Scleroatrophic lichen in women: improvement of methods for an objective assessment of clinical manifestations and therapy

Background. The prevalence of scleroatrophic lichen and the lack of unified approaches to the diagnosis and treatment of this disease require the development of new approaches to both diagnosis and improvement of treatment methods for this nosology. Objective. Offering the methods for an objective assessment of the effectiveness of the treatment of vulvar lichen sclerosus (VLS) and evaluation of the stage-by-stage treatment of disease using these methods. The LS-S index was proposed for assessing the area of skin lesion, and LS-A index - for evaluating the activity of the skin process in VLS. The LS-S index was based on the assessment of the lesion area by subdivision of the vulva into zones, while the LS-A index includes the main clinical manifestations of VLS and their severity. The practical application of the indices against the background of a three-stage treatment of VLS was evaluated. Methods. The observation group consisted of 41 patients with vulvar lichen sclerosus aged 19 to 59 years. Using the LS-S index, the patients were classified as follows: 27 women had a lesion estimated at 9 points (there were no perianal lesions in this group); 11 patients had a lesion area of 5 points, and 3 patients - 7points An assessment was performed using the developed indices of vulvar lichen sclerosus, allowing to evaluate the activity of the skin process and its area. Evaluation was carried out before treatment, on the 14th, 30th, 90th and 120th days. The stages of treatment consisted in the sequential use of topical glucocorticosteroids, injections of autologous plasma, and fractional CO2 laser. Results. The use of indices for assessing the area and activity of the skin process after the stage-by-stage treatment showed the convenience and simplicity of their use and made it possible to objectify the data obtained as a result of treatment: after the three-stage treatment, 27 women had a lesion estimated at 5 points (there were no perianal lesions in this group); 11 patients had a lesion area of 2 points, and 3 patients had a lesion area of 4 points, which corresponded to a distinct positive dynamics, having a numerical expression. Administred therapy was not accompanied by significant adverse events. Conclusion. The use of the index of activity of the skin process and the index for assessing the area of skin lesion of the vulva region in VLS is a convenient and practical tool for an objective assessment of the dynamics of skin changes during therapy, which includes a three-stage approach with sequential use of topical corticosteroids, injections of autologous plasma, and fractional CO2 laser.

scleroatrophic lichen, scleroatrophic lichen index, autologous plasma, fractional CO2 laser, treatment of scleroatrophic lichen