What follow-up protocols should I implement for patients diagnosed with vulval lichen sclerosus?

Follow-up protocols for patients diagnosed with vulval lichen sclerosus include:

• Referral to secondary care (vulval clinic, dermatologist, or gynaecologist with expertise in vulval disease) to confirm diagnosis and initiate treatment with very potent topical corticosteroids.
• Long-term management often requires repeated, intermittent courses of potent topical corticosteroids to control symptoms and prevent progression.
• Patients should be advised on vulval self-examination, although evidence for its benefit is lacking; this may help in early detection of any suspicious changes.
• Urgent referral (within 2 weeks) is indicated if there are any unexplained vulval lumps, ulcerations, bleeding, or persistent abnormal areas suspicious for vulval intraepithelial neoplasia or malignancy.
• Regular follow-up in secondary care is important to monitor treatment response, manage symptoms, and surveil for potential malignant transformation, as lichen sclerosus is a premalignant condition.
• Primary care should manage associated symptoms and provide supportive care such as emollients and symptomatic relief, but persistent or unclear cases should be referred back to specialists.

These protocols aim to provide symptomatic relief, reduce inflammation, restore the skin barrier, and prevent malignant progression through specialist monitoring and treatment adjustments.

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