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Voss FO, Groenewegen KL, Vermaat H, Bleeker MCG, van Beurden M. Prevalence of prescribing topical corticosteroids to patients with lichen sclerosus following surgery for vulvar cancer: a survey among gynaecologic oncologists in The Netherlands. J OBSTET GYNAECOL 2024; 44:2294330. [PMID: 38156715 DOI: 10.1080/01443615.2023.2294330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcinoma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC). METHODS An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed. RESULTS Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p < 0.001). If treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups. The most reported reason for treating patients in both groups with TCS was symptoms, followed by clinical aspects of the lesion and prevention of progression to dVIN and VSCC. CONCLUSION The majority of GOs who participated in our study endorse the utilisation of long-term ultra-potent TCS therapy in both patients with LSnoVSCC and LSVSCC. Nevertheless, Dutch GOs are currently prescribing TCS more frequently to patients with LSnoVSCC than to patients with LSVSCC.
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Affiliation(s)
- Féline O Voss
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Karelina L Groenewegen
- Department of Gynaecology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Hester Vermaat
- Department of Dermatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Maaike C G Bleeker
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Marc van Beurden
- Department of Gynaecology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek hospital, Amsterdam, The Netherlands
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Meyer-Wilmes P, Wittenborn J, Kupec T, Caspers R, Stickeler E, Iborra S. Patient satisfaction and sexual issues in vulvar lichen sclerosus treatment: a monocentric certified dysplasia unit survey analysis. Arch Gynecol Obstet 2024; 310:507-513. [PMID: 38703281 PMCID: PMC11169031 DOI: 10.1007/s00404-024-07519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Vulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic. METHODS This survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions on general treatment, diagnostic delays, disease education, psychologic and sexual issues, and specific questions regarding the COVID-19 pandemic. The questionnaires were distributed between January 2021 and September 2023. RESULTS This study included 103 patients diagnosed with VLS, who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychologic problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient's perspective (3.83/5 before vs. 3.67/5 after; p = 0.046). There was a general request for booklets to inform and educate the patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation. CONCLUSION This study highlights the need for more effective treatments for VLS and an increased awareness of psychologic and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care with adequate disease education in a team of specialists from various disciplines.
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Affiliation(s)
- Philipp Meyer-Wilmes
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Julia Wittenborn
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Tomáš Kupec
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Rebecca Caspers
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Séverine Iborra
- Department of Gynecology and Obstetrics, Solingen Municipal Hospital gGmbH, Gotenstraße 1, 42653, Solingen, Germany
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Rees S, Arnold S, Kherlopian A, Fischer G. Attitudes Toward Proactive Topical Corticosteroid Use Among Women With Vulval Lichen Sclerosus. J Low Genit Tract Dis 2024; 28:183-188. [PMID: 38518216 DOI: 10.1097/lgt.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Some practitioners are adopting proactive topical corticosteroid (TCS) therapy for vulval lichen sclerosus (VLS). We sought to understand patient attitudes toward proactive TCS therapy for VLS in a context in which proactive therapy is adopted. METHODS Four online focus group discussions with 12 participants. Data analysis was informed by social constructionist grounded theory. RESULTS All participants had accepted a proactive regimen. Three themes were developed from the analysis: "Coming to accept proactive therapy," "Motivators to maintaining a proactive regimen," and "The importance of a routine that fits me." Within each theme are subthemes illustrating different dimensions of the theme. CONCLUSIONS Accepting proactive TCS therapy for VLS requires incorporating regular TCS use into a patient's identity, unlearning previous understandings regarding the safety of long-term TCS use, and adopting a regimen that fits within patients' lives and minimizes the loss of autonomy.
