Presenting Author:

Aleksandra Florek, M.D.

Principal Investigator:

Bethanee Schlosser, M.D.

Department:

Dermatology

Keywords:

Quality of Life, Vulvar Lichen Sclerosus, Vulvar Lichen Planus, Vulvodynia, Skindex-29

Location:

Ryan Family Atrium, Robert H. Lurie Medical Research Center

C19 - Clinical Women's Health Research

Quality of Life: Vulvar Lichen Sclerosus, Lichen Planus, and Vulvodynia

The vulvar-specific Skindex-29 (vsSK-29), a patient self-administered instrument, has been validated for quality of life measurement in vulvodynia. However, its utility has not been reported for other vulvar diseases. The vsSK-29 was administered to patients with vulvar lichen planus (LP), vulvar lichen sclerosus (LS), and vulvodynia (V) who were seen in a vulvar mucosal specialty dermatology clinic in a large urban center over a 1.5-year follow-up period. Patients diagnosed with 2 or more of these conditions or vulvar squamous cell carcinoma (ICD 184.4) were excluded. ANOVA and Bonferroni-corrected post-hoc pairwise t-testing were used for analysis. Between 2010 and 2014, 22 LP (ICD9 697.0), 105 LS (ICD9 701.0), and 45 V (ICD9 625.7, 625.9) met study entry criteria at initial visit. As reported previously from our data, V was associated with poorer functional QoL scores compared to LS and LP (p = 0.0005). Mean function domain scores for LP, LS, and V were 29.0, 27.0, and 41.9, respectively. For LP, LS, and V, mean symptom domain scores were 50.0, 42,7, and 46.8, respectively, and mean emotion domain scores were 42.2, 42.7, and 50.6, respectively, with no significant differences. At 15 months, LP (p = 0.053), LS (p< 0.0001), and V (p = 0.0009) function scores improved to 25.0, 14.7, and 16.3, respectively. Symptom scores for LP (p = 0.008), LS (p< 0.0001), and V (not significant) improved to 32.1, 26.8, and 34.3, respectively. Emotion scores for LP (p=0.006), LS (p< 0.0001), and V (p = 0.002) improved to 20.0, 24.4, and 26.8, respectively. Only VLS was adequately sized to evaluate impact of adherence to therapy on QoL, which was done at 3 and 6 months. Overall, 80.0% of VLS patients were adherent to therapy at 3 or 6 months. At these time points, QoL scores did not correlate with patient-reported adherence to therapy. Although baseline visits had the largest number of adjustments in either steroid frequency of application or potency, at 60, for the 64 combined LS and LP patients that followed-up at 3 months, 42 adjustments occurred at 9 months for the 31 combined LS and LP patients that had follow-up data at 1 year. Complication rates in all patients over the entire follow-up period for steroid rosacea, steroid atrophy, allergic contact dermatitis, and irritant contact dermatitis were 6.5%, 4.1%, 1.0%, and 0.7%. In patients with the selected vulvar dermatologic conditions, proper treatment can significantly improve quality of life with low risk of complications. Close follow-up is needed to monitor disease activity and adjust medication regimens accordingly.