M. Wijaya1,2, G. Lee1, G. Fischer1,2,3, A. Lee1
Background: Evidence is increasing regarding the beneﬁt of long-term topical corticosteroids in reducing the risks of disease relapse, scarring progression and vulval neoplasia in vulval lichen sclerosus (VLS). Less is known about the quality of life (QoL) in patients undergoing the treatment regime.
Objective: To investigate the QoL in VLS patients treated with long-term, individualised topical corticosteroid treat- ment.
Methods: A cross-sectional study comparing new and long-term VLS patients attending a dermato-gynaecology practice in Sydney, Australia. Participants were invited to complete the Vulval Quality of Life Index (VQLI). VQLI scores were compared between the two groups.
Results: 204 biopsy-proven VLS patients, 68 new pre-treat- ment and 136 treated patients on topical corticosteroids for two years or longer. Treated participants scored lower in all VQLI components, including total score (median 2.0 [IQR 0.0–6.0] vs 13.5 [IQR 7.5–22.0]; p < .001), symptoms (median 0.5 [IQR 0.0–0.5] vs 1.3 [IQR 0.8–2.0]; p < .001), anxiety (median 0.0 [IQR 0.0–0.3] vs 0.8 [IQR 1.1–2.0]; p < .001), activities of daily living (median 0.2 [IQR 0.0–0.3] vs 0.5 [IQR 0.2–1.1]; p < .001), sexuality (median 0.0 [IQR 0.0–0.7] vs 1.0 [IQR 0.0–2.0]; p < .001). Mild and reversible side effects were developed in 11 (8.1%) patients. Partially compliant patients were twelve times as likely to develop scarring progression than fully compliant patients (7 [22.6%] vs 2 [1.9%]; p < .001). Conclusions: Long-term, individualised topical corticos- teroid treatment is safe and effective in maintaining dis- ease remission and improves the QoL of VLS patients. Fully compliant patients demonstrate better treatment out- comes than partially compliant patients.