Abstract
Answer A
Lichen sclerosus is the most common of the vulval dystrophies and probably represents an autoimmune disorder. It characteristically presents with vulval itching, pain and dyspareunia. Examination typically reveals an ‘ivory white’ atrophic vulva, with small or absent labia.
Treatment is with very potent topical steroids which should be applied once daily for 4 weeks, and then tapered down to twice-weekly application. There is a small risk of progression to vulval carcinoma, and therefore regular monitoring is required. Patients who fail to respond to treatment, or in whom the diagnosis is in doubt, require secondary care referral to gynaecology or dermatology.
DermNet NZ