Pediatric Vulvar Lichen Sclerosus: Is a One-Size-Fits-All Prolonged Induction Therapeutic Regimen Effective? A Referral Center Experience.

STUDY

OBJECTIVE

To evaluate the efficacy and safety of a prolonged 6-month induction regimen using ultrapotent topical corticosteroids and daily emollient in the treatment of pediatric vulvar lichen sclerosus (pVLS).

METHODS

This retrospective observational study included 94 girls with clinical diagnosis of pVLS between 2021 and 2025. All patients underwent a standardized treatment protocol with clobetasol propionate 0.05% ointment applied daily for 30 days, every other day for 30 days, and twice weekly for 120 days, alongside daily application of a vitamin E-based emollient. Clinical evaluations and symptom assessments were conducted at baseline (T0), 3 months (T1), and 6 months (T2).

RESULTS

Symptom remission was achieved in 83% of patients, with marked reductions in itching from 80% (T0) to 13% (T2), *P* < .001, and burning from 36% (T0) to 8% (T2), *P* < .001. Dysuria, dyschezia, and nocturnal awakenings resolved completely by the T1 follow-up. Significant improvements in clinical signs were observed in vulvar area. Improvements in perianal signs were more modest but statistically significant for fissures/erosions (P < .001) and hyperkeratosis/lichenification (P = .018). No significant changes were observed in anatomical alterations. Mild, self-limiting side effects were reported in 8% of patients at T1 and in only 1% at T2. No serious adverse events occurred.

CONCLUSION

A prolonged induction regimen with ultrapotent topical corticosteroids demonstrates high efficacy with a substantial symptom and sign resolution and favorable safety profile.