title: Management of vulvovaginal lichen planus:  a new approach.
abstract: OBJECTIVE
  This study aimed to report on a novel approach to therapy in a large private dermatogynecology practice using multimodal therapies with adjunctive use of systemic agents where necessary.
  
  
  METHODS
  This was a retrospective audit of the presentation and management of 131 patients with a clinical diagnosis of vulvovaginal lichen planus.
  
  
  RESULTS
  The most frequently presenting symptoms were genital soreness, itch, and burning. Of the 131 patients, 39 (30%) had extragenital disease, mainly oral. Eighty-four (64%) had no external disease. Twenty-two (17%) had introital erosions as the only visible abnormality. Fifty-five (42%) had some degree of labial fusion. Two had full-thickness vulval intraepithelial neoplasia (VIN). Remission induction was achieved in most patients with superpotent topical steroids, but 53 (40%) of 131 patients used oral prednisolone either as an adjunct therapy or alone. All compliant patients achieved symptomatic and objective disease control in a mean of 7.5 weeks. Of the 131 patients, 48 (37%) required multimodal therapy to maintain their initial improvement. Forty-five (34.3%) patients used topical tacrolimus, usually with topical corticosteroids, for maintenance. Eleven (8.5%) required low-dose weekly methotrexate. Fourteen patients experienced adverse reactions severe enough to lead to the cessation of that treatment. The mean length of follow-up was 6.4 years (range = 1 mo to 15 y). The 2 patients with VIN at presentation have had no recurrence. No other patient has yet developed VIN or carcinoma.
  
  
  CONCLUSIONS
  Long-term symptomatic and objective control of vulvovaginal lichen planus is possible but requires multimodal therapies, flexible treatment programs, and the judicious use of oral agents.
authors.affiliation: Department of Obstetrics & Gynaecology. jennybrd@bigpond.net.au
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bradford
authors.forename: Gayle
authors.initials: G
authors.lastname: Fischer
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008010:Lichen Planus / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids; D016559:Tacrolimus