title: Physician-administered clinical score of vulvar lichen sclerosus: A study of 36 cases.
abstract: BACKGROUND
  Vulvar lichen sclerosus (VLS) often remains undetected for years due to lack of awareness, as well as private nature of the disease. Advanced disease severely affects the quality of life and is associated with increased risk of vulvar squamous cell carcinoma (SCC). The aim of this study was to assess the usefulness of a physician-administered clinical scoring system for the clinical diagnosis and evaluation of VLS. To the best of our knowledge, this is the first study using the clinical score developed by Günthert et al on the VLS patients.
  
  
  METHODS
  The study conducted was an observational cross-sectional study of 36 cases attending Dermatology OPD of Government Medical College with clinically proven and previously untreated VLS enrolled over a 1 year period. Cases were retrospectively subjected to evaluation by physician-administered clinical score based on 6 clinical features, viz. erosions, agglutination, hyperkeratosis, stenosis, fissures, and atrophy.
  
  
  RESULTS
  The average age of 36 clinically diagnosed VLS cases was 56.4 years. Most common clinical features were hyperkeratosis and atrophy found in 86.11% cases followed by erosions (75%) with one-third cases having grade 2 (severe) changes. One case had well-differentiated SCC clitoris at presentation. The mean physician-administered clinical score was 5.583, and 80.56% cases had clinical score ≥4 validating the clinical diagnosis.
  
  
  CONCLUSIONS
  Early diagnosis and prompt treatment is the key to prevent sequelae and complications of VLS. The physician-administered clinical score can be a useful tool to diagnose and later evaluate the response of treatment and prognosis of VLS cases.
authors.affiliation: Department of Dermatology and Cosmetic Dermatology, Fortis Hospital, Mumbai, Maharashtra, India.
authors.forename: Smriti
authors.initials: S
authors.lastname: Naswa
authors.affiliation: Department of Skin-VD, Medical College, Baroda, Gujarat, India.
authors.forename: Yogesh S
authors.initials: YS
authors.lastname: Marfatia
keywords: Clinical score; vulva; vulvar lichen sclerosus