| Abstract [eng] |
Vulvar lichen sclerosus is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. Lichen planus occurs in approximately 2% of women. Common symptoms are intense vulvar itching, burning sensation, pain and dyspareunia. In severe cases scarring can lead to anatomical changes such as clitoral phimosis, labial adhesions and vulvar introital stenosis. Vulvar lichen sclerosus clinical signs include whitening and atrophy of the skin, perianal involvement can lead to the classic “figure of eight” shape of the lesion. The aetiology is unknown, but there is an association with autoimmune disorders and genetic factors. Infections, hormonal influences, trauma and chronic irritation have been suggested as possible triggers in genetically predisposed individuals. The time from reported onset of symptoms until diagnosis may range from 5 to 15 years. Recognition and treatment of vulvar condition is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. The diagnosis in most patients is usually made clinically, but a confirmatory biopsy is helpful in cases where there is some clinical doubt about the diagnosis and if there is any suspicion of neoplastic change. The gold standard treatment for vulvar lichen sclerosus consists of high-potency topical corticosteroids, such as clobetasol dipropionate. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet rich plasma therapy, fat grafting, hyaluronic acid therapy and energy-based modalities such as the fractional CO2 laser and photodynamic therapy. Surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis lead to improved sexual dysfunction and satisfactory outcomes. |
