What are the recommended first-line treatments for managing vulval lichen sclerosus in adult women?

First-line treatment for managing vulval lichen sclerosus in adult women is the use of very potent topical corticosteroid ointments. These are usually initiated by a specialist in secondary care once the diagnosis is confirmed. The treatment typically involves repeated, intermittent courses of these potent corticosteroids for longer-term management to reduce inflammation and control symptoms.

Ointments are preferred over creams because they contain fewer preservatives that may cause secondary contact allergy and have less water content, reducing stinging on application.

Emollients should be offered alongside corticosteroids to help restore the skin barrier and provide symptomatic relief.

Referral to secondary care is recommended to confirm diagnosis and initiate treatment.