Lichen sclerosus is a chronic skin disease that mostly affects adult women, but also men and children. It mainly occurs in the genital area and around the anus. Affected women and girls frequently report itching, pain, and burning in the involved area. Scarring after inflammation may cause fusion of the vaginal lips, narrowing of the vaginal opening, and burying of the clitoris. Sex is often painful, less pleasurable, or impossible because of the pain. Lichen sclerosus in men and boys may cause tightening of the foreskin, leading to difficulty in passing urine or painful erection. Pain on opening the bowels may also be present, causing constipation, especially in children. Treating this disease is beneficial as the symptoms can be relieved, and further damage to the genital area and around the anus may be prevented. Various topical treatments for lichen sclerosus have been devised. This review aimed to identify which topical treatments are effective and safe.
We included 7 trials, with a total of 249 participants, covering 6 treatments in this review. Topical clobetasol propionate and mometasone furoate were effective in treating genital lichen sclerosus. There was no substantial difference in the efficacy of relieving symptoms (e.g. itching and pain) between pimecrolimus cream and clobetasol propionate, but the former was less effective in improving gross appearance.
More research is needed for a number of reasons: to decide the strength of steroids that should be used, as well as the frequency and length of application to the skin which gives the best results; to examine other skin treatments; to assess the long-term benefits of topical treatments with regard to relieving symptoms and reducing the risk of developing genital cancers; and to examine the benefits of treatments on the quality of the sex lives of people with this condition.