13 responses to “Help – the steroids are not working – Helping women with refractory vulvar lichen sclerosus”

  1. Excellent, well written article.

  2. Very interesting and informative article with practical approach.

  3. Helpful review of the subject

  4. Agree with all of the above comments. Table 1 with instructions to patients will be very helpful. I would like to make copies and hand them out to patients

  5. Please download the patient education handout for lichen sclerosus at bcvulvarhealth.ca under health information – it has this table and other instructions for patients.

  6. thank you

  7. Would the recommendations be the same for pediatric patients presenting with LS?

  8. Yes. Treatment of acute LS is similar. Maintenance therapy is recommended till at least puberty. Potency of steroid can be reduced.
    Here is good review of Pediatric Lichen sclerosus.

  9. Any suggestions for managing fissures and tears? (Other than the obvious, preventing them by using steroid as directed and avoiding constipation).
    Suggestions as to how to keep steroid ointment from migrating to normal skin?

  10. A patient on mine with specialist confirmed lichen sclerosis, learned that her sister had the same condition. the sister had consulted a naturopath who recommended discontinuing all dairy products. This resolved all her symptoms. My patient followed the same advice and also obtained resolution of her symptoms. Every now and then she slips up and has some dairy products and the itch will return for a short while. Milk allergy?

  11. Regarding recurrent fissures and tears – assuming woman is adherent to topical steroid therapy
    1 Review skin care routine (eliminate chemical and physical irritants that could be drying skin; for example soap and pamtyliners).
    2 Suggest moisturizing skin daily or a soak and seal” routine. Sit in bath, gently pat skin dry then use a barrier (zinc or petroleum base) on the skin.
    3 Consider adding local estrogen replacement for post-menopausal women.
    4 Non-healing cuts should be biopsies.
    Applied in a thin layer steroid should not migrate but wearing underwear after application should prevent spread to thighs

  12. High potency steroids such as clobetasone may be contraindicated if the patient also has a chronic infection such as Lyme disease, syphilis, leishmaniasis, tuberculosis, etc–the same things that are a caution for any use of a potent immunosuppressant. Steroids have been associated with a return of Bells palsy and hemi-facial paralysis in Lyme patients, for example.

  13. It is my belief that for those patients who do respond to ultra potent topical steroids but still have some residual problems such as painful sex or frequent flare ups, that an attempt at complete resolution (not just remission) should be attempted using tacrolimus 0.1% ointment.

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