Lichen Sclerosus Maintenance — SCE Dermatology MCQ

Correct answer: C — Reduce to 1-2 times weekly application for maintenance — proactive long-term treatment reduces relapse and SCC risk

After the initial treatment phase for genital LS (typically Clobetasol propionate 0.05% OD for 4 weeks, then alternate days for 4 weeks, then twice weekly for 4 weeks — the '3-month ladder'), long-term maintenance with 1-2 applications per week is recommended. This proactive maintenance approach reduces relapse frequency, prevents disease progression, and may reduce the SCC risk associated with chronic LS inflammation. The potent steroid is safe for long-term genital use at this reduced frequency — genital steroid atrophy risk at 1-2 times weekly is minimal. Annual clinical review should include assessment for phimosis progression, clinical signs of SCC, and education about self-examination for new lumps or non-healing ulcers.

Reference: BAD 2018 LS Guidelines