Format

Send to

Choose Destination
Maturitas. 2013 Mar;74(3):279-82. doi: 10.1016/j.maturitas.2012.12.006. Epub 2013 Jan 3.

EMAS clinical guide: vulvar lichen sclerosus in peri and postmenopausal women.

Author information

1
Department of Obstetrics and Gynecology, Zaragoza University Facultad de Medicina, Lozano Blesa University Hospital, Zaragoza 50009, Spain. Electronic address: faustino.perez@unizar.es.
2
Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania.
3
Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
4
Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa School of Medicine, Valikonagi Cad. No: 93/4, Nisantasi, 34365 Istanbul, Turkey.
5
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, GR-11528 Athens, Greece.
6
Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
7
Department of Medicine, Cardiology Unit and Head Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Thorax N3:06, SE 17176 Stockholm, Sweden.
8
Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, F-31059 Toulouse cedex 09, France.
9
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
10
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.

Abstract

INTRODUCTION:

Vulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms.

AIMS:

The purpose of this clinical guide is to provide advice on early recognition and treatment.

MATERIAL AND METHODS:

Literature review and consensus of expert opinion.

RESULTS AND CONCLUSIONS:

The etiology of LS in peri and postmenopausal women is unknown, although autoimmune, genetic and infectious factors have been implicated. Definitive diagnosis of non-malignant disorders depends on the histology of biopsied tissue. LS associated with cellular atypia should be classified as intraepithelial neoplasia. Topical corticosteroids are the most effective treatment, although prolonged treatment may be associated with dermal atrophy. Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be a safe and effective alternative treatment without risk of corticosteroid-related vulvar atrophy since they do not affect collagen synthesis. LS recurrences are frequent, and can lead to significant physical discomfort and emotional distress that affect mood and sexual relationships. Anatomical changes may require surgical management.

KEYWORDS:

Calcineurin inhibitors; Clobetasol propionate; Corticosteroids; Dyspareunia; Lichen sclerosus; Pimecrolimus; Pruritus; Tacrolimus; Testosterone; Vulvar kraurosis

PMID:
23291001
DOI:
10.1016/j.maturitas.2012.12.006
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center