BSV09 The efficacy of systemic therapy for lichen sclerosis: a retrospective cohort study within a specialist dermatology service

Abstract

Lichen sclerosus (LS) is a chronic inflammatory condition affecting anogenital skin, with a prevalence of up to 3% in postmenopausal patients. It is associated with significant symptom burden, impaired quality of life and diagnostic delay. The BAD recommends ultrapotent topical corticosteroids as first-line therapy, but around 12% of patients experience persistent disease despite appropriate topical treatment. In these cases, off-label systemic therapies may be used, although evidence remains limited. The aim of this study was to conduct a retrospective observational cohort study within a specialist dermatology service to determine the number of patients with LS seen over 2 years, the proportion requiring systemic treatment, and clinical outcomes. Secondary dermatology care clinic records were reviewed to identify patients with LS from 1 January 2024 to 31 December 2025. Data were collected on the number of cases, those prescribed systemic therapy, and – among patients treated with systemics – the agent used, the duration of treatment, clinical and symptomatic response, adverse effects, and presence of coexisting vulvodynia, incontinence or vulval intraepithelial neoplasia (VIN). In total 570 patients with LS were identified, of whom 25 (4.4%) received systemic therapy. Ages ranged from 32 to 90 years. Vulvodynia, urinary incontinence and VIN were present in 48%, 64% and 8%, respectively. Systemic agents included acitretin (52%), methotrexate (28%), mycophenolate (16%) and ciclosporin (4%). The mean interval from diagnosis to systemic initiation was 7 years. Symptomatic improvement occurred in 77% of patients and clinical improvement in 80%, with an average time to response of 12 months. Remission was documented in 25%, while 44% discontinued treatment due to adverse effects. Only 4.4% of patients with LS required systemic therapy, but 80% showed clinical benefit. These findings support BAD guidance that systemic agents may be useful in selected refractory cases. Further controlled studies are needed to define optimal systemic strategies for different LS phenotypes.