Clinical outcomes and adherence to topical corticosteroid therapy in women with vulvar lichen sclerosus: A retrospective cohort study.

ABSTRACT Background Vulvar lichen sclerosus (VLS) is a progressive dermatitis with significant itching, pain, and sexual dysfunction. Objective To investigate topical steroid use and clinical improvement across multiple specialties. Methods Retrospective cohort study at dermatology, gynecology, and vulvovaginal specialty clinics from 2012-2017. Descriptive statistics and panel logistic regression performed. Results 333 women attended 1525 visits (median 6/patient, range 1-24 visits). Patients used steroids exactly as prescribed at 66% of visits, less than prescribed at 26%, and not at all at 8%. Versus no use, exact use improved symptoms (OR 4.6, 95% CI 2.2-9.6) and physical exam (6.9, 2.7-17.6) more than infrequent steroid use (symptoms 2.5, 1.2-5.4; physical exam 4.2, 1.6-11.0). Sexual activity status was noted in 93% of vulvovaginal, 29% of gynecology, and 0% of dermatology visits. At intake, 42% were sexually inactive due to pain; of these, 37% became sexually active after steroid treatment. Steroid adherence was not associated with change in sexual activity. Conclusions Women with VLS improve more when topical steroids are used exactly as prescribed, though some improvement occurs with imperfect use. Sexual activity documentation is inconsistent, limiting quality-of-life follow-up.