Vulval lichen sclerosus: An Australasian management consensus

Janice Yeon; Amanda Oakley; Ann Olsson; Catherine Drummond; Emma Veysey; Gillian Marshman; Helen Saunders; Jacinta Opie; Jennifer Bradford; Judith Cole; Kate DeAmbrosis; Kathryn Cook; Linda Pepall; Lois Jane Eva; Michael Sladden; Priya Selva-Nayagam; Roderic Phillips; Sally Ball; Sarah Hill; Tanja Bohl; Tania Day; Geoffrey Lee; Gayle Fischer

doi:10.1111/ajd.13594

Vulval lichen sclerosus: An Australasian management consensus

Australas J Dermatol. 2021 Aug;62(3):292-299. doi: 10.1111/ajd.13594. Epub 2021 Jun 12.

Authors

Janice Yeon^{1

2}, Amanda Oakley³, Ann Olsson⁴, Catherine Drummond^{5

6}, Emma Veysey⁷, Gillian Marshman^{4

8}, Helen Saunders⁹, Jacinta Opie^{10

11}, Jennifer Bradford¹², Judith Cole¹³, Kate DeAmbrosis¹⁴, Kathryn Cook^{15

16}, Linda Pepall¹⁷, Lois Jane Eva¹⁸, Michael Sladden¹⁹, Priya Selva-Nayagam²⁰, Roderic Phillips²¹, Sally Ball²², Sarah Hill²³, Tanja Bohl²⁴, Tania Day²⁵, Geoffrey Lee^{26

27}, Gayle Fischer^{26

27}

Affiliations

¹ The Skin Hospital, Sydney, New South Wales, Australia.
² Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
³ Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand.
⁴ Flinders Medical Centre, Bedford Park, South Australia, Australia.
⁵ Department of Dermatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
⁶ Medical School, Australian National University, Canberra, New South Wales, Australia.
⁷ Dermatology Department, The Royal Women's Hospital, Parkville, Victoria, Australia.
⁸ Flinders University Medical School, Adelaide, South Australia, Australia.
⁹ The Royal Women's Hospital, Victoria and Dermatology Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
¹⁰ Dermatogynaecology Clinic, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
¹¹ Department of Dermatology, Austin Health Heidelberg, Heidelberg, Victoria, Australia.
¹² School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia.
¹³ St John of God Dermatology, Subiaco, Western Australia, Australia.
¹⁴ Mater Misericordiae Hospital, South Brisbane, Queensland, Australia.
¹⁵ Obstetrician and Gynecologist at Vulval Clinic, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
¹⁶ Sexual Health Physician at Melbourne Sexual Health Clinic, Carlton, Victoria, Australia.
¹⁷ Royal Street Dermatology, Yokine, Western Australian, Australia.
¹⁸ Department of Gynaecological Oncology, National Women's Health at Auckland City Hospital, Auckland, New Zealand.
¹⁹ Department of Medicine, University of Tasmania, Launceston, Tasmania, Australia.
²⁰ Department of Dermatology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
²¹ Department of Paediatrics, Monash University Melbourne, Clayton, Victoria, Australia.
²² Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
²³ Tristram clinic, Hamilton Lake, Hamilton, New Zealand.
²⁴ Vulva Clinic, Jean Hailes Medical Centre, Clayton, Victoria, Australia.
²⁵ Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
²⁶ Northern Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.
²⁷ Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

PMID: 34117779
DOI: 10.1111/ajd.13594

Abstract

Background/objectives: Vulval lichen sclerosus (VLS) is a chronic inflammatory skin condition predominantly affecting the anogenital region in women and children. To date, there is lack of agreement amongst experts on a severity scale to aid assessment, research and treatment stratification on VLS. Furthermore, literature on best practice for long-term management of VLS is lacking. The aim of this consensus is to provide broad guidelines on the short and long-term management of VLS.

Methods: An initial focus group of Australasian experts in vulval dermatology developed a draft consensus statement for the management of VLS. Based on the results of the draft statement, a consensus panel of 22 Australasian experts, comprised of the initial and additional members, participated in an anonymous four-stage eDelphi process. Round 1 involved generation and voting on statements from the draft consensus statement developed by the focus group. In Rounds 2, 3 & 4, panel members were presented formal feedback from previous rounds and asked to indicate their level of agreement. Consensus was reached if there was ≥70% agreement on the importance of an item in the 4 (agree) to 5 (strongly agree) range.

Results: The expert panel, with a total of 504 collective years of experience in the field of VLS, reached consensus on a core set of 51 management statements related to diagnosis, severity, initial and long-term management, follow-up, and complications of VLS.

Conclusions: This study has identified a set of management statements for VLS that may be useful in clinical practice in the Australasian population.

Keywords: consensus; lichen sclerosus; management; recommendations; vulva.

MeSH terms

Consensus*
Dermatologists / standards
Female
Humans
Lichen Sclerosus et Atrophicus / prevention & control
Lichen Sclerosus et Atrophicus / therapy*
Practice Guidelines as Topic / standards*
Practice Patterns, Physicians' / standards*
Vulvar Lichen Sclerosus / prevention & control
Vulvar Lichen Sclerosus / therapy*