Background: Vulvar Lichen Sclerosus (VLS) is a chronic inflammatory disease with a huge
impact on a person’s quality of life. A correct therapy is required for relieving symptoms, reversing
signs and preventing further anatomical changes.
Objective: The main objective of the present paper is to provide suggestions for the best treatment approach,
based on the available evidence. Treatment strategies are divided on the basis of the treatment
phase, distinguishing options for initial, acute or attack treatment and those for long-term, maintenance
Methods: An electronic search was performed using the National Library of Medicine PubMed database.
All the studies evaluating treatment of vulvar lichen sclerosus published in the English literature
were analyzed, including controlled studies, case series, guidelines and reviews.
Results: Current evidence identifies ultra-potent and potent corticosteroids, administered for 12 weeks,
as the first-line recommended treatment for active VLS. Topical calcineurin inhibitors, tacrolimus and
pimecrolimus, are effective and safe alternatives. Long-term maintenance strategies aimed at preventing
recurrences are required, after the initial treatment phase. Maintenance treatment mostly consists in
topical corticosteroids, administered i) on an “as needed” basis (“reactive” scheme), ii) on a continuative
regimen, iii) on a low-dose, intermittent regimen (“proactive” scheme). Further investigations are
needed for better defining the placement of other options within the VLS therapeutic algorithm, including
retinoids, physical and systemic treatments.
Conclusion: The available evidence provides useful indications for the management of VLS. Both the
identification of new therapeutic targets and the optimization of the available options represent the
main objectives of future research.