Guideline sources The following summarized guidelines for the evaluation and management of vulvar lichen simplex chronicus are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2020) and the European Academy of Dermatology and Venereology (EADV 2017). 1 2 Guidelines 1. Diagnostic investigations Patch testing: refer patients with suspected contact allergy to a dermatologist for patch testing. B Laboratory tests: obtain serum ferritin in patients with suspected iron deficiency, such as vegetarians and patients donating blood. B 2. Diagnostic procedures Biopsy: Consider performing biopsy only in patients with uncertainty about the diagnosis of LSC. C Recognize that it may be difficult to distinguish LSC from psoriasis on histopathological grounds. B https://web.pathway.md/diseases/recTSNqWbd1Wk4AUR 1/2 6/29/23, 3:45 AM Vulvar lichen simplex chronicus Pathway 3. Medical management Topical corticosteroids: As per ACOG 2020 guidelines, offer medium-potency or high-potency topical corticosteroid ointment and oral antipruritic medication as needed in patients with vulvar LSC. B As per EADV 2017 guidelines, offer superpotent topical corticosteroids such as clobetasol propionate 0.05% ointment once or BID in patients with severe vulvar LSC. B 4. Nonpharmacologic interventions Vulvar care: As per ACOG 2020 guidelines, provide education on how to stop the "itch-scratch cycle," and information regarding vulvar care and hygiene in patients with vulvar LSC. B As per EADV 2017 guidelines: Advise using saline soaks, followed and later replaced by lubricants (unperfumed creams), to improve skin barrier function in patients with vulvar LSC. B Advise wearing silk fabric underwear to reduce the need for topical corticosteroids in patients with vulvar LSC. B 5. Therapeutic procedures Ultraviolet phototherapy: offer narrowband UV B phototherapy delivered by comb-like instrument in patients with vulvar LSC. B 6. Follow-up and surveillance Follow-up: Obtain follow-up in patients with: mild LSC: as clinically required severe LSC (when using potent topical corticosteroids): 4 weeks, then as required. B References 1. van der Meijden WI, Boffa MJ, Ter Harmsel WA et al. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2017 Jun;31 6 925 941. Open 2. No authors listed. Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin, Number 224. Obstet Gynecol. 2020 Jul;136 1 222 225. Open https://web.pathway.md/diseases/recTSNqWbd1Wk4AUR 2/2