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Vulvar lichen planus

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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Guidelines

1.Diagnostic investigations

Evaluation for oral involvement: 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

2.Medical management

Corticosteroids, topical
Offer ultrapotent topical corticosteroids such as clobetasol propionate in patients with VLP.
B
Insufficient evidence to recommend an optimal regimen for ultrapotent topical corticosteroids.
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  • Corticosteroids (vaginal)

  • Calcineurin inhibitors

  • Management of co-occurring infections

3.Therapeutic procedures

Vaginal dilators: 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

4.Follow-up and surveillance

Follow-up
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