EuroGuiderm guideline on lichen sclerosus—Treatment of lichen sclerosus
Introduction Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a...
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| Published in | Journal of the European Academy of Dermatology and Venereology Vol. 38; no. 10; pp. 1874 - 1909 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article Web Resource |
| Language | English |
| Published |
England
John Wiley and Sons Inc
01.10.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0926-9959 1468-3083 1468-3083 |
| DOI | 10.1111/jdv.20083 |
Cover
| Abstract | Introduction
Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early.
Objectives
The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow‐up of patients with LS and inform about new developments and potential research aspects.
Materials and Methods
The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF‐EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives.
Results
Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co‐treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases.
Conclusions
LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long‐term. |
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| AbstractList | Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early.INTRODUCTIONLichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early.The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects.OBJECTIVESThe guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects.The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives.MATERIALS AND METHODSThe guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives.Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases.RESULTSUltrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases.LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.CONCLUSIONSLS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term. [en] INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES: The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS: The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS: Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS: LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term. Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term. Introduction Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. Objectives The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow‐up of patients with LS and inform about new developments and potential research aspects. Materials and Methods The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF‐EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. Results Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co‐treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. Conclusions LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long‐term. |
| Author | Lazzeri, M. Kühn, H. Regauer, S. Nikkels, A. F. Hiltunen‐Back, E. Vassileva, S. Rall, K. K. Simpson, R. Sárdy, M. Kirtschig, G. Boffa, M. J. Fischer, B. Mendling, W. Barbagli, G. Chi, C. C. Becker, K. Dauendorffer, J. N. Voswinkel, L. Günthert, A. Müller, S. Stein, R. Hees, C. Thune, T. Ramakers, M. J. Corazza, M. Kreuter, A. Larsen, H. K. Sepp, N. Promm, M. Wölber, L. Werner, R. N. Kinberger, M. Seitzberg, S. Gaskins, M. Köllmann, N. H. Tsiogka, A. Höfinger, A. |
| Author_xml | – sequence: 1 givenname: G. orcidid: 0000-0002-1433-2407 surname: Kirtschig fullname: Kirtschig, G. email: g.kirtschig@gmail.com organization: Medbase Health Centre – sequence: 2 givenname: M. orcidid: 0000-0002-7673-9974 surname: Kinberger fullname: Kinberger, M. organization: Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin – sequence: 3 givenname: A. surname: Kreuter fullname: Kreuter, A. organization: HELIOS St. Elisabeth Hospital Oberhausen – sequence: 4 givenname: R. surname: Simpson fullname: Simpson, R. organization: University of Nottingham – sequence: 5 givenname: A. surname: Günthert fullname: Günthert, A. organization: Gynäkologisches Tumorzentrum St. Anna – sequence: 6 givenname: C. surname: Hees fullname: Hees, C. organization: Erasmus University Medical Center – sequence: 7 givenname: K. surname: Becker fullname: Becker, K. organization: Office for Paediatric Surgery – sequence: 8 givenname: M. J. surname: Ramakers fullname: Ramakers, M. J. organization: CenSeRe (Centre for Psychological, Relational, Sexual Health) – sequence: 9 givenname: M. surname: Corazza fullname: Corazza, M. organization: University of Ferrara – sequence: 10 givenname: