Stay informed. Stay hopeful. Better answers are coming!

Living with lichen sclerosus can sometimes feel as though the treatment conversation hasn’t changed very much over the years. For many of us, the advice has centered on one very important treatment: a high-potency topical corticosteroid such as clobetasol.

There is good reason for that. Potent topical steroids remain the first-line treatment for vulvar lichen sclerosus (VLS), and many women do extremely well with them. They can control inflammation and symptoms and, with appropriate long-term management, help protect against the scarring and structural changes LS can cause.

But not everyone responds as well as we would hope.

Some women continue to experience itching, burning, painful intercourse, tearing, frequent flares or progressive changes even when they are following their treatment plan. Others are left dealing with the effects of scarring that occurred before their LS was diagnosed or adequately controlled.

That is why a recent Medscape article, “What’s New in Vulvar Lichen Sclerosus Treatment?”, caught my attention.

I wanted to share what I learned because the article describes several areas of research that could eventually expand the treatment options available to people living with LS.

First, the treatment we already know works

One thing I don’t want anyone to take away from this research is that steroids have suddenly become outdated.

They haven’t.

High-potency topical corticosteroids remain the foundation of LS treatment. The newer therapies being investigated are particularly relevant to people whose disease remains active or troublesome despite appropriate conventional treatment.

That’s an important distinction because it can be tempting when we hear about a new treatment to assume it must be better than an older medication.

The evidence isn’t there yet.

What is encouraging is that researchers are looking beyond a one-size-fits-all approach.

JAK inhibitors: targeting inflammation differently

One of the developments that interested me most involves medications called JAK inhibitors.

JAK inhibitors work by interfering with particular signaling pathways involved in inflammation. Medscape discusses baricitinib and abrocitinib as examples being investigated in difficult-to-treat VLS.

Early results in patients who had not responded adequately to potent steroids or calcineurin-inhibitor creams have been promising.

That doesn’t mean JAK inhibitors are ready to replace clobetasol. They aren’t established first-line LS treatments, and systemic JAK inhibitors can have important risks and side effects that physicians have to consider carefully.

But from a patient’s perspective, I find the research encouraging for another reason.

Instead of simply asking, “How do we suppress the inflammation?” researchers are increasingly investigating the specific biological pathways involved in LS and whether those pathways can be targeted more precisely.

That could eventually matter greatly for people whose LS has been difficult to control.

Laser therapy: promising, but an area where patients should be careful

Another area receiving attention is fractional CO₂ laser therapy.

Research discussed by Medscape suggests that laser treatment may improve symptoms in some women with VLS that hasn’t responded adequately to conventional treatment. Interestingly, the article also discusses the possibility that some patients may respond better to steroid maintenance after laser treatment.

Rather than necessarily replacing steroids, laser might eventually prove useful as an adjunct for selected patients whose disease has been difficult to control.

But this is also an area where I think patients need to be cautious.

Laser treatments are already commercially available, and it is easy for the marketing of a treatment to get ahead of the science. There is a major difference between saying that a therapy is being studied and showing encouraging results and saying that it has been proven to be superior to established treatment.

For now, I would put laser in the “promising and worth watching” category rather than viewing it as a replacement for established LS therapy.

What I take away from this

For me, the encouraging part isn’t that we’ve suddenly found a replacement for steroids. We haven’t.

It’s that researchers are investigating different ways of treating LS, including therapies aimed at specific inflammatory pathways and options for patients whose disease remains difficult to control.

And there is another particularly interesting area of research: Can we do more than control inflammation? Could we someday help repair some of the tissue damage LS leaves behind?

That’s where PRP, fat grafting and other regenerative approaches enter the picture—and I’ll look at those in Part 2.

Stay informed. Stay hopeful. Better answers are coming!

This article is one patient’s discussion of published research and is intended for educational purposes. It isn’t medical advice and shouldn’t replace evaluation or treatment by a healthcare professional experienced in lichen sclerosus.