Introduction
If you’ve spent time in lichen sclerosus (LS) support groups, you’ve probably noticed that people receive very different advice about treatment. Some healthcare providers recommend long-term steroid use, while others tell patients to stop once their symptoms improve. Some recommend avoiding certain activities, while others encourage patients to continue living normally. And then there are newer procedures, such as lasers and platelet-rich plasma (PRP), which are often marketed as alternatives to steroids.
With so much conflicting information, how do we know what the research actually supports?
In 2026, researchers published updated lichen sclerosus guidelines, building on the 2024 European recommendations and the earlier 2015 guidelines. These guidelines review available research and provide recommendations for treating LS, managing symptoms, and protecting skin health over time.
There are some interesting updates, particularly around skincare, lifestyle recommendations, and newer treatments. However, some of the most important recommendations haven’t changed at all. Let’s explore what the new guidelines say and what they mean for people living with LS.
Understanding the New Lichen Sclerosus Guidelines
The 2026 guidelines are called S3 guidelines, which means researchers used a structured process to review scientific evidence and reach agreement among experts. They also grade their recommendations according to how strongly a treatment should be recommended or avoided.
Here is what those recommendations mean:
| Recommendation | What it means |
|---|---|
| Strongly recommended ↑↑ | Experts strongly recommend this option based on the available evidence, benefits, risks, and expert agreement. |
| Suggested ↑ | Experts generally favor this option, but the best choice may depend on the person’s needs, preferences, and circumstances. |
| May be considered ⇔ | Experts cannot currently recommend for or against this option. Evidence may be limited, unreliable, or conflicting. |
| Suggested against ↓ | Experts generally suggest avoiding this option, although individual circumstances may affect the decision. |
| Strongly recommended against ↓↓ | Experts strongly recommend avoiding this option based on the available evidence, risks, benefits, and expert agreement. |
These recommendation levels can help you understand how strongly the guideline supports—or does not support—a treatment, but they are not rules about what you must choose. Your health history, treatment goals, preferences, access to care, and tolerance for risks and benefits all matter. If your healthcare provider recommends an option, especially one listed as “may be considered,” it is reasonable to ask what evidence supports it, what benefits and risks are known, what remains uncertain, and what other options are available. Being an informed patient does not mean making one particular choice; it means having the information you need to make that choice together with your healthcare provider. You can read the full 2026 lichen sclerosus guideline here.
High-Level Quick and Easy Overview of the Treatment Guidelines & Recommendations
Topical Treatments
Treatments applied directly to the affected skin.
| Treatment | Recommendation | What this means |
|---|---|---|
| Topical corticosteroids such as clobetasol or mometasone | Strongly recommended ↑↑ | The gold-standard treatment for vulvar LS. They reduce inflammation and help prevent long-term skin and structural changes. |
| Topical calcineurin inhibitors such as tacrolimus or pimecrolimus | Suggested ↑ | A second-choice or additional anti-inflammatory treatment when topical steroids cannot be used or are not providing enough control. |
| Topical retinoids | May be considered ⇔ | Evidence is limited. They are not a standard first-line treatment. |
| Topical hormones such as estrogen, progesterone, or testosterone | Strongly recommended against ↓↓ | These hormones are not recommended to treat LS itself. Vaginal estrogen may still be used to treat a separate condition, such as genitourinary syndrome of menopause (GSM). |
Systemic Treatments
Systemic treatments work throughout the body and may help selected patients who need more than topical therapy.
| Treatment | Recommendation | What this means |
|---|---|---|
| Acitretin | Suggested ↑ | An oral retinoid that may be considered when systemic treatment is needed. It requires specialist oversight and has important risks, including severe pregnancy-related risks. |
| Methotrexate | Suggested ↑ | An immune-modifying medication that may be considered for difficult-to-control LS. It requires ongoing medical monitoring. |
Other Treatments & Procedures
The guidelines also discuss procedures and other approaches. Many receive an open recommendation (⇔), meaning the evidence is not strong enough to recommend either for or against them.
