Topical corticosteroids Prescribed more for Vulvar lichen sclerosus Patients Without a History of VSCC Compared to Post-Surgery LS Patients: Study

Vulvar lichen sclerosus (LS) is a long-term skin condition that can advance to vulvar squamous cell carcinoma (VSCC) via differentiated vulvar intraepithelial neoplasia (dVIN). Symptoms of LS are managed with topical corticosteroids (TCS), which can also impede the progression to dVIN and VSCC. Nonetheless, existing global guidelines do not provide specific recommendations for treating LS following VSCC surgery.

Recent study aimed to evaluate the management of vulvar lichen sclerosus (LS) patients without a history of vulvar squamous cell carcinoma (VSCC) and those with LS following surgery for VSCC, particularly regarding the prescribing of topical corticosteroids (TCS) for these patient groups. The study conducted a survey among registered gynecologic oncologists in the Netherlands to assess the frequency, type, and duration of TCS treatment prescribed for these patient groups and the reasons for initiating TCS treatment.

The findings of the study demonstrate that Dutch gynecologic oncologists prescribed TCS more often to patients with LS without a history of VSCC compared to patients with LS following surgery for VSCC. Specifically, TCS were prescribed more frequently to LSnoVSCC patients (86%) compared to LSVSCC patients (52%). When TCS treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups.

The most common reasons for treating patients in both groups with TCS were symptoms, followed by clinical aspects of the lesion and prevention of progression to differentiated vulvar intraepithelial neoplasia (dVIN) and VSCC. The study highlighted that LS is a chronic skin condition with the potential to progress to VSCC through dVIN. LS symptoms are commonly treated with TCS, which can also prevent progression to dVIN and VSCC. The survey revealed that Dutch gynecologic oncologists prescribed TCS more frequently to LSnoVSCC patients than to LSVSCC patients, indicating a variation in TCS prescription practice between these patient groups.

Factors Influencing Prescription Behavior

The study provided insights into the different factors influencing the prescription behavior of gynecologic oncologists for LSnoVSCC and LSVSCC patients. The findings will contribute to the evolving understanding of the management of patients with LS, especially following VSCC, and could inform further prospective studies and potential integration of TCS use in (inter)national LS and vulvar cancer guidelines.

Conclusion

In conclusion, the study highlighted variations in TCS prescription patterns for LS patients without a history of VSCC compared to those with LS following surgery for VSCC among Dutch gynecologic oncologists. These findings underscore the evolving clinical practice and expert clinical opinions concerning the management of LS patients, indicating the need for further research and prospective studies to inform guidelines and enhance patient care.

Key Points

- The study aimed to evaluate the management of vulvar lichen sclerosus (LS) patients without a history of vulvar squamous cell carcinoma (VSCC) and those with LS following surgery for VSCC, particularly regarding the prescribing of topical corticosteroids (TCS) for these patient groups.

- Dutch gynecologic oncologists prescribed TCS more often to patients with LS without a history of VSCC compared to patients with LS following surgery for VSCC. TCS were prescribed more frequently to LS without VSCC patients (86%) compared to LSVSCC patients (52%).

- Ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups when TCS treatment was initiated.

- The most common reasons for treating patients in both groups with TCS were symptoms, followed by clinical aspects of the lesion and prevention of progression to differentiated vulvar intraepithelial neoplasia (dVIN) and VSCC.

- LS is a chronic skin condition with the potential to progress to VSCC through dVIN. TCS treatment is commonly used to manage LS symptoms and can also prevent progression to dVIN and VSCC.

- The study highlighted variations in TCS prescription patterns for LS patients without a history of VSCC compared to those with LS following surgery for VSCC among Dutch gynecologic oncologists. These findings underscore the need for further research and prospective studies to inform guidelines and enhance patient care, contributing to the evolving understanding of the management of patients with LS.

Reference –

Féline O. Voss, Karelina L. Groenewegen, Hester Vermaat, Maaike C.G. Bleeker & Marc van Beurden (2024) Prevalence of prescribing topical corticosteroids to patients with lichen sclerosus following surgery for vulvar cancer: a survey among gynaecologiconcologists in The Netherlands, Journal of Obstetrics and Gynaecology, 44:1, 2294330, DOI:10.1080/01443615.2023.2294330