title: EMAS clinical guide: vulvar lichen sclerosus in peri and postmenopausal women.
abstract: BACKGROUND
  Vulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms.
  
  
  OBJECTIVE
  The purpose of this clinical guide is to provide advice on early recognition and treatment.
  
  
  METHODS
  Literature review and consensus of expert opinion.
  
  
  CONCLUSIONS
  The etiology of LS in peri and postmenopausal women is unknown, although autoimmune, genetic and infectious factors have been implicated. Definitive diagnosis of non-malignant disorders depends on the histology of biopsied tissue. LS associated with cellular atypia should be classified as intraepithelial neoplasia. Topical corticosteroids are the most effective treatment, although prolonged treatment may be associated with dermal atrophy. Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be a safe and effective alternative treatment without risk of corticosteroid-related vulvar atrophy since they do not affect collagen synthesis. LS recurrences are frequent, and can lead to significant physical discomfort and emotional distress that affect mood and sexual relationships. Anatomical changes may require surgical management.
authors.affiliation: Department of Obstetrics and Gynecology, Zaragoza University Facultad de Medicina, Lozano Blesa University Hospital, Zaragoza 50009, Spain. Electronic address: faustino.perez@unizar.es.
authors.forename: Faustino R
authors.initials: FR
authors.lastname: Pérez-López
authors.affiliation: Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania.
authors.forename: Iuliana
authors.initials: I
authors.lastname: Ceausu
authors.affiliation: Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Herman
authors.initials: H
authors.lastname: Depypere
authors.affiliation: Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa School of Medicine, Valikonagi Cad. No: 93/4, Nisantasi, 34365 Istanbul, Turkey.
authors.forename: C Tamer
authors.initials: CT
authors.lastname: Erel
authors.affiliation: 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, GR-11528 Athens, Greece.
authors.forename: Irene
authors.initials: I
authors.lastname: Lambrinoudaki
authors.affiliation: Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rees
authors.affiliation: Department of Medicine, Cardiology Unit and Head Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Thorax N3:06, SE 17176 Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
authors.affiliation: Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, F-31059 Toulouse cedex 09, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tremollieres
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Simoncini
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D047648:Perimenopause; D017698:Postmenopause; D011230:Precancerous Conditions / Q000175:diagnosis; D016559:Tacrolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D014845:Vulvar Diseases / Q000188:drug therapy; D007724:Vulvar Lichen Sclerosus / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; C117268:pimecrolimus; D016559:Tacrolimus
keywords: Calcineurin inhibitors; Clobetasol propionate; Corticosteroids; Dyspareunia; Lichen sclerosus; Pimecrolimus; Pruritus; Tacrolimus; Testosterone; Vulvar kraurosis