A multidisciplinary view of vulvar lichen sclerosus: a dermatologist and medical lawyer's opinion
DOI: 10.32364/2618-8430-2025-8-4-9
A.A. Khryanin1,2, M.V. Radchenko3,4
1Novosibirsk State Medical University, Novosibirsk, Russian Federation
2Regional Public Organization Association of Obstetricians, Gynecologists and Dermatovenerologists, Novosibirsk, Russian Federation
3South Ural State University, Chelyabinsk, Russian Federation
4South Ural State Medical University, Chelyabinsk, Russian Federation
The paper discusses several issues that arise in medical practice when determining approaches to treatment of patients with vulvar lichen sclerosus (VLS). Can an obstetrician gynecologist prescribe VLS treatment solely? Based on trust and natural shyness of women in the vast majority of cases, it is an obstetrician gynecologist who is the first and sometimes the only doctor asked for help by his/her patients. Therefore, the authors recommend that an obstetrician-gynecologist precisely should start to treat VLS with conventional symptomatic therapy. However, the clinician should keep in mind a patient's clinical model in each specific case. Therefore, differential diagnosis with other skin lesions must be performed beforehand considering a somatic pathology and a patient's medical history. A clinician may need to consult an interdisciplinary specialist. While an endocrinologist or an infectious disease specialist may not be consulted in all clinical cases, a VLS patient must be referred to a dermatovenerologist. The authors consider that the patient must be consulted by a dermatovenerologist (especially during differential diagnosis). Later, the patient is managed by her attending physician. Thus, to manage VLS patients properly, a doctor should develop his/her medical judgment and keep down his/her selfish intentions to manage the patient single-handedly without medical practitioners of different areas involved to consult and to adjust the prescribed treatment.
Keywords: vulvar lichen sclerosus, comorbidity, oncological alertness, differential diagnosis, clinical guidelines, treatment.
For citation: Khryanin A.A., Radchenko M.V. A multidisciplinary view of vulvar lichen sclerosus: a dermatologist and medical lawyer's opinion. Russian Journal of Woman and Child Health. 2025;8(4):338–345 (in Russ.). DOI: 10.32364/2618-8430-2025-8-4-9
ABOUT THE AUTHORS:
Alexey A. Khryanin — Dr. Sc. (Med.), Professor of the Department of Dermatovenerology and Cosmetology, Novosibirsk State Medical University; 52, Krasnyi ave., Novosibirsk, 630091, Russian Federation; President of Regional Public Organization Association of Obstetricians, Gynecologists and Dermatovenerologists; 55, Lenin str., Novosibirsk, 630004, Russian Federation; ORCID iD 0000-0001-9248-8303
Margarita V. Radchenko — C. Sc. (Law), Assistant Professor of the Department of Civil Law and Civil Proceedings, South Ural State University; 76, Lenin ave., Chelyabinsk, 454080, Russian Federation; Assistant Professor of the Department of Public Health and Healthcare, Institute of Continuing Professional Education, South Ural State University; 64, Vorovskyi str., Chelyabinsk, 454141, Russian Federation; ORCID iD 0009-0001-2711-0870
Contact information: Alexey A. Khryanin, e-mail: khryanin@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 10.07.2025.
Revised 04.08.2025.
Accepted 27.08.2025.
2. Funaro D. Lichen sclerosus: a review and practical approach. Dermatol Ther. 2004;17(1):28–37. DOI: 10.1111/j.1396-0296.2004.04004.x
3. Kirtschig G., Becker K., Günthert A. et al. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol. 2015;29(10):e1–43. DOI: 10.1111/jdv.13136
4. Доброхотова Ю.Э., Боровкова Е.И., Бурденко М.В. и др. Склероатрофический лихен: этиология, клиника, лечение. Вопросы гинекологии, акушерства и перинатологии. 2023;2(2):109–114. DOI: 10.20953/1726-1678-2023-2-109-114Dobrokhotova Yu.E., Borovkova E.I., Burdenko M.V. et al. Scleroatrophic lichen: etiology, clinical presentation, and treatment. Gynecology, Obstetrics and Perinatology. 2023;22(2):109–114 (in Russ.). DOI: 10.20953/1726-1678-2023-2-109-114
5. Аполихина И.А., Плахова К.И., Соколова А.В., Чернуха Л.В. Склерозирующий лихен вульвы. Акушерство и гинекология. 2020;S9:8–13.Apolikhina I.A., Plakhova K.I., Sokolova A.V., Chernukha L.V. Sclerosing lichen of the vulva. Akusherstvo I Ginekologiya. 2020;S9:8–13 (in Russ.).