| Treatment | Recommendation | What this means |
|---|---|---|
| Steroid injections | May be considered ⇔ | May be considered in selected adults with difficult-to-treat areas (e.g., thick plaques of skin not responding to first- or second-line topicals). This is not routine first-line treatment. |
| Platelet-rich plasma (PRP) | May be considered ⇔ | Evidence remains limited. An open recommendation does not mean PRP has been proven effective or is recommended for routine LS treatment. Evidence is not strong enough for a clear recommendation for or against it. |
| Laser therapy | May be considered ⇔ | Certain laser approaches may be considered in adults, but evidence and long-term outcomes remain uncertain. Evidence is not strong enough for a clear recommendation for or against it. |
| UV light therapy (phototherapy) | May be considered ⇔ | Uses controlled ultraviolet light. It is not a standard first-line treatment for vulvar LS. Evidence is not strong enough for a clear recommendation for or against it. |
| Photodynamic therapy | May be considered ⇔ | Uses a light-sensitive medication and a specific light source. Evidence is not strong enough for a clear recommendation for or against it. |
| Cryotherapy | Suggested against ↓ | Uses extreme cold to freeze tissue. The guidelines generally suggest against its use for vulvar LS. |
| Surgery for LS-related scarring | Suggested ↑ | May be appropriate when scarring causes ongoing functional problems despite adequate medical treatment. |
Putting These Recommendations Into Perspective
These treatments are not equal alternatives. Topical corticosteroids remain the strongly recommended first-line treatment for vulvar lichen sclerosus. Some other treatments may have a role in specific situations, while several newer procedures receive only an open recommendation (⇔) because the evidence remains limited or uncertain.
Let’s dive a little deeper into the new guidelines.
Topical Steroids Remain the Gold Standard for Lichen Sclerosus
One thing hasn’t changed between the 2015, 2024, and 2026 lichen sclerosus guidelines: potent and ultrapotent topical corticosteroids remain the first-line treatment for genital LS. These include medications such as clobetasol 0.05% ointment, which reduce inflammation, help prevent permanent changes to the skin, and reduce the risk of cancer.
This is important because LS is a chronic inflammatory condition. While itching, burning, and pain are common symptoms, ongoing inflammation can also cause scarring and changes to vulvar anatomy. For example, the labia minora may become smaller or fuse with surrounding tissue, and the clitoral hood may develop adhesions.
Appropriate steroid treatment helps control this inflammation, even when symptoms are mild or absent. The guidelines continue to support long-term treatment plans tailored to each person’s disease activity, rather than stopping medication simply because itching has improved.
Concerns about steroid safety are understandable, especially when patients hear warnings about skin thinning. However, appropriately prescribed and monitored topical corticosteroids have a strong record of safety and effectiveness in LS. Research also links consistent topical corticosteroid treatment with a lower risk of vulvar squamous cell carcinoma, the type of vulvar cancer associated with LS.
The goal of treatment isn’t simply to stop itching or pain (though, of course, this is a very important part of it). It’s also to control inflammation, protect vulvar anatomy, and maintain long-term skin health, while reducing the risk of vulvar cancer.
Moisturizers and Everyday Vulvar Care Get More Attention
The updated guidelines place greater emphasis on moisturizers and everyday skincare. While previous guidelines discussed gentle vulvar care, the 2026 lichen sclerosus guidelines provide clearer recommendations about emollients, which are moisturizing products that help protect the skin barrier.
For adult and pediatric vulvar LS, the guidelines strongly recommend using emollients alongside prescribed treatment. These products can reduce dryness, protect sensitive skin from friction, and improve comfort. However, they do not replace topical corticosteroids because they do not adequately treat the underlying inflammation; they are an adjunct or add-on to your main treatment plan.
The guidelines also recommend reducing unnecessary irritation from cleansing products, moisture, and friction. Here is a simple overview of the practical recommendations.
Everyday Skincare and Lifestyle Recommendations
| Recommended | Best to Avoid or Limit |
|---|---|
| Gentle vulvar cleansing | Excessive washing or scrubbing |
| Fragrance-free moisturizers | Perfumed skincare products |
| Comfortable clothing | Clothing that causes irritation or friction |
| Changing damp underwear or pads | Prolonged exposure to moisture |
| Simple, well-tolerated skincare | Wet wipes and irritating cleansing products |
| Protecting sensitive skin | Unnecessary herbal creams and topical products |
Does This Mean You Should Avoid Exercise or Sex?
Not necessarily, and I think this distinction matters.
