Take 10: Lichen sclerosus

2 minute read

Pushback against topical corticosteroids by health professionals can be damaging for people with lichen sclerosus

Pushback against topical corticosteroids by health professionals can be damaging for people with lichen sclerosus, who usually require lifelong treatment.

Lichen sclerosus is a non-contagious skin disease that affects around one in 80 women. It usually affects post-menopausal women but can also occur in younger women and men.

Around 4% of women with the condition will develop vulvar cancer.

“The only thing that predicts whether a patient is going to get cancer from this condition is lack of treatment,” says Associate Professor Gayle Fischer, a dermatologist at the University of Sydney.

While topical steroids are the gold standard for treatment, there is a lot of pushback within the medical community these days, she says.

“We call it corticosteroid phobia. And that has been getting stronger and stronger over the past 20 years.

“It comes from all sections of the medical community, not just from general practitioners, pharmacists, complementary practitioners and, of course, it is all over the internet.

“You are not going to see anything good about topical steroids on the internet anywhere.”

Professor Fischer says providing patients with appropriate fact sheets and information about topical steroids can help. Doctors can also encourage treatment adherence by scheduling yearly appointments with patients.

Initially, patients with lichen sclerosus must use potent topical steroids every day for five to six months to put the condition into remission.

“Once they are in remission you can then maintain it with weak to moderate potency topical corticosteroids and to titrate that to the individual patient,” says Professor Fischer.


In this video, Professor Fischer discusses:

– How does lichen sclerosus commonly present?
– Is there a typical history associated with lichen sclerosus?
– What should you look for when examining a patient that may have lichen sclerosus?
– Who, what, when and where should you biopsy if you suspect lichen sclerosus?
– Is more than one biopsy sample necessary?
– Why are long-term potent topical steroids important?
– What is the gold standard for treatment?

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