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Affiliation(s)
- Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Susanne Arnold
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Gayle Fischer
- Sydney Medical School, University of Sydney, Sydney, Australia
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Popa A, Dumitrascu MC, Petca A, Petca RC, Sandru F. Vulvar Lichen Sclerosus: Navigating Sex Hormone Dynamics and Pioneering Personalized Treatment Paradigm. J Pers Med 2024; 14:76. [PMID: 38248777 PMCID: PMC10817476 DOI: 10.3390/jpm14010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Vulvar lichen sclerosus (VLS) is a frequently overlooked inflammatory disorder affecting the skin and mucous membranes of the vulva. With a propensity for atrophy, severe scarring, functional impairment, and malignant evolution, VLS is a disease that recurs frequently; early diagnosis, rapid treatment, and ongoing patient follow-up are essential. Potent topical corticosteroids (TCSs) are now widely recognized as the most effective treatment for achieving remission in VLS, but considering the potential complications of long-term treatment with potent TCSs, understanding the evolution of VLS during puberty becomes particularly crucial in determining the necessity for aggressive or more conservative therapeutic interventions. Emerging treatments, including PRP (platelet-rich plasma), stem cell therapy, and energy-based lasers like fractional CO2 and Nd-YAG, are being investigated to identify more effective VLS treatments than ultrapotent topical corticosteroids. However, more research is needed to assess the efficacy and safety of these new medicines. Topical clobetasol 0.05% ointment daily for 4-12 weeks is the gold standard for treating VLS. This article is a narrative review of the English-language medical literature from 2017 to November 2023, following three main sections concerning VLS: studies of the evolution amid pubertal hormonal changes; studies of the outcomes of personalized conventional therapies; and studies addressing the spectrum of innovative modalities for VLS.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Debaene B, Vandeweege S, Verstraelen H. Vulvar lichen sclerosus in pregnancy: Unaddressed needs and systematic review. SKIN HEALTH AND DISEASE 2023; 3:e281. [PMID: 37799355 PMCID: PMC10549801 DOI: 10.1002/ski2.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/26/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
Women with vulvar lichen sclerosus (vLS) often express their concern over disease course, treatment, and complications relating to vLS in pregnancy and following childbirth. We used such patient concerns as study objectives in a systematic literature research. Although few, mostly low-quality studies have been published on that matter, and albeit the vast majority of women will have stable vLS during pregnancy, available data also suggest that in a small but significant proportion of patients, pregnancy and delivery may complicate the course of vLS and vice versa.
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Affiliation(s)
- Britt Debaene
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | | | - Hans Verstraelen
- Department of Obstetrics & GynaecologyGhent University HospitalGhentBelgium
- Department of Human Structure and RepairFaculty of Medicine and Health SciencesGhent UniversityGhentBelgium
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Wijaya M, Lee G, Fischer G. Why do some patients with vulval lichen sclerosus on long-term topical corticosteroid treatment experience ongoing poor quality of life? Australas J Dermatol 2022; 63:463-472. [PMID: 36208206 PMCID: PMC9828553 DOI: 10.1111/ajd.13926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/31/2022] [Accepted: 08/28/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify reasons for ongoing poor quality of life (pQOL) in a subset of long-term topical corticosteroid-treated vulval lichen sclerosus (VLS) patients. METHODS A prospective cross-sectional study of patients attending a dermato-gynaecology practice in Sydney, Australia, comparing VLS patients with good quality of life (gQOL) and pQOL, in pre-treatment and long-term treatment groups, using the Vulval Quality of Life Index (VQLI). Demographics, VQLI scores and treatment characteristics were compared between gQOL and pQOL patients. RESULTS A total of 255 biopsy-proven VLS patients, 67 in pre-treatment and 188 in long-term treated groups were considered. There were 33 (49.3%) pQOL patients in pre-treatment and 13 (6.9%) in treatment groups (p < 0.001). The highest-scoring domain in treated pQOL patients was sexuality (1.7 [interquartile range (IQR) 1.0-2.0]), followed by anxiety [1.3 (IQR 1.0-1.5]), symptoms (1.0 [IQR 0.5-1.5]) and activities of daily living (0.7 [IQR 0.3-1.0]). Compared to treated gQOL, treated pQOL had significantly higher proportions of patients with partial treatment adherence (8 [61.5%] vs 42 [24.0%], p = 0.006), suboptimal disease control (7 [53.8%] vs 20 [11.4%], p < 0.001), scarring progression (3 [23.1%] vs 7 [4.0%], p = 0.024) and urinary incontinence (5 [38.5%] vs 27 [15.4%], p = 0.049). CONCLUSIONS Only a minority of long-term treated VLS patients reported ongoing pQOL. Of those who did, sexuality and anxiety domains were found to be the main sources of distress. Three major areas distinguishing gQOL from pQOL patients were (1) treatment adherence and disease control, (2) psychological factors and (3) urinary incontinence.
