Clinical outcomes and adherence to topical corticosteroid therapy in women with vulvar lichen sclerosus: A retrospective cohort study - 07/08/20

Doi : 10.1016/j.jaad.2020.05.006

Jaden R. Kohn, MD, MPH ^a,^b,^⁎ , Trissa M. Connors, MD, MPH ^a,^c, Warren Chan, BS, MS ^a, Cynthia S. Liang, BS ^a, Harry Dao, MD ^c,^d, Anuja Vyas, MD ^e,^f
^a Baylor College of Medicine, Houston, Texas
^b Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland
^c Department of Dermatology, Baylor College of Medicine, Houston, Texas
^d Department of Dermatology, Loma Linda University, Loma Linda, California
^e Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
^f Houston Methodist Obstetrics and Gynecology Associates, Houston, Texas

^∗Correspondence to: Jaden R. Kohn, MD, MPH, 600 N Wolfe St, Baltimore, MD 21287.600 N Wolfe StBaltimoreMD21287

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Abstract

Background

Vulvar lichen sclerosus is a progressive dermatitis with significant itching, pain, and sexual dysfunction.

Objective

To investigate topical steroid use and clinical improvement across multiple specialties.

Methods

Retrospective cohort study at dermatology, gynecology, and vulvovaginal specialty clinics from 2012 to 2017. Descriptive statistics and panel logistic regression were performed.

Results

A total of 333 women attended 1525 visits (median 6/patient; range, 1-24 visits). Patients used steroids exactly as prescribed at 66% of visits, less than prescribed at 26%, and not at all at 8%. Versus no use, exact use improved symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.2-9.6) and physical examination findings (OR, 6.9; 95% CI, 2.7-17.6) more than infrequent steroid use (symptoms: OR, 2.5; 95% CI, 1.2-5.4; physical examination findings: OR, 4.2; 95% CI, 1.6-11.0). Sexual activity status was noted in 93% of vulvovaginal, 29% of gynecology, and 0% of dermatology visits. At intake, 42% of women were sexually inactive because of pain; of these, 37% became sexually active after steroid treatment. Steroid adherence was not associated with change in sexual activity.

Conclusions

Women with vulvar lichen sclerosus improve more when topical steroids are used exactly as prescribed, although some improvement occurs with imperfect use. Sexual activity documentation is inconsistent, limiting quality of life follow-up.

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Key words : female genitalia, lichen sclerosus et atrophicus, retrospective cohort, sexual function, topical corticosteroid, vulva, vulvar lichen sclerosus

Abbreviations used : CI, CM, ICD, OR, VLS

Plan

Methods

Results

Patient characteristics

Clinical management

Clinical impact of treatment adherence

Discussion

Conclusion

	Drs Kohn and Connors are cofirst authors.
	Funding sources: None.
	Conflicts of interest: None disclosed.
	IRB approval status: The Baylor College of Medicine Institutional Review Board approved this study. (Protocol Number: H40206. Status: Approved.)
	Reprints not available from the authors.