Vulvovaginal Lichen Planus Treatment: A Survey of Current Practices

A Survey of Current Practices2][3][4] Treatment is very difficult.Vulvovaginal LP is perceived as poorly responsive to topical corticosteroids.To our knowledge, no randomized controlled trials of treatment have been performed, and only 1 case series exists. 1 Treatment efficacy data are anecdotal or based on isolated case reports. 5,6The aims of this survey were to summarize the symptoms and clinical features of vulvovaginal LP and to record the therapeutic practices of physicians with special interest in genital LP in different regions of the world, with a view toward a cooperative international treatment study.Methods.Members of the International Society for the Study of Vulvovaginal Disease (ISSVD) with a special interest in genital LP were invited to participate.Nine physicians prospectively recorded data for all cases of vulvovaginal LP seen from May 1 through September 30, 2004.The entry criterion was a definite clinical diagnosis of vulvovaginal LP.Data were collected by the consulting physician using a standardized questionnaire, in-person interview, clinical examination, and case note review.Age at onset was defined as the age when a patient first experienced LP-related symptoms in the anogenital area.The presence or absence of vulvar and/or vaginal pruritus, burning, soreness, dyspareunia, apareunia, and vaginal discharge was recorded.Clinical examination included vaginal speculum examination except when vaginal stenosis or pain prevented this.Clinical features of the vulva, vagina, perineum, and perianal region (red and/or purple color, lacy changes, erosions, scarring, and stenosis) were noted.The presence or absence of LP at other cutaneous and mucosal sites was recorded.The history or presence of genital malignancy associated with LP was noted.All current and past treatments (surgical, systemic, and topical) were recorded.The type of corticosteroid (topical midpotent, topical superpotent, vaginal ointment and/or foam, vaginal tablet and/or suppository, oral prednis[ol]one, intramuscular triamcinolone, and intralesional triamcinolone) was recorded.Treatment regimens were analyzed by region.Descriptive statistics were generated to delineate features of the disease and the study population.The relationship between treatment regimens and region was assessed using 2 tests of independence.All statistical tests were performed at an ␣ level of .05,and all analyses were conducted using the SAS statistical software package, version 9.0 (SAS Institute, Cary, North Carolina).