Treatment of Genital Lichen Sclerosus in Women When UVA1 Phototherapy or Systemic Therapy Has Not Improved Symptoms

Clinical Scenario

This protocol applies to women aged 18 or older with genital lichen sclerosus who are not pregnant and who have advanced through prior lines of management without sufficient symptom control.

Prior Therapy — Escalation Trigger

The preceding treatment step — UVA1 phototherapy or systemic therapy — did not achieve adequate improvement of symptoms and signs, specifically reduction of pruritus and hyperkeratosis. This protocol defines the clinical step taken after that failure.

Next-Step Management — Partial Overview

When persistent introital stenosis continues to cause mechanical problems despite guideline-conform steroid treatment, a surgical intervention addressing the stenosis is indicated. The full protocol specifies procedure selection, patient criteria, and clinical sequencing.

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References

DOI: 10.1111/jdv.20083

We recommend ultrapotent or potent topical corticosteroids in women with genital lichen sclerosus.

We suggest de-adhesion / synechiolysis / perineoplasty in women with lichen sclerosus who have a persistent introital stenosis that causes mechanical problems in voiding or sexual intercourse, despite guideline-conform treatment with steroids.

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