The guidelines recommend reducing friction and irritation, but this does not mean everyone with LS needs to stop exercising, swimming, cycling, or having sex. If an activity causes discomfort or tearing, you may need to make temporary adjustments, particularly during a flare. However, once you get your LS under control, you may find that you can return to the activities you love.
I (Jaclyn) stopped all sexual activity for a full year because I was in too much pain, my tissues felt raw, and I wasn’t emotionally ready. Once clobetasol and daily moisturizer helped my tissues heal, I worked with a sex therapist and pelvic floor physical therapist, used dilators, and gradually returned to a healthy, active sex life.
I took the same approach with exercise. I modified activities while my LS was active, but today I do all the sports I enjoy. The key for me has been staying patient and gentle with my body, reducing unnecessary friction when possible—such as using a barrier ointment—and adjusting when my body needs extra care.
We need to be careful not to turn general skincare recommendations into unnecessary restrictions. Living with a chronic vulvar condition can already affect confidence, intimacy, and quality of life. The goal should be to help people participate in activities they enjoy while protecting their skin, not make them afraid of everyday movement.
Poor hygiene does not cause lichen sclerosus. Gentle skincare helps manage irritation, but washing more frequently will not treat LS.
What Has Changed With Laser Treatments and PRP?
This is arguably one of the most interesting updates in the 2026 lichen sclerosus guidelines.
Earlier European guidelines were cautious about laser treatments and platelet-rich plasma (PRP) because there was not enough high-quality evidence supporting their effectiveness. The 2026 guidelines now provide open recommendations for certain laser procedures and PRP in adults.
As a reminder, an open recommendation (⇔) means the guideline authors cannot currently recommend for or against a treatment. Limited or conflicting evidence may prevent researchers from showing that the benefits clearly outweigh the risks. In other words, “may be considered” does not mean “recommended” or “proven effective.” Instead, an open recommendation gives patients and healthcare providers room to discuss the option while considering individual circumstances and the uncertainty in the evidence.
What is PRP?
PRP involves taking a small amount of blood, separating the platelet-rich portion, and injecting it into the affected tissue. Researchers have studied whether growth factors released by platelets might help tissue repair. Laser treatments, meanwhile, use focused energy to affect the skin and potentially encourage tissue changes.
At first glance, the updated recommendations may sound like a major breakthrough. However, an open recommendation does not mean a treatment has been proven effective. It means experts cannot confidently recommend it for or against routine use based on the available evidence.
This distinction matters because studies have not established that laser treatments or PRP provide the same long-term protection against inflammation, scarring, or cancer as appropriately used topical corticosteroids. Some studies report symptom improvements, but improving symptoms does not always mean a treatment has controlled the underlying disease.
As a researcher and patient advocate, I think we need to share these findings carefully. People living with chronic vulvar pain understandably look for new treatment options, especially when conventional treatments haven’t provided enough relief. However, patients deserve to know whether a treatment has strong scientific evidence behind it or whether its benefits remain uncertain.
The 2024 ISSVD Practical Guide takes a more cautious approach to platelet-rich plasma (PRP), noting that studies have not shown meaningful benefits beyond placebo. Although the 2026 lichen sclerosus guidelines state that clinicians may consider PRP for selected adults, this does not mean researchers have proven that PRP effectively treats LS or prevents long-term complications. It’s also important to understand that the ISSVD Practical Guide provides detailed clinical guidance, while the 2026 guidelines use a formal system to grade treatment recommendations. Because these documents serve different purposes, differences in their wording do not necessarily mean the experts disagree about the evidence.
For now, laser treatments and PRP should not replace established first-line LS treatment. We still need larger, well-designed studies that examine long-term outcomes, including inflammation, scarring, cancer risk, and quality of life.
What If Topical Steroids Aren’t Working?
The updated guidelines also discuss additional medications for people whose LS is difficult to control. These include topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, which reduce inflammation without using steroids.
For more complex cases, specialists may consider systemic medications such as methotrexate or acitretin. Systemic medications work throughout the body rather than only where you apply them. Healthcare providers generally reserve these treatments for selected patients because they have more limited evidence and require additional monitoring due to side effects.
However, before moving to stronger or more complex treatments, the guidelines emphasize something I think is incredibly important: healthcare providers should reassess why a patient isn’t improving.
