Borghi Alessandro, Corazza Monica
Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy.
Curr Pharm Biotechnol. 2021;22(1):99-114. doi: 10.2174/1389201021666200516154310.
Vulvar Lichen Sclerosus (VLS) is a chronic inflammatory disease with a huge impact on a person's quality of life. A correct therapy is required for relieving symptoms, reversing signs and preventing further anatomical changes.
The main objective of the present paper is to provide suggestions for the best treatment approach, based on the available evidence. Treatment strategies are divided on the basis of the treatment phase, distinguishing options for initial, acute or attack treatment and those for long-term, maintenance treatment.
An electronic search was performed using the National Library of Medicine PubMed database. All the studies evaluating treatment of vulvar lichen sclerosus published in the English literature were analyzed, including controlled studies, case series, guidelines and reviews.
Current evidence identifies ultra-potent and potent corticosteroids, administered for 12 weeks, as the first-line recommended treatment for active VLS. Topical calcineurin inhibitors, tacrolimus and pimecrolimus, are effective and safe alternatives. Long-term maintenance strategies aimed at preventing recurrences are required, after the initial treatment phase. Maintenance treatment mostly consists in topical corticosteroids, administered i) on an "as needed" basis ("reactive" scheme), ii) on a continuative regimen, iii) on a low-dose, intermittent regimen ("proactive" scheme). Further investigations are needed for better defining the placement of other options within the VLS therapeutic algorithm, including retinoids, physical and systemic treatments.
The available evidence provides useful indications for the management of VLS. Both the identification of new therapeutic targets and the optimization of the available options represent the main objectives of future research.
外阴硬化性苔藓（VLS）是一种对患者生活质量有巨大影响的慢性炎症性疾病。需要采取正确的治疗方法来缓解症状、逆转体征并防止进一步的解剖学改变。
本文的主要目的是根据现有证据为最佳治疗方法提供建议。治疗策略根据治疗阶段进行划分，区分初始、急性或发作期治疗的选择以及长期维持治疗的选择。
使用美国国立医学图书馆的PubMed数据库进行电子检索。分析了英文文献中所有评估外阴硬化性苔藓治疗的研究，包括对照研究、病例系列、指南和综述。
目前的证据表明，超高效和高效皮质类固醇连续使用12周是活动性VLS的一线推荐治疗方法。局部钙调神经磷酸酶抑制剂他克莫司和吡美莫司是有效且安全的替代药物。在初始治疗阶段之后，需要采取旨在预防复发的长期维持策略。维持治疗主要包括局部皮质类固醇，给药方式如下：i）按需给药（“反应性”方案），ii）持续给药方案，iii）低剂量间歇给药方案（“预防性”方案）。需要进一步研究以更好地确定其他治疗方法在VLS治疗方案中的位置，包括维甲酸、物理治疗和全身治疗。
现有证据为VLS的管理提供了有用的指导。确定新的治疗靶点和优化现有治疗方法都是未来研究的主要目标。
