If you’ve spent time in patient communities lately, you’ve probably noticed more conversations about newer treatments, especially biologics and other targeted therapies. Many people are asking whether options exist beyond steroids, whether these newer medications might work better, and whether they could eventually offer safer or more personalized approaches for vulvar lichen sclerosus (VLS).
These are thoughtful and important questions. As targeted treatments become available for other inflammatory diseases, it is natural for people living with VLS to wonder whether similar advances might apply here. To understand where things stand, it helps to explore what targeted therapies are, how they work, and how they compare to our current standard of care.
Disclaimers
*This post comes from a review of evidence-based literature on vulvar lichen sclerosus. Importantly, it is Jaclyn’s interpretation of the literature and its findings. It is up to date as of February 2026.
**If this post is helpful to you, we’d love your support so we can continue providing important education like this. Donate today, volunteer with us, or share our posts in your support groups.
What Are Targeted Therapies?
Targeted therapies are medications designed to act on specific parts of the immune system rather than suppressing inflammation broadly.
Older anti-inflammatory treatments often worked like turning down the main power switch in a building to stop one noisy machine, effective, but not selective. Targeted therapies, by contrast, are more like flipping off only the switch connected to that one machine while leaving the rest of the building functioning normally.
This approach is sometimes called precision medicine. Instead of affecting the entire immune system, these therapies focus on particular molecules or pathways known to drive inflammation.
Two major categories of targeted therapies often discussed in dermatology and autoimmune medicine are:
- Biologics
- Small-molecule inhibitors, such as JAK inhibitors
Biologics: Precision Treatments Made from Living Systems
Biologics are medications made from living systems rather than chemically manufactured compounds. Most are monoclonal antibodies or similar proteins created using biotechnology. They are designed to bind to specific immune signals and block them.
A helpful way to think about biologics is that traditional medications are mixed in a lab like chemical recipes, while biologics are more like highly trained specialists created to perform one specific job.
For many years, inflammatory diseases were treated by calming the immune system broadly. As researchers learned more about immune pathways, they began identifying the exact signals driving specific diseases. This led to biologics, medications that block one precise part of the immune response instead of turning down the entire system.
Instead of throwing a blanket over an entire fire, biologics aim to spray water directly onto the spark causing it.
Biologics are now widely used for conditions such as psoriasis, atopic dermatitis, rheumatoid arthritis, inflammatory bowel disease, and other immune-mediated diseases.
Systemic biologics are given by injection or infusion and work throughout the body. Some people may hear about medications such as dupilumab. In VLS, systemic biologics currently have only anecdotal evidence and are used rarely, typically in severe or complex cases under specialist care.
JAK Inhibitors and Other Small-Molecule Targeted Therapies
You may have heard about JAK inhibitors, especially if you attended our 2025 Holistic Healing Summit, where Dr. Melissa Mauskar delivered an exceptional talk on the future of VLS treatments. JAK inhibitors are another form of targeted therapy often discussed alongside biologics, but they are scientifically distinct.
Unlike biologics, which are large protein-based medications, JAK inhibitors are small-molecule drugs that work inside cells.
They block signaling pathways used by inflammatory cytokines (small immune messengers that tell the body to increase inflammation). When those signals cannot reach the cell’s control center, inflammatory activity decreases.
In simple terms, in VLS, cytokines are messages telling the immune system to activate. JAK proteins act like internal wiring that delivers that message. JAK inhibitors interrupt that wiring so the message never reaches its destination.
Another way to picture this is as a fire alarm system. Cytokines are like smoke alarms going off. JAK proteins are the wires carrying the alarm signal. JAK inhibitors cut the wires so the alarm does not keep triggering an emergency response when there is no real fire.
But Wait…That’s a Good Thing?
Believe it or not, yes, it is a good thing. This is because in VLS, there is chronic, overactive immune signaling driving inflammation. The immune system is reacting more than it should, and that ongoing inflammation from overactive immune signaling can lead to tissue changes and scarring. The goal of treatment for VLS is to calm or regulate that overactivity; this results in a significant reduction of inflammation. Less inflammation, fewer symptoms, less tissues changes, slowed/halted progression!
Some JAK inhibitors are already approved for other inflammatory diseases, including rheumatoid arthritis and atopic dermatitis. In VLS, topical JAK inhibitors are currently being investigated to determine whether they are safe and effective and whether they could one day serve as alternatives or adjuncts to corticosteroids.
Are Targeted Therapies Approved for VLS?
At this time, targeted therapies such as biologics and JAK inhibitors are not approved as routine treatment for vulvar lichen sclerosus.
We do not yet have large, high-quality clinical trials proving that these medications are safe and effective for VLS. Most available evidence comes from small case series or individual reports, often involving people with steroid-resistant disease.
This does not mean these therapies will never become options. Research is actively ongoing, and properly designed clinical trials are the critical step in determining whether a medication truly works and is safe for long-term use. There is genuine scientific interest and momentum in this area, and it is reasonable to feel hopeful about future possibilities. With good clinical trials, we could see more targeted therapies becoming available to our community.
