This protocol is for patients with vulvar lichen sclerosus (EB60.0) whose symptoms persisted through a full course of topical calcineurin inhibitor therapy — and in whom escalation to the next treatment line is now being considered.

Previous line — failure condition

Prior targets not met

The preceding line used topical calcineurin inhibitors — tacrolimus 0.1% or pimecrolimus 1% cream — applied to the affected vulval skin. The defined goal was improvement in vulval pruritus and burning/pain within 12 weeks. Failure to achieve that improvement triggers escalation to the protocol described here.

Next-line approach — partial overview

At this stage the treatment strategy involves systemic or light-based interventions that go beyond topical application and require involvement of a relevant specialist. The complete sequencing, selection criteria, and all associated considerations are contained in the full protocol.

References

DOI: 10.1111/jdv.18102

There is some data from two small RCTs of not very high quality showing the efficacy of systemic retinoids for example aciretin in the treatment of genital LS.
Retinoids may be considered if standard therapy for LS has failed but should only be given by a dermatologist, experienced in the use of these agents.
Phototherapy is effective in some LS patients.
Among different UV regimens, the best data are available for UVA1 and may be considered if topical corticosteroids have failed.

View source ↗

Vulvar lichen sclerosus when topical calcineurin inhibitors have not achieved symptom control

References