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Children - OD for three months Maintenance treatment is then required once to twice a week, and more often for a flare - if a patient is using more than 30 g over a 6 month period then a review is needed Such a regime not only improves symptoms in the majority of patients, but also stops scarring Other treatments sometimes used include the topical calcineurin inhibitors - tacrolimus 0.1% ointment (Protopic ) and pimecrolimus cream (Elidel ) Long-term follow-up in Secondary Care is appropriate for patients with genital LS associated with troublesome symptoms, localised skin thickening (associated with a higher risk of malignant change), or VIN Stable disease Should be reviewed annually except in well-counselled patients who control their symptoms well If review is by the General Practitioner this should be communicated to the patient and GP by the clinic Written instruction should be given to the patient at the time of their discharge from the clinic warning them that any persistent area of well-defined erythema, bleeding/ulceration, or skin thickening/lump must be reported to their family practitioner straight away, who will then make an urgent referral back to an appropriate specialist, as such an occurrence could represent malignant transformation Other resources Patients The Lichen Sclerosus Guide Patient support group - Lichen Sclerosus Support Network Healthcare professionals British Association of Dermatologists Guidelines The British Society for the Study of Vulval Disease (BSSVD) The International Society for Vulvovaginal Disease (ISSVD) - A Practical Guide to the Diagnosis and Management of Lichen Sclerosus and a Best Practice Follow-up Guide Disclaimer - the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor

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