British Association of Dermatologists guidelines for the management of lichen sclerosus 2018 F.M. Lewis, F.M. Tatnall, S.S. Velangi, C. B. Bunker, A. Kumar, F. Brackenbury, M.F. Mohd Mustapa and L.S. Exton British Journal of Dermatology. DOI:10.1111/bjd.16241

Introduction What’s already known? The previous BAD guidelines for the management of lichen sclerosus (LS) were published in 2010 These recommended an ultra-potent topical steroid as first-line management

Methods Guidelines developed according to GRADE methodology Guideline Development Group included dermatologists, patient representatives and methodologists Literature search up to July 2017

Clinical questions to answer In people with LS: What are the clinical outcomes and cost effectiveness of therapies? What is the most appropriate treatment regimen? Is maintenance treatment required? What follow-up protocols are needed?

Results 270 papers evaluated 15 studies analysed in quantitative review 255 case series & reports listed

Recommendations Strong evidence – ‘Offer’ treatment to people with LS Weak evidence – ‘Consider’ treatment for people with LS Strong evidence against – ‘Do not offer’ treatment to people with LS

Recommendations 31 recommendations for treatment 9 recommendations for future research

Main recommendations All people with LS should be managed by healthcare professionals experienced in treating LS Offer initial treatment with 0.05 % clobetasol propionate ointment for 3 months to females with LS Individualise subsequent treatment to maintain control

Main recommendations Offer surgical intervention to males with LS who do not respond or have meatal involvement N.B. no strong evidence for any therapy in extragenital disease

Future research recommendations Does the disease remit? What is the role of newer treatments or combination treatments? Establishing a national database for extragenital disease as rare and little, if any, evidence for treatment

Discussion What does this study add? Confirms ultra-potent steroid as first-line treatment, now with RCT evidence Covers roles of primary and secondary care healthcare professionals Recommended pathways presented as algorithms

Discussion What does this study add? Findings were used to update BAD patient information leaflets (PILs)

Conclusions Up-to-date guidelines for management of all people with LS Future research recommendations

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