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Vulvar lichen planus

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of vulvar lichen planus are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2020) and the European Academy of Dermatology and Venereology (EADV 2017). ...
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Diagnostic investigations

Evaluation for oral involvement: as per ACOG 2020 guidelines, obtain evaluation of the oral cavity because oral involvement is common in patients with erosive lichen planus.
B
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  • Evaluation for comorbidities

Medical management

Corticosteroids, topical
As per EADV 2017 guidelines:
Offer ultrapotent topical corticosteroids such as clobetasol propionate in patients with VLP.
B
Insufficient evidence to recommend an optimal regimen for ultrapotent topical corticosteroids.
I

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  • Corticosteroids (vaginal)

  • Calcineurin inhibitors

  • Management of co-occurring infections

Therapeutic procedures

Vaginal dilators: as per ACOG 2020 guidelines, advise using graded vaginal dilators in conjunction with topical intravaginal corticosteroids to prevent vaginal scarring, synechiae, and complete obliteration of the vaginal vault in patients with lichen planus.
B

Follow-up and surveillance

Follow-up
As per EADV 2017 guidelines:
Obtain careful monitoring for all potentially toxic therapies (such as azathioprine, dapsone, griseofulvin, chloroquine, minocycline, cyclosporine, methotrexate, mycophenolate, retinoids, oral corticosteroids) preferably supervised by a dermatologist at a specialized clinic.
B
Assess active disease as clinically required. Ensure long-term specialized follow-up in patients with erosive VLP.
B