Vulvar lichen sclerosus (VLS) treatment is evolving fast, with JAK inhibitors, CO2 laser therapy, and platelet-rich plasma (PRP) emerging as promising options for patients who don't respond to standard corticosteroid therapy. Clinical guidelines in Europe and the UK have already been updated to reflect these advances. Experts stress that earlier diagnosis and a multidisciplinary care approach are key to improving patient outcomes.
Vulvar lichen sclerosus (VLS), a chronic inflammatory skin condition affecting the anogenital region, has long been managed primarily with topical corticosteroids — but for patients with refractory disease, that's often not enough. Now, a wave of emerging therapies is giving clinicians new tools to work with, and European and British clinical guidelines have already been updated to reflect the shift.
Leading the charge are JAK inhibitors, particularly baricitinib and abrocitinib, which have shown promising results in clinical trials since 2020 for patients who've failed both first-line corticosteroids and second-line calcineurin inhibitors. Fractional CO2 vaginal laser therapy is also gaining traction, with evidence showing it can induce remission in corticosteroid-resistant flare-ups — and even prime patients to respond to maintenance corticosteroid therapy afterward. Regenerative approaches like platelet-rich plasma (PRP) and autologous fat grafting are also being explored, with leading vulvar pathology societies now recognizing PRP as a legitimate option for treatment-resistant cases.
Key Takeaways:
Why it matters: VLS significantly impacts genital self-image, sexual function, and overall quality of life. Underdiagnosis remains a major barrier, and expanding the treatment toolkit — alongside a multidisciplinary care model — could meaningfully improve outcomes for the many women living with this condition.