S. orcidid: 0000-0002-0200-4254 surname: Müller fullname: Müller, S. organization: University Hospital Basel – sequence: 11 givenname: S. surname: Seitzberg fullname: Seitzberg, S. organization: The Danish Lichen Sclerosus Association – sequence: 12 givenname: M. J. surname: Boffa fullname: Boffa, M. J. organization: Mater Dei Hospital – sequence: 13 givenname: R. surname: Stein fullname: Stein, R. organization: University of Medical Center Mannheim, Heidelberg University – sequence: 14 givenname: G. surname: Barbagli fullname: Barbagli, G. organization: Centro Chirurgico Toscano – sequence: 15 givenname: C. C. orcidid: 0000-0001-5699-0283 surname: Chi fullname: Chi, C. C. organization: Chang Gung University – sequence: 16 givenname: J. N. orcidid: 0000-0001-7763-7323 surname: Dauendorffer fullname: Dauendorffer, J. N. organization: University Hospital Saint Louis – sequence: 17 givenname: B. surname: Fischer fullname: Fischer, B. organization: Switzerland/Verein Lichen Sclerosus e.V – sequence: 18 givenname: M. surname: Gaskins fullname: Gaskins, M. organization: Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin – sequence: 19 givenname: E. surname: Hiltunen‐Back fullname: Hiltunen‐Back, E. organization: Helsinki University Hospital – sequence: 20 givenname: A. surname: Höfinger fullname: Höfinger, A. organization: Switzerland/Verein Lichen Sclerosus e.V – sequence: 21 givenname: N. H. surname: Köllmann fullname: Köllmann, N. H. organization: Switzerland/Verein Lichen Sclerosus e.V – sequence: 22 givenname: H. surname: Kühn fullname: Kühn, H. organization: The German Lichen Sclerosus Association – sequence: 23 givenname: H. K. orcidid: 0000-0001-8420-696X surname: Larsen fullname: Larsen, H. K. organization: Copenhagen University Hospital, Bispebjerg Hospital – sequence: 24 givenname: M. surname: Lazzeri fullname: Lazzeri, M. organization: IRCCS Humanitas Research Hospital – sequence: 25 givenname: W. surname: Mendling fullname: Mendling, W. organization: Helios University Hospital Wuppertal–University Witten/Herdecke – sequence: 26 givenname: A. F. surname: Nikkels fullname: Nikkels, A. F. organization: University Medical Center of Liège – sequence: 27 givenname: M. surname: Promm fullname: Promm, M. organization: University Medical Centre of Regensburg – sequence: 28 givenname: K. K. surname: Rall fullname: Rall, K. K. organization: Women's University Hospital Tuebingen – sequence: 29 givenname: S. surname: Regauer fullname: Regauer, S. organization: Medical University Graz – sequence: 30 givenname: M. orcidid: 0000-0003-4306-5093 surname: Sárdy fullname: Sárdy, M. organization: Semmelweis University – sequence: 31 givenname: N. surname: Sepp fullname: Sepp, N. organization: Ordensklinikum Linz Elisabethinen – sequence: 32 givenname: T. surname: Thune fullname: Thune, T. organization: Haukeland University Hospital – sequence: 33 givenname: A. orcidid: 0000-0002-6853-9788 surname: Tsiogka fullname: Tsiogka, A. organization: National and Kapodistrian University of Athens – sequence: 34 givenname: S. surname: Vassileva fullname: Vassileva, S. organization: University Hospital “Alexandrovska”, Medical University – Sofia – sequence: 35 givenname: L. surname: Voswinkel fullname: Voswinkel, L. organization: The German Lichen Sclerosus Association – sequence: 36 givenname: L. surname: Wölber fullname: Wölber, L. organization: University Medical Centre Hamburg‐Eppendorf and Centre for Colposcopy and Vulvovaginal Disease Jersualem Hospital Hamburg – sequence: 37 givenname: R. N. orcidid: 0000-0003-3209-1392 surname: Werner fullname: Werner, R. N. organization: Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38822598$$D View this record in MEDLINE/PubMed |
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| Snippet | Introduction
Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and... Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it... [en] INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching... |
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| SubjectTerms | Dermatologie Dermatology Female Human health sciences Humans Infectious Diseases Laser Therapy Lichen Sclerosus et Atrophicus - complications Lichen Sclerosus et Atrophicus - therapy Male Practice Guidelines as Topic Pregnancy Pregnancy Complications - therapy Sciences de la santé humaine |
| Title | EuroGuiderm guideline on lichen sclerosus—Treatment of lichen sclerosus |
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