Article, 2024
EuroGuiderm guideline on lichen sclerosus—introduction into lichen sclerosus
Journal of the European Academy of Dermatology and Venereology,
ISSN
1468-3083,
0926-9959,
10.1111/jdv.20082
Contributors
Kirtschig, Gudula
(Corresponding author)
[1]
Kinberger, Maria
0000-0002-7673-9974
[2]
Kreuter, Alexander
0000-0003-2275-499X
[3]
Simpson, R.
[4]
Günthert, A
[5]
van Hees, C.
[6]
Becker, K.
[7]
Ramakers, M J
[8]
Corazza, Monica
0000-0003-2105-6217
[9]
Müller, S.
[10]
von Seitzberg, S.
[11]
Boffa, Michael John
[12]
Stein, R
[13]
Barbagli, G.
[14]
C., C.
[15]
[16]
Dauendorffer, Jean-Noël
[17]
Fischer, B
[18]
Gaskins, M.
[2]
Hiltunen-Back, Eija
[19]
Höfinger, A
[18]
Köllmann, N H
[18]
Kühn, H.
[20]
Larsen, Helle Kiellberg
0000-0001-8420-696X
[21]
Lazzeri, Massimo
0000-0002-4411-3715
[22]
Mendling, Werner
0000-0002-6845-9411
[23]
Nikkels, Arjen F
0000-0001-5240-4806
[24]
Promm, Martin
[25]
Rall, K K
[26]
Regauer, Sigrid
[27]
Sárdy, Miklós
0000-0003-4306-5093
[28]
Sepp, Norbert
[29]
Thune, Turid
[30]
Tsiogka, A.
[31]
Vassileva, Snejina G
0000-0003-1623-2482
[32]
Voswinkel, L.
[20]
Wölber, Linn Lena
[33]
Werner, R. N.
[2]
Affiliations
- [1]
Medbase
[NORA names:
Switzerland; Europe, Non-EU; OECD];
- [2]
Charité - University Medicine Berlin
[NORA names:
Germany; Europe, EU; OECD];
- [3]
Helios St. Elisabeth Klinik Oberhausen
[NORA names:
Germany; Europe, EU; OECD];
- [4]
University of Nottingham
[NORA names:
United Kingdom; Europe, Non-EU; OECD];
- [5]
Gynäkologisches Tumorzentrum St. Anna, Lucerne, Switzerland
[NORA names:
Switzerland; Europe, Non-EU; OECD];
(... more)
- [6]
Erasmus MC
[NORA names:
Netherlands; Europe, EU; OECD];
- [7]
Office for Paediatric Surgery, Bonn, Germany
[NORA names:
Germany; Europe, EU; OECD];
- [8]
CenSeRe (Centre for Psychological, Relational, Sexual Health), Voorschoten, The Netherlands
[NORA names:
Netherlands; Europe, EU; OECD];
- [9]
University of Ferrara
[NORA names:
Italy; Europe, EU; OECD];
- [10]
University Hospital of Basel
[NORA names:
Switzerland; Europe, Non-EU; OECD];
- [11]
The Danish Lichen Sclerosus Association, Hørve, Denmark
[NORA names:
Denmark; Europe, EU; Nordic; OECD];
- [12]
Mater Dei Hospital
[NORA names:
Malta; Europe, EU];
- [13]
University Medical Centre Mannheim
[NORA names:
Germany; Europe, EU; OECD];
- [14]
Centro Chirurgico Toscano, Arezzo, Italy
[NORA names:
Italy; Europe, EU; OECD];
- [15]
Chang Gung Memorial Hospital
[NORA names:
Taiwan; Asia, East];
- [16]
Chang Gung University
[NORA names:
Taiwan; Asia, East];
- [17]
Hôpital Saint-Louis
[NORA names:
France; Europe, EU; OECD];
- [18]
The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
[NORA names:
Switzerland; Europe, Non-EU; OECD];
- [19]
Helsinki University Hospital
[NORA names:
Finland; Europe, EU; Nordic; OECD];
- [20]
The German Lichen Sclerosus Association, Germany
[NORA names:
Germany; Europe, EU; OECD];
- [21]
Bispebjerg Hospital
[NORA names:
Capital Region of Denmark;
Hospital; Denmark; Europe, EU; Nordic; OECD];
- [22]
IRCCS Humanitas Research Hospital
[NORA names:
Italy; Europe, EU; OECD];
- [23]
Witten/Herdecke University
[NORA names:
Germany; Europe, EU; OECD];
- [24]
Centre Hospitalier Universitaire de Liège
[NORA names:
Belgium; Europe, EU; OECD];
- [25]
University Hospital Regensburg
[NORA names:
Germany; Europe, EU; OECD];
- [26]
Universitätsklinikum Tübingen
[NORA names:
Germany; Europe, EU; OECD];
- [27]
Medical University of Graz
[NORA names:
Austria; Europe, EU; OECD];
- [28]
Semmelweis University
[NORA names:
Hungary; Europe, EU; OECD];
- [29]
Department of Dermatology and Venereology, Ordensklinikum Linz Elisabethinen, Linz, Austria
[NORA names:
Austria; Europe, EU; OECD];
- [30]
Haukeland University Hospital
[NORA names:
Norway; Europe, Non-EU; Nordic; OECD];
- [31]
National and Kapodistrian University of Athens
[NORA names:
Greece; Europe, EU; OECD];
- [32]
Medical University of Sofia
[NORA names:
Bulgaria; Europe, EU];
- [33]
University Medical Center Hamburg-Eppendorf
[NORA names:
Germany; Europe, EU; OECD]
(less)
Abstract
INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness. It may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are redness and oedema, typically followed by whitening of the genital skin; sometimes fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early.
OBJECTIVES: The guideline intends to provide guidance on the diagnostic of LS, highlight important aspects in the care of LS patients (part 1), generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects.
MATERIALS AND METHODS: The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives.
RESULTS: Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases.
CONCLUSIONS: LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
Keywords
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words
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