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Lichen sclerosus — MCCQE Part 1 MCQ

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ModerateVulvar SymptomsLichen sclerosusMCCQE Part 1

A 68-year-old woman has chronic vulvar itch and dyspareunia. Examination shows porcelain-white atrophic plaques in a figure-of-eight distribution around the vulva and perianal area. Which of the following is the most appropriate management?

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Correct answer: A — High-potency topical corticosteroid and follow-up for symptom control and malignancy surveillance

Vulvar lichen sclerosus is treated with high-potency topical corticosteroids and follow-up because of scarring and small risk of vulvar squamous cell carcinoma. Estrogen may help genitourinary syndrome of menopause but is not definitive for lichen sclerosus. Persistent or atypical lesions may require biopsy.

Reference: SOGC vulvar dermatology guidance; Canadian dermatology practice