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Management of Vulvovaginal Lichen Planus: A New Approach

Bradford, Jennifer MBBS, FRANZCOG1; Fischer, Gayle MD, MBBS, FACD2

Journal of Lower Genital Tract Disease: January 2013 - Volume 17 - Issue 1 - p 28–32
doi: 10.1097/LGT.0b013e318258bf5b
Original Articles

Objective This study aimed to report on a novel approach to therapy in a large private dermatogynecology practice using multimodal therapies with adjunctive use of systemic agents where necessary.

Materials and Methods This was a retrospective audit of the presentation and management of 131 patients with a clinical diagnosis of vulvovaginal lichen planus.

Results The most frequently presenting symptoms were genital soreness, itch, and burning. Of the 131 patients, 39 (30%) had extragenital disease, mainly oral. Eighty-four (64%) had no external disease. Twenty-two (17%) had introital erosions as the only visible abnormality. Fifty-five (42%) had some degree of labial fusion. Two had full-thickness vulval intraepithelial neoplasia (VIN). Remission induction was achieved in most patients with superpotent topical steroids, but 53 (40%) of 131 patients used oral prednisolone either as an adjunct therapy or alone. All compliant patients achieved symptomatic and objective disease control in a mean of 7.5 weeks. Of the 131 patients, 48 (37%) required multimodal therapy to maintain their initial improvement. Forty-five (34.3%) patients used topical tacrolimus, usually with topical corticosteroids, for maintenance. Eleven (8.5%) required low-dose weekly methotrexate. Fourteen patients experienced adverse reactions severe enough to lead to the cessation of that treatment. The mean length of follow-up was 6.4 years (range = 1 mo to 15 y). The 2 patients with VIN at presentation have had no recurrence. No other patient has yet developed VIN or carcinoma.

Conclusions Long-term symptomatic and objective control of vulvovaginal lichen planus is possible but requires multimodal therapies, flexible treatment programs, and the judicious use of oral agents.

Long-term control of vulvovaginal lichen requires multimodal therapies, flexible treatment programs, and the judicious use of oral agents. We report a novel approach to the management of vulvovaginal lichen planus, which results in improved control rates.

1Department of Obstetrics & Gynaecology, and 2Discipline of Dermatology, School of Medicine, University of Sydney, Sydney, Australia

Reprint requests to: Jennifer Bradford, MBBS, FRANZCOG, 174 Murray Farm Rd, Beecroft, NSW, Australia. E-mail:

The authors did not receive financial support for this study.

©2013The American Society for Colposcopy and Cervical Pathology