title: A multi-centre audit on genital lichen sclerosus in the North West of England.
abstract: BACKGROUND
  Guidelines for the management of genital Lichen sclerosus (LS) have recently been updated.
  
  
  OBJECTIVE
  To look at the audit points suggested by the updated guidelines: performance of biopsies in active LS not responding to treatment; clear follow-up arrangements for patients with active disease; patient awareness of need to report suspicious lesions; and use of an appropriate topical steroid regieme.
  
  
  METHODS
  Patients with a diagnosis of genital LS seen over the preceding 12 months were identified from eight hospital Trusts. In this study, 194 patients participated, 178 females and 16 males.
  
  
  RESULTS
  The diagnosis was purely clinical in 62 patients - the remainder required biopsies. The commonest reason for performing a biopsy was to clarify the diagnosis (116), followed by to rule out malignancy (11). The majority (98%) were offered follow-up after the initial consultation and only 19 patients were discharged to primary care. In this study, 37% patients had documented evidence that a patient information leaflet had been given. 112 were treated with the clobetasol propionate 0.05% regieme quoted in the guideline.
  
  
  CONCLUSIONS
  We conclude biopsies should be done as indicated in the guideline and the reason for biopsy documented. Discharge may be possible at 6 months for stable uncomplicated disease, although this may prove difficult if adequate follow-up arrangements are not available in the community. We advocate that all patients should receive a patient information leaflet and must be made aware of the increased risk of SCC. Topical corticosteroid treatment should be simplied to the regieme documented in the guidelines unless contraindicated.
authors.affiliation: Lanarkshire centre for Dermatology, Glasgow, UK.
authors.forename: G
authors.initials: G
authors.lastname: Raj
authors.forename: H K
authors.initials: HK
authors.lastname: Bell
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052798:Balanitis Xerotica Obliterans / Q000188:drug therapy* / Q000453:epidemiology; D001706:Biopsy; D002648:Child; D054869:Clinical Audit; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000188:drug therapy* / Q000453:epidemiology; D005832:Genital Diseases, Male / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D007724:Vulvar Lichen Sclerosus / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013256:Steroids