Vulvovaginal Lichen Planus Treatment Outcomes: A Systematic Review of Novel and Established Therapies

Vulvovaginal lichen planus (VVLP) is a chronic inflammatory mucocutaneous disease causing significant morbidity. Despite various available treatments, evidence regarding their effectiveness remains fragmented. To systematically evaluate the efficacy and safety of therapeutic interventions for VVLP with or without concomitant gingival involvement. We searched MEDLINE, Embase, CINAHL, and Scopus databases without date restrictions. We included randomized and non-randomized studies reporting treatment outcomes in adults with VVLP. Two reviewers independently screened studies and extracted data. Risk of bias was assessed. We analyzed 1417 patients across 66 studies. Monotherapy was used in 25.2% (357/1417), dual-component therapy in 12.0% (170/1417), triple-component therapy in 51.2% (726/1417), and complex therapy in 11.6% (164/1417) of cases. Among monotherapies, systemic corticosteroids demonstrated the highest complete resolution (CR) rate at 88.9% (24 of 27 patients), followed by biologics with tildrakizumab achieving 88.0% CR (22 of 25 patients), and JAK inhibitors with tofacitinib showing 75.0% CR (6 of 8 patients), and intravaginal corticosteroid suppositories at 55.7% (54 of 97 patients). Triple-component therapy combining systemic corticosteroids, topical calcineurin inhibitors, and antimetabolites (methotrexate or mycophenolate mofetil) was most commonly used (66.8%, 485/726), with 41.6% achieving CR. Adverse events were generally mild, including burning sensations with topical agents and gastrointestinal symptoms with systemic immunosuppressants. Recurrence rates varied widely: 84% for topical corticosteroids alone, 11.9% for methotrexate, and 3.2% for tildrakizumab. While corticosteroids remain the mainstay of VVLP treatment, newer therapies, including JAK inhibitors (75.0% CR, 6 of 8 patients) and biologics, show promising efficacy. Among biologic monotherapies, tildrakizumab achieved 88.0% CR (22 of 25 patients), while the overall CR rate across all 31 biologic-treated patients was 71.0% (22 of 31 patients). These findings are based on small patient numbers and require validation in larger controlled trials. Triple-combination therapy is frequently employed for resistant cases. High recurrence rates with monotherapy suggest combination approaches may be necessary for the long term.PROSPERO Registration: CRD42025101229.