title: A Survey of Experts Regarding the Treatment of Adult Vulvar Lichen Sclerosus.
abstract: OBJECTIVE
  The objective of this work was to survey physician members and fellows of the International Society for the Study of Vulvovaginal Disease to determine current expert opinion regarding the management of adult vulvar lichen sclerosus.
  
  
  METHODS
  A cross-sectional design was used. An electronic survey was emailed to all members and fellows of the International Society for the Study of Vulvovaginal Disease. Responses were analyzed using univariate methods. Subgroup analyses were performed to report treatment differences between gynecologists and dermatologists and between physicians in the United States and Europe.
  
  
  RESULTS
  In total, 128 (42%) of 305 providers responded to the survey. Analysis was confined to the 114 physician respondents who treat patients with lichen sclerosus. Clobetasol propionate 0.05% is the most common first-line agent used in lichen sclerosus (85%). The most common second-line agents used are tacrolimus (39%), other topical steroids (28%), and intralesional steroids (13%). Most physicians (59%) start all patients with lichen sclerosus on drug therapy at an initial visit, regardless of symptoms. Dermatologists are more likely to treat all patients (both symptomatic and asymptomatic) than gynecologists (p < .01). Most physicians (64%) continue maintenance therapy in all patients. Gynecologists are more likely than dermatologists to treat only when patients are symptomatic versus using maintenance therapy (p = .03). Physicians practicing in the United States are more likely than those practicing in Europe to treat all patients with maintenance therapy (p < .01).
  
  
  CONCLUSIONS
  Lichen sclerosus management varies among experts. Variations exist between physician specialties and between those practicing in different geographic locations. Uncertainty regarding optimal treatment remains, especially regarding long-term management.
authors: Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors: Amanda
authors: A
authors: Selk
mesh_terms: D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002990:Clobetasol / Q000627:therapeutic use; D003880:Dermatology / Q000379:methods / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006176:Gynecology / Q000379:methods / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020407:Internet; D010820:Physicians / Q000706:statistics & numerical data*; D012955:Societies, Medical; D013256:Steroids / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use; D014481:United States; D007724:Vulvar Lichen Sclerosus / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D002990:Clobetasol; D016559:Tacrolimus