From the Journals

Most patients with lichen sclerosus receive appropriate treatment



Most clinicians are appropriately prescribing high-potency steroids for vulvar lichen sclerosus, but the recent analysis of a large commercial insurance database suggests that the condition may be underdiagnosed.

Steroids prescribed to lichen sclerosus patients by provider type

The claims-based prevalence of 0.05% found in the study is lower than previously reported, and only 16% of the diagnoses were in women aged 18-44 years, Laura E. Melnick, MD, and associates wrote after identifying 10,004 females aged 0-65 years with lichen sclerosus in the IBM MarketScan Commercial Claims and Encounters Databases from 2015 to 2017. The majority (79%) of those diagnosed were aged 45-65 years (average, 50.8 years).

In pediatric patients (up to age 17 years), the low prevalence (0.01%) “may be attributable to several factors including relative rarity, as well as variability in pediatric clinicians’ familiarity with [lichen sclerosus] and in patients’ clinical symptoms,” said Dr. Melnick and associates in the department of dermatology at New York University.

Just over half of all diagnoses (52.4%) were made by ob.gyns., with dermatologists next at 14.5%, followed by family physicians (6.5%), nurse practitioners (2.5%), and internists (0.4%), they reported in the International Journal of Women’s Dermatology.

Treatment for lichen sclerosus, in the form of high-potency topical corticosteroids, was mostly appropriate. Ob.gyns. prescribed class 1/2 steroids to 83% of their patients, tops among all clinicians. Dermatologists were just over 80%, and the other clinician categories were all over 70%, the investigators said.

“Understanding the current management of [lichen sclerosus] is important given that un- or undertreated disease can significantly impact patients’ quality of life, lead to increased lower urinary tract symptoms and irreversible architectural changes, and predispose women to squamous cell carcinoma,” they wrote.

SOURCE: Melnick LE et al. Int J Womens Dermatol. 2020. doi: 10.1016/j.ijwd.2020.05.001.

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