Frequently asked questions about vulvar lichen sclerosus treatments
About corticosteroids
What is the best treatment for vulvar lichen sclerosus?
There is no single best treatment for all patients. Clobetasol propionate 0.05% is the first-line treatment according to the international BAD 2018 and EADV 2024 guidelines. For patients with an insufficient response or significant tissue damage, alternatives such as topical tacrolimus and regenerative medicine exist. The choice depends on the individual clinical situation and should be made with a specialist.
Is clobetasol used for life?
In most cases, yes — although the regimen changes over time. The induction phase is intensive (daily application for weeks). This is followed by a maintenance regimen with reduced frequency (once or twice a week). Discontinuing treatment usually leads to a relapse of symptoms.
Does clobetasol cause vulvar atrophy?
Prolonged use of potent corticosteroids can cause skin atrophy. In VLS, atrophy is already a consequence of the disease itself. With the correct regimen — appropriate dosage and progressive reduction — the risk of additional atrophy from treatment is manageable and lower than the risk of disease progression without treatment.
Can I use clobetasol during pregnancy?
Potent topical corticosteroids should be used with caution during pregnancy. Clobetasol is classified as category C in pregnancy. If you have VLS and are pregnant or planning a pregnancy, consult your specialist to assess the benefit-risk ratio in your specific case.
About regenerative medicine
What is the difference between PRP and the Liquenia® Treatment?
PRP alone provides platelet growth factors that stimulate cellular repair, but available evidence is limited and inconsistent for VLS. The Liquenia® Treatment uses nanofat and stromal vascular fraction (SVF), both obtained from the patient’s own adipose tissue. SVF adds mesenchymal stem cells with documented anti-inflammatory and immunomodulatory effects, and nanofat provides growth factors from the adipose tissue. The complete protocol has more published evidence for VLS than PRP alone.
How many regenerative medicine sessions are necessary?
In most patients, a single session of the Liquenia® Treatment is sufficient to achieve significant and sustained improvement. The need for additional sessions is evaluated during the 12-month follow-up.
About surgery
Does surgery cure lichen sclerosus?
No. Surgery treats the anatomical sequelae of VLS — labial fusion, narrowing of the introitus, clitoral phimosis — but it does not treat the disease itself. After surgery, medical treatment must continue to control the active disease and reduce the risk of scarring recurrence.
About complementary treatments
Are there natural treatments for vulvar lichen sclerosus?
Natural oils and products can complement pharmacological treatment — providing hydration and protection to sensitive vulvar skin — but they cannot replace it. VLS is an autoimmune disease that requires active pharmacological treatment for control. Delaying or replacing that treatment with natural products can lead to disease progression with irreversible sequelae.
Is tacrolimus safe in the long term?
Topical tacrolimus has an FDA warning regarding a possible increased risk of lymphoma with long-term use. This warning is controversial and is not supported by solid causal evidence. European guidelines (EADV) have a more permissive position. The decision to use it should be made with your specialist, assessing the individual clinical situation.