Lichen sclerosus is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site, where it may cause itching and soreness. The therapeutic approach for LS aims at:
- Rapid improvement of symptoms such as pruritus, pain, or burning
- Maintenance or improvement of quality-of-life (QoL), including sexual health and voiding
- Disease control looking at signs of disease to avoid, i.e., scarring, resorption of structures, skin atrophy, and malignant transformation
- Reduction of flare-ups
- Cure of LS in males
For each patient, the aims of treatment have to be assessed individually, and the aims have to be reassessed during the course of the disease.
| Therapy | Recommendation |
| Skin care and basic therapy |
· Use of topical ointments instead of creams or gels · Avoidance of trigger factors (mechanical factors such as trauma, unnecessary surgical interventions, piercings) and irritants (excessive water exposure or cleansing products, synthetic and tight clothing, use of wet wipes, etc.) · Avoidance of over-the-counter medications, lenitive herbal products, topical antihistamines and anesthetics and perfumed products is suggested |
| Topical emollients |
· Co-treatment with topical emollients is recommended during standard therapy in women with genital LS. · Co-treatment with topical emollients is recommended for girls with genital LS. · Co-treatment with topical emollients is suggested for men and boys with genital LS. · Co-treatment with topical emollients is suggested for patients with extragenital LS. |
| Topical and intralesional corticosteroids |
· Ultrapotent or potent topical corticosteroids are recommended for women, girls, men, and boys with genital LS. · Ultrapotent or potent topical corticosteroids are suggested for patients with extragenital LS. · Topical steroid ointments are recommended instead of creams and lotions. · Intralesional corticosteroids to hyperkeratotic lesions are suggested for women with topical steroid-resistant genital LS, if malignancy has been excluded. |
| Topical calcineurin inhibitors | · Topical calcineurin inhibitors are suggested for women, girls, men, and boys with genital LS as the second choice or as additional treatment if topical corticosteroids are contraindicated or insufficient (off-label). |
| Topical retinoids | · A recommendation for the use of topical retinoids could not be made. |
| Topical hormone preparations | · A recommendation against topical hormone preparations was made for women, girls, men, and boys with genital LS, and for extragenital LS. |
| Platelet-rich plasma | · A recommendation for the use of platelet-rich plasma could not be made. |
| UV therapy |
· UVA 1 therapy is suggested in women with genital LS as a second-choice treatment, taking into account carcinogenicity and practicality. · A recommendation against UV therapy was made for girls with genital LS. · A recommendation could not be made with respect to UV therapy in men with genital LS. · A recommendation against UV therapy was made for boys with genital LS. · UV therapy is recommended in patients with extragenital LS. |
| Photodynamic therapy |
· A recommendation for the use of photodynamic therapy for adults with genital LS could not be made. · A recommendation against photodynamic therapy was made for children with LS. · A recommendation for the use of photodynamic therapy for patients with extragenital LS could not be made (off-label). |
| Laser therapy |
· A recommendation for the use of laser therapy in adults could not be made. · A recommendation against laser therapy was made for children with LS. |
| Cryotherapy | · A recommendation for the use of cryotherapy could not be made. |
| Systemic therapy |
· Acitretin is suggested for women with genital LS, if systemic therapy is needed, taking into account teratogenicity (off-label). · Acitretin is suggested for men with genital LS, if systemic therapy is needed (off-label). · Methotrexate is suggested for adults with genital and/or extragenital LS, taking into account teratogenicity, if systemic therapy is needed (off-label). · A recommendation against potassium para-aminobenzoate as systemic therapy was made. |
| Surgical interventions |
· Adhesion/de-adhesion/synechiolysis/perineoplasty is suggested for women with LS who have persistent introital stenosis that causes mechanical problems in voiding or sexual intercourse, despite guideline-conform treatment with steroids.· A recommendation against surgical treatment was made for the management of genital LS in girls. · Circumcision is suggested, preferably removing the complete foreskin if guideline-conform treatment with e.g., steroids in men with phimosis caused by LS fails. · Frenuloplasty is suggested in combination with intralesional triamcinolone or, alternatively, a complete circumcision if guideline-conform treatment with e.g., steroids in men with scarring or shortening of the frenulum caused by LS fails. · Urethroplasty is suggested using oral mucosa grafts in men with urethral stricture due to LS, causing mechanical problems in voiding or sexual intercourse. · Circumcision is suggested, preferably removing the complete foreskin if guideline-conform treatment with e.g., steroids in boys with phimosis caused by LS fails. · Frenuloplasty is suggested in combination with intralesional triamcinolone, or alternatively, a complete circumcision if guideline-conform treatment with e.g., steroids fails in boys with scarring or shortening of the frenulum caused by LS. |
| LS: Lichen sclerosus; UV: Ultraviolet. | |
Reference: Kirtschig G, Kinberger M, Kreuter A, et al. EuroGuiderm guideline on lichen sclerosus – Treatment of lichen sclerosus. J Eur Acad Dermatol Venereol. 2024;38(10):1874–1909.