Vulvar Lichen Sclerosus: A Literature Review with Consideration of Integrative Therapies.

Abstract

Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin condition characterized by vulvar pruritus, pain, dyspareunia, and architectural changes, including significant and permanent scarring and deformity of the vulva if left untreated. Untreated VLS significantly increases the risk of invasive squamous cell carcinoma, even in asymptomatic patients. However, there is an overall paucity of preclinical and clinical research on VLS. Although the disease is becoming more commonly recognized, it is often under- or misdiagnosed and its prevalence is likely underestimated. While the exact underlying etiology is still unknown, VLS is most likely an autoimmune disorder within the background of genetic predisposition and environmental triggers. The skin and gut microbiomes also appear to be involved. The first line treatment for VLS, ultrapotent topical corticosteroids, helps relieve symptoms and reduce the risk of architectural changes and vulvar cancer. The second-line medications and treatments with more limited evidence of efficacy include topical calcineurin inhibitors, topical hormones, platelet-rich plasma, and fractional CO₂ laser therapy. Surgical intervention may also be required. Additionally, some VLS patients and practitioners report improvements with diet and lifestyle changes, nutritional supplements, low-dose naltrexone, botanical medicines, and other integrative treatments, although clinical research on these integrative therapies for VLS is generally lacking. This review aims to describe VLS in adult women, summarize the recently published literature, and provide a clinical overview that includes evidence-based integrative therapies.