People with LS can also develop other conditions, including contact dermatitis, vulvar yeast, infections, lichen planus, menopause-related vulvar changes, or pelvic floor dysfunction. Other conditions may cause burning, itching, or pain even when treatment has controlled the LS inflammation.
For example, increasing steroid use may not resolve pain caused by tight pelvic floor muscles. Similarly, someone experiencing menopause-related dryness may benefit from vaginal estrogen, even though estrogen itself does not treat LS.
This is why I think we need to be cautious about labeling someone as having treatment-resistant LS. Before reaching that conclusion, clinicians should confirm that patients are applying the medication correctly, determine whether the diagnosis explains their symptoms, and check for other conditions that could contribute to the problem.
Persistent symptoms deserve investigation, not dismissal.
What About Hormone Creams?
The 2026 lichen sclerosus guidelines continue to recommend against using topical estrogen, progesterone, or testosterone specifically to treat LS.
However, this does not mean estrogen has no place in vulvar care. People experiencing genitourinary syndrome of menopause (GSM) may benefit from vaginal estrogen. GSM occurs when lower estrogen levels cause changes to vaginal and vulvar tissues, leading to dryness, irritation, and discomfort. Some people may also use topical estrogen, testosterone, or both as an adjunct to their LS treatment when their healthcare provider recommends it for another specific need.
Someone can have both LS and GSM, and treating both conditions may be necessary to improve their symptoms. The important distinction is that estrogen helps address hormone-related tissue changes, while topical corticosteroids treat LS inflammation.
What Do the New Lichen Sclerosus Guidelines Mean for Patients?
Overall, the 2026 guidelines reinforce much of what we’ve advocated for at LichenS Support Network for years. Effective LS care requires early diagnosis, appropriate anti-inflammatory treatment, ongoing follow-up, and attention to the patient’s quality of life.
The newer recommendations provide additional options for selected patients, but they also show where researchers still need more evidence. We have promising ideas and emerging treatments, but we need stronger evidence showing whether they actually improve long-term disease outcomes.
I also think it’s important to recognize that not every study measures what matters most to patients. Reducing itching is important, but what about preventing scarring, maintaining sexual function, reducing pain, and improving daily life? These outcomes deserve just as much attention when researchers evaluate new treatments.
If you’re unsure whether your current care follows the latest lichen sclerosus guidelines, ask your healthcare provider to assess how well your treatment controls your LS, review your treatment schedule, and check whether another condition could contribute to persistent symptoms. If they recommend a newer treatment, ask what research supports it and what benefits you can realistically expect.
The Bottom Line on the 2026 Lichen Sclerosus Guidelines
The updated guidelines bring helpful changes, particularly around skincare, additional treatment options, and the importance of reassessing symptoms that don’t improve. They also provide clearer guidance on newer procedures, although many of these treatments still lack strong evidence.
What hasn’t changed is the foundation of effective LS care. Potent and ultrapotent topical corticosteroids remain the most reliable, well-studied treatment for controlling genital lichen sclerosus. Gentle skincare can support comfort, while regular follow-up helps ensure the disease remains controlled over time.
There is room for excitement about future treatments, but we should also recognize the value of the therapies we already know work.
As research continues, our goal at LichenS Support Network is to help people with LS understand the science, ask informed questions, and make decisions alongside their healthcare providers.
Because better guidelines are important, but making sure people living with LS actually benefit from them is what matters most.
Disclaimer
This article reflects Jaclyn’s interpretation of the published evidence-based literature and clinical guidelines. It is current as of October 2026 and is intended for educational purposes, not individualized medical advice.
Sources
- Kirtschig G, et al. (2026). Evidence- and consensus-based guideline on lichen sclerosus. 2026 S3 Guideline
- Kirtschig G, et al. (2024). EuroGuiDerm guideline on lichen sclerosus: Introduction. 2024 Guideline, Part 1
- Kirtschig G, et al. (2024). EuroGuiDerm guideline on lichen sclerosus: Treatment. 2024 Guideline, Part 2
- Kirtschig G, et al. (2015). Evidence-based (S3) guideline on (anogenital) lichen sclerosus. 2015 S3 Guideline
- ISSVD (2024). Lichen Sclerosus: ISSVD Practical Guide to Diagnosis and Management.
