Influence of treatment of erosive lichen planus of the vulva on its prognosis

Objective: To record the clinical features, symptomatic response to treatment, and resolution of clinical signs in a large cohort of women with erosive lichen planus of the vulva. Design: Descriptive, prospective cohort study with a mean follow-up of 72 months. Setting: The vulval clinics of a teaching and district general hospital in Oxfordshire, England. Patients: One hundred fourteen adult women with a definite clinical diagnosis of erosive lichen planus of the vulva. Interventions: Patients received topical corticosteroids with or without other topical preparations and systemic treatments as part of their normal care. Main Outcome Measures: Symptomatic response to individual treatments (good, partial, or poor), overall symptomatic response to treatment and with time (good, partial, no change, or worse), response of the vulval signs (total, partial, moderate, minor,, same, or worse), and the presence or absence of moderate or severe scarring. Results: The mean age at onset of vulval symptoms was 56.9 years. First-line therapy was an ultrapotent topical corticosteroid in 89 women (78%), of whom 63 (71%) were symptom free while receiving treatment. Overall and with time, 86 women (75%) improved with treatment, including 62 (54%) who were symptom free (good response) and 24 (21%) who had a partial response. Eighteen (16%) had no change and 10 (9%) were worse. Overall response of the vulval signs was recorded in 113 patients. Only 10 (9%) of these had complete resolution of clinical signs excepting scarring, with 57 (50%) showing resolution of erosions. Squamous cell carcinoma developed in 3 women (3%). Conclusions: Topical ultrapotent corticosteroid is an effective treatment for erosive lichen planus of the vulva, giving relief of symptoms in 71%. With time and treatment, three quarters of patients can expect overall improvement of symptoms and one half, healing of erosions.