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Lichen Sclerosus — SCE Dermatology MCQ

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ModerateGenital DermatologyLichen SclerosusSCE Dermatology

A 40-year-old woman presents with chronic pruritus vulvae. Examination shows white, atrophic, crinkled skin ('cigarette paper') of the vulva and perianal area in a figure-of-eight distribution with labial fusion. Biopsy confirms lichen sclerosus. What is the first-line treatment?

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Correct answer: E — Ultrapotent topical corticosteroid (Clobetasol propionate 0.05%)

Ultrapotent topical corticosteroids (Clobetasol propionate 0.05%) are first-line treatment for vulval lichen sclerosus per BAD guidelines. The standard regimen is once daily for 4 weeks, then alternate days for 4 weeks, then twice weekly for 4 weeks, then as needed for maintenance. Topical calcineurin inhibitors are second-line. Long-term follow-up is essential due to the 4-5% risk of vulval SCC developing in affected skin. Moderate potency steroids are insufficient for genital lichen sclerosus.

Reference: BAD 2018 Guidelines for management of lichen sclerosus