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Vulvar lichen simplex chronicus

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The following summarized guidelines for the evaluation and management of vulvar lichen simplex chronicus 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

Patch testing: refer patients with suspected contact allergy to a dermatologist for patch testing.
B
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  • Laboratory tests

2.Diagnostic procedures

Biopsy
Consider performing biopsy only in patients with uncertainty about the diagnosis of LSC.
C
Recognize that it may be difficult to distinguish LSC from psoriasis on histopathological grounds.
B

3.Medical management

Topical corticosteroids: as per ACOG 2020 guidelines, offer medium-potency or high-potency topical corticosteroid ointment and oral antipruritic medication as needed in patients with vulvar LSC.
B

4.Nonpharmacologic interventions

Vulvar care: as per ACOG 2020 guidelines, provide education on how to stop the "itch-scratch cycle," and information regarding vulvar care and hygiene in patients with vulvar LSC.
B

5.Therapeutic procedures

Ultraviolet phototherapy: offer narrowband UVB phototherapy delivered by comb-like instrument in patients with vulvar LSC.
B

6.Follow-up and surveillance

Follow-up: obtain follow-up in patients with:
mild LSC: as clinically required
severe LSC (when using potent topical corticosteroids): 4 weeks, then as required
B