Characterizing the Frequency and Severity of Clinical Signs and Architectural Changes in Vulvar Lichen Sclerosus

Untreated vulvar lichen sclerosus (VLS) can have a significant negative impact on quality of life, increase the risk of neoplastic transformation, and lead to irreversible architectural changes. Early and appropriate management using ultrapotent topical steroids is crucial to alleviate symptoms and prevent long-term complications. This study aimed to characterize clinical signs and architectural changes of 364 VLS patients at a tertiary center. The majority of the patients had sought care from ≥1 provider previously, were referred by a physician, had undergone prior vulvar biopsies, and had previously tried topical steroids. The authors observed predominantly mild clinical signs alongside more frequent severe architectural changes. These findings highlight the increased need for nuanced clinical evaluation, sufficient lifelong maintenance therapy to prevent architectural changes, and improved clinical scoring systems to differentiate between active VLS disease and residual damage.