6. Хрянин А.А., Соколовская А.В., Бочарова В.К. Склероатрофический лихен: современные представления и гипотезы. Гинекология. 2022;24(3):212–218. DOI: 10.26442/20795696.2022.3.201694Khryanin A.A., Sokolovskaya A.V., Bocharova V.K. Scleroatrophic lichen: modern concepts and hypotheses. Gynecology. 2022;24(3):212–218 (in Russ.). DOI: 10.26442/20795696.2022.3.201694
7. Игнатовский А.В., Смирнова И.О., Петунова Я.Г. и др. Склерозирующий и атрофический лихен гениталий — современный взгляд на патогенез и провоцирующие факторы. Клиническая дерматология и венерология. 2023;22(1):7–13. DOI: 10.17116/klinderma2023220117Ignatovskii A.V., Smirnova I.O., Petunova Ya.G. et al. Genital lichen sclerosus et atrophicus: a current view on the pathogenesis and triggers. Russian Journal of Clinical Dermatology and Venereology. 2023;22(1):7–13 (in Russ.). DOI: 10.17116/klinderma2023220117
8. Krapf J.M., Mitchell L., Holton M.A., Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020;12:11–20. DOI: 10.2147/IJWH.S191200
9. Virgili A., Borghi A., Toni G. et al. Prospective clinical and epidemiologic study of vulvar lichen sclerosus: analysis of prevalence and severity of clinical features, together with historical and demographic associations. Dermatology. 2014;228(2):145–151. DOI: 10.1159/000356163
10. Чернова Н.И., Багаева М.И., Стовбун С.В. и др. Современные возможности повышения эффективности терапии склеротического лишая вульвы. Клиническая дерматология и венерология. 2016;15(4):55–58. DOI: 10.17116/klinderma201615455-58Chernova N.I., Bagaeva M.I., Stovbun S.V. et al. Current potential of improving the effectiveness of treatment of vulvar lichen sclerosus. Clinical Dermatology and Venereology. 2016;15(4):55–58 (in Russ.). DOI: 10.17116/klinderma201615455-58
11. Хрянин А.А., Соколовская А.В., Маркарьян Д.Р. и др. Заболевания кожи промежности и перианальной области. М.: ГЭОТАР-Медиа; 2022.Khryanin A.A., Sokolovskaya A.V., Markaryan D.R. et al. Diseases of the skin of the perineum and perianal area. M.: GEOTAR-Media; 2022 (in Russ.).
12. Bornstein J., Goldstein A.T., Stockdale C.K. et al. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Obstetrics and Gynecology. 2016;127:745–751. DOI: 10.1097/AOG.0000000000001359
13. Bornstein J., Sideri M., Tatti S. et al. 2011 terminology of the vulva of the International Federation for Cervical Pathology and Colposcopy. J Low Genit Tract Dis. 2012;16(3):290–295. DOI: 10.1097/LGT.0b013e31825934c7
14. Жарикова П.С., Плахова К.И. Патогенез генитального склероатрофического лихена: потенциальные генетические и иммунные маркеры развития. Вопросы гинекологии, акушерства и перинатологии. 2022;21(1):95–100. DOI: 10.20953/ 1726-1678-2022-1-95-100Zharikova P.S., Plakhova K.I. Pathogenesis of vulvar lichen sclerosus: potential genetic and immune markers of development. Gynecology, Obstetrics and Perinatology. 2022;21(1):95–100 (in Russ.). DOI: 10.20953/ 1726-1678-2022-1-95-100
15. Жаров А.В., Новикова Е.Г., Рерберг А.Г., Колесникова Е.В. Инновационные подходы к лечению больных с местными рецидивами рака вульвы на фоне склеротического лишая. Опухоли женской репродуктивной системы. 2022;18(4):59–68. DOI: 10.17650/1994-4098-2022-18-4-59-68Zharov A.V., Novikova E.G., Rerberg A.G., Kolesnikova E.V. Innovative approaches to the treatment of local recurrent vulvar cancer in patients with lichen sclerosus. Tumors of female reproductive system. 2022;18(4):59–68 (in Russ.). DOI: 10.17650/1994-4098-2022-18-4-59-68
16. Sheinis M., Green N., Vieira-Baptista P. et al. Adult Vulvar Lichen Sclerosus: Can Experts Agree on the Assessment of Disease Severity? J Low Genit Tract Dis. 2020;24(3):295–298. DOI: 10.1097/LGT.0000000000000534
17. Saunders N.A., Welch K.C., Haefner H.K. et al. Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment. J Low Genit Tract Dis. 2024;28(1):73–75. DOI: 10.1097/LGT.0000000000000776
18. Edwards S.K., Bates C.M., Lewis F. et al. 2014 UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015;26(9):611–624. DOI: 10.1177/0956462414554271
19. Lewis F.M., Tatnall F.M., Velangi S.S. et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018;178(4):839–853. DOI: 10.1111/bjd.16241
20. Bleeker M.C., Visser P.J,. Overbeek L.I. et al. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiol Biomarkers Prev. 2016;25(8):1224–1230. DOI: 10.1158/1055-9965.EPI-16-0019
21. Зароченцева Н.В., Джиджихия Л.К. Интраэпителиальная неоплазия вульвы: современный взгляд на проблему. Российский вестник акушера-гинеколога. 2020;20(1):44–53. DOI: 10.17116/rosakush20202001144Zarochentseva N.V., Dzhidzhikhiya L.K. Vulvar intraepithelial neoplasia: current approach to the problem. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(1):44–53 (in Russ.). DOI: 10.17116/rosakush20202001144
22. Мухин А.А., Жаров А.В., Чернова Л.Ф. и др. Хирургическое лечение больных раком вульвы. Вопросы онкологии. 2018;64(2):190–195. DOI: 10.37469/0507-3758-2018-64-2-190-195Mukhin A.A., Zharov A.V., Chernova L.F. et al. Surgical treatment of patients with vulvar cancer. Issues in Oncology. 2018;64(2):190–195 (in Russ.). DOI: 10.37469/0507-3758-2018-64-2-190-195
23. Пахарукова М.И., Юшков Б.Г. Сравнительный анализ эффективности цитологического метода исследования в диагностике плоскоклеточной карциномы вульвы и шейки матки. Новости клинической цитологии России. 2024;28(3):05–09. DOI: 10.24412/1562-4943-2024-3-0001Pakharukova M.I., Yushkov B.G. Comparative analysis of the effectiveness of the cytological research method in the diagnosis of squamous cell carcinoma of the vulva and cervix. Russian News of Clinical Cytology. 2024;28(3):05–09 (in Russ.). DOI: 10.24412/1562-4943-2024-3-0001
This work is licensed under a Creative Commons «Attribution» 4.0 License.
