Vulvar lichen sclerosus (VLS) is a progressive dermatitis with significant itching, pain, and sexual dysfunction.
To investigate topical steroid use and clinical improvement across multiple specialties.
Retrospective cohort study at dermatology, gynecology, and vulvovaginal specialty clinics from 2012-2017. Descriptive statistics and panel logistic regression performed.
333 women attended 1525 visits (median 6/patient, range 1-24 visits). Patients used steroids exactly as prescribed at 66% of visits, less than prescribed at 26%, and not at all at 8%. Versus no use, exact use improved symptoms (OR 4.6, 95% CI 2.2-9.6) and physical exam (6.9, 2.7-17.6) more than infrequent steroid use (symptoms 2.5, 1.2-5.4; physical exam 4.2, 1.6-11.0). Sexual activity status was noted in 93% of vulvovaginal, 29% of gynecology, and 0% of dermatology visits. At intake, 42% were sexually inactive due to pain; of these, 37% became sexually active after steroid treatment. Steroid adherence was not associated with change in sexual activity.
Women with VLS improve more when topical steroids are used exactly as prescribed, though some improvement occurs with imperfect use. Sexual activity documentation is inconsistent, limiting quality-of-life follow-up.
Copyright © 2020. Published by Elsevier Inc.