1. 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: /bjd.16241

2. 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

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

4. 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?

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

6. 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

7. Recommendations 31 recommendations for treatment
9 recommendations for future research

8. 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

9. 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

10. 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

11. 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

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

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

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