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Affiliation(s)
- Marlene Wijaya
- Faculty of Medicine, Northern Clinical SchoolUniversity of SydneySt LeonardsNew South WalesAustralia,Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Geoffrey Lee
- Faculty of Medicine, Northern Clinical SchoolUniversity of SydneySt LeonardsNew South WalesAustralia,Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Gayle Fischer
- Faculty of Medicine, Northern Clinical SchoolUniversity of SydneySt LeonardsNew South WalesAustralia,Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia,North Shore Private HospitalSt LeonardsNew South WalesAustralia
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Yeon J, Oakley A, Olsson A, Drummond C, Veysey E, Marshman G, Saunders H, Opie J, Bradford J, Cole J, DeAmbrosis K, Cook K, Pepall L, Eva LJ, Sladden M, Selva-Nayagam P, Phillips R, Ball S, Hill S, Bohl T, Day T, Lee G, Fischer G. Vulval lichen sclerosus: An Australasian management consensus. Australas J Dermatol 2021; 62:292-299. [PMID: 34117779 DOI: 10.1111/ajd.13594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Vulval lichen sclerosus (VLS) is a chronic inflammatory skin condition predominantly affecting the anogenital region in women and children. To date, there is lack of agreement amongst experts on a severity scale to aid assessment, research and treatment stratification on VLS. Furthermore, literature on best practice for long-term management of VLS is lacking. The aim of this consensus is to provide broad guidelines on the short and long-term management of VLS. METHODS An initial focus group of Australasian experts in vulval dermatology developed a draft consensus statement for the management of VLS. Based on the results of the draft statement, a consensus panel of 22 Australasian experts, comprised of the initial and additional members, participated in an anonymous four-stage eDelphi process. Round 1 involved generation and voting on statements from the draft consensus statement developed by the focus group. In Rounds 2, 3 & 4, panel members were presented formal feedback from previous rounds and asked to indicate their level of agreement. Consensus was reached if there was ≥70% agreement on the importance of an item in the 4 (agree) to 5 (strongly agree) range. RESULTS The expert panel, with a total of 504 collective years of experience in the field of VLS, reached consensus on a core set of 51 management statements related to diagnosis, severity, initial and long-term management, follow-up, and complications of VLS. CONCLUSIONS This study has identified a set of management statements for VLS that may be useful in clinical practice in the Australasian population.
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Affiliation(s)
- Janice Yeon
- The Skin Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Oakley
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Ann Olsson
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Catherine Drummond
- Department of Dermatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Medical School, Australian National University, Canberra, New South Wales, Australia
| | - Emma Veysey
- Dermatology Department, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Marshman
- Flinders Medical Centre, Bedford Park, South Australia, Australia.,Flinders University Medical School, Adelaide, South Australia, Australia
| | - Helen Saunders
- The Royal Women's Hospital, Victoria and Dermatology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jacinta Opie
- Dermatogynaecology Clinic, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Dermatology, Austin Health Heidelberg, Heidelberg, Victoria, Australia
| | - Jennifer Bradford
- School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Judith Cole
- St John of God Dermatology, Subiaco, Western Australia, Australia
| | - Kate DeAmbrosis
- Mater Misericordiae Hospital, South Brisbane, Queensland, Australia
| | - Kathryn Cook
- Obstetrician and Gynecologist at Vulval Clinic, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Sexual Health Physician at Melbourne Sexual Health Clinic, Carlton, Victoria, Australia
| | - Linda Pepall
- Royal Street Dermatology, Yokine, Western Australian, Australia
| | - Lois Jane Eva
- Department of Gynaecological Oncology, National Women's Health at Auckland City Hospital, Auckland, New Zealand
| | - Michael Sladden
- Department of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Priya Selva-Nayagam
- Department of Dermatology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Roderic Phillips
- Department of Paediatrics, Monash University Melbourne, Clayton, Victoria, Australia
| | - Sally Ball
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sarah Hill
- Tristram clinic, Hamilton Lake, Hamilton, New Zealand
| | - Tanja Bohl
- Vulva Clinic, Jean Hailes Medical Centre, Clayton, Victoria, Australia
| | - Tania Day
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Geoffrey Lee
- Northern Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gayle Fischer
- Northern Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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