adjuncts in the treatment of VLS. Moisturizers increase the water content in the stratum corneum of the skin, which strengthens the weakened skin barrier and reduces subclinical inflammation. A study conducted by Simonart et al concluded that more than 50% of women who applied a daily moisturizer along with their topical corticosteroids remained asymptomatic for a median time of 58 months. In that study, over two thirds of women discontinued their topical corticosteroid without any effects on vulvar condition over the same period of time.
Surgery is not indicated for the removal of vulvar tissue affected by uncomplicated VLS because it will not cure the condition. Surgery is typically reserved for cases of VLS with malignancy or severe scarring and adhesions that interfere with urinary and/or sexual function. In the postoperative period, dilators are often warranted to reduce the recurrence of introitus narrowing. In the presence of vulvar SCC, an oncologic gynecologist is the most appropriate specialist for surgical management. Mechanical problems related to scarring and adhesions can be effectively managed by a gynecologic surgeon.
Dermatologists and gynecologists have used several alternative therapies for the treatment of LS with varying degrees of success. Some of these alternative therapies include photodynamic therapy, ultraviolet phototherapy, cryotherapy, and laser vaporization. Although these treatments have improved symptoms for many patients, there is limited evidence to support that alternative treatments slow disease progression or decrease recurrence rates. As a result, alternative therapies must be investigated further before they can be recommended for patients with VLS.
Nonpharmacologic Management
Therapeutics
In addition to pharmacologic treatment, patients must receive education regarding the importance of avoiding skin irritants and using comfort measures. These nonpharmacologic interventions can improve symptom management and improve quality of life. Avoidance of potential skin irritants such as soaps, sanitary pads, excessive scratching, and tight clothing can decrease local inflammation. Comfort measures that are nonirritating to the skin such as the application of cool gel packs, use of sitz baths, and daily application of petroleum jelly may provide temporary symptom relief. Skin moisturizers not containing common allergens such as a propylene glycol and lanolin may also minimize local inflammation.
When used daily and applied liberally, petroleum jelly and other moisturizers are effective adjuncts in the treatment of VLS. Moisturizers increase the water content in the stratum corneum of the skin, which strengthens the weakened skin barrier and reduces subclinical inflammation. A study conducted by Simonart et al concluded that more than 50% of women who applied a daily moisturizer along with their topical corticosteroids remained asymptomatic for a median time of 58 months. In that study, over two thirds of women discontinued their topical corticosteroid without any effects on vulvar condition over the same period of time.
Surgery
Surgery is not indicated for the removal of vulvar tissue affected by uncomplicated VLS because it will not cure the condition. Surgery is typically reserved for cases of VLS with malignancy or severe scarring and adhesions that interfere with urinary and/or sexual function. In the postoperative period, dilators are often warranted to reduce the recurrence of introitus narrowing. In the presence of vulvar SCC, an oncologic gynecologist is the most appropriate specialist for surgical management. Mechanical problems related to scarring and adhesions can be effectively managed by a gynecologic surgeon.
Alternate Therapy
Dermatologists and gynecologists have used several alternative therapies for the treatment of LS with varying degrees of success. Some of these alternative therapies include photodynamic therapy, ultraviolet phototherapy, cryotherapy, and laser vaporization. Although these treatments have improved symptoms for many patients, there is limited evidence to support that alternative treatments slow disease progression or decrease recurrence rates. As a result, alternative therapies must be investigated further before they can be recommended for patients with VLS.
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