The patient is diagnosed with lichen sclerosus. Which of the following is the best treatment option for this patient?

Question

The patient is diagnosed with lichen sclerosus.  Which of the following is the best treatment option for this patient?

Quizplus · Accepted Answer

11ec25c8_d9f5_2063_bc81_651af49ddfa9_MD0003_00 The treatment of lichen sclerosus is aimed at improving symptoms (eg, vulvar pain and pruritus) and to possibly prevent further disease progression. The first-line treatment is with superpotent topical corticosteroids (eg, clobetasol), which decreases the chronic inflammation associated with lichen sclerosus. In addition, continued topical corticosteroid therapy may also prevent disease progression to vulvar intraepithelial neoplasia or vulvar cancer. Patients may also use topical emollients for daily symptom management. (Choices A and E) Cryotherapy and topical imiquimod are treatment options for condyloma acuminata (ie, genital warts), caused by human papillomavirus types 6 and 11. Neither is indicated in the management of lichen sclerosus. (Choice B) A radical vulvectomy is reserved for the treatment of biopsy-proven vulvar cancer. Surgery is not recommended for most cases of lichen sclerosus because postoperative scarring can exacerbate symptoms and disease progression. (Choice D) Vaginal estrogen cream is used in the treatment of the genitourinary syndrome of menopause (also known as vulvovaginal atrophy). Educational objective: First-line treatment of vulvar lichen sclerosus is with superpotent topical corticosteroids (eg, clobetasol), which decreases chronic inflammation, thereby improving symptoms and potentially preventing disease progression. References: Lichen sclerosus-presentation, diagnosis and management. (http://www.ncbi.nlm.nih.gov/pubmed/27232363) Diagnosis and treatment of lichen sclerosus: an update. (http://www.ncbi.nlm.nih.gov/pubmed/23329078)

The Patient Is Diagnosed with Lichen Sclerosus