But Wait…My Friend Got a JAK Inhibitor Cream Prescribed to Her: How is This Possible
I (Jaclyn) definitely know folks who use a topical JAK inhibitor to treat their VLS. While these medications are not officially approved for vulvar lichen sclerosus at this time, they may be prescribed off-label by vulvar dermatologists or specialists when first- and second-line treatment options have failed.
“Off-label” simply means a medication is being used for a condition other than the one it was formally approved for. This is legal and common in medicine, especially when specialists are managing complex or treatment-resistant cases.
That said, when a medication is prescribed off-label, clear communication between the healthcare provider and patient is essential. Patients should be informed that the therapy is still under investigation for VLS, that large clinical trials are not yet available, and that long-term safety and effectiveness data specific to VLS may be limited.
It is also important that these treatments are prescribed and monitored by an experienced clinician. Follow-up appointments, symptom tracking, and careful observation for side effects are key parts of responsible use. Off-label does not mean unsafe, but it does mean that thoughtful discussion, shared decision-making, and ongoing monitoring matter even more.
How Do Targeted Therapies Compare to Steroids Right Now?
Even though targeted therapies sound more advanced, precision does not automatically mean better.
At present, high-potency topical corticosteroids (most commonly clobetasol 0.05% ointment) remain the first-line, evidence-based treatment for VLS.
When used correctly, they:
- Reduce inflammation
- Relieve itching, burning, and pain
- Prevent scarring and structural changes
- Help maintain long-term disease control
- Reduce the risk of vulvar cancer
To date, corticosteroids are the only treatment shown to reduce vulvar cancer risk in VLS.
Clinical studies consistently show strong effectiveness. Approximately 66% of patients achieve complete remission with clobetasol, while around 30% experience partial improvement, totaling roughly 96% overall response. Another prospective study reported 77% complete symptomatic remission and 47% clinical improvement.
Concerns about skin thinning are understandable. However, research demonstrates that when corticosteroids are used as directed and monitored by an experienced clinician, long-term use is both safe and effective.
Calcineurin inhibitors such as tacrolimus and pimecrolimus may be used as second-line or adjunct treatments, but their long-term evidence base is not as strong, and they have not been shown to reduce vulvar cancer risk.
For now, steroids remain the most reliable and well-studied option for controlling VLS.
To truly determine whether a targeted therapy like a JAK inhibitor could replace or outperform steroids, we would need rigorous head-to-head clinical trials comparing them directly.
Why Interest in Targeted Therapies Is Growing
The growing interest in biologics and targeted therapies reflects something important. People living with lichen sclerosus want more options, more personalized care, alternatives if first-line therapies do not work well, and treatments with fewer side effects.
This curiosity is not a problem. It often drives scientific progress. Patient questions and advocacy frequently help shape research priorities and funding decisions.
Where Research Is Headed
Current research in vulvar lichen sclerosus is exploring targeted immune therapies, along with improved strategies for long-term disease monitoring.
At the same time, the strongest evidence still supports early diagnosis, consistent steroid therapy, and regular follow-up as the most effective way to protect vulvar health today.
The Bottom Line on Targeted Therapies for Vulvar Lichen Sclerosus
Targeted therapies, including biologics and JAK inhibitors, represent an exciting and evolving area of research in vulvar lichen sclerosus. They may one day play a meaningful role in treatment.
At present, however, they remain investigational for VLS. Anyone considering new or emerging therapies should speak with a clinician experienced in vulvar disease so that decisions can be made based on current evidence, safety, and individual needs.
As research continues to evolve, patient engagement, thoughtful questions, and advocacy remain essential forces moving the field forward.
And yes, there is room for optimism and hope as we continue to learn more.
Sources
Borghi, A., et al. “Proactive Maintenance Therapy with Mometasone Furoate 0.1% Ointment for Vulvar Lichen Sclerosus.” British Journal of Dermatology, vol. 169, no. 5, 2013, pp. 1109-1114.
Bradford, J., and G. Fischer. “Long-Term Management of Vulval Lichen Sclerosus.” JAMA Dermatology, vol. 146, no. 11, 2010, pp. 1221-1226.
British Association of Dermatologists. “Guidelines for the Management of Lichen Sclerosus.” British Journal of Dermatology, 2010.
Cooper, S. M., et al. “Does Treatment of Vulvar Lichen Sclerosus Influence Its Prognosis?” JAMA Dermatology, vol. 140, no. 11, 2004, pp. 1225-1228.
Coondoo, A. “Biologics in Dermatologic Therapy – An Update.” Indian Journal of Dermatology, vol. 54, no. 4, 2009, pmc.ncbi.nlm.nih.gov/articles/PMC2810684/.
Eskandari, F., et al. “Biologics in Dermatology: An Integrated Review.” Indian Dermatology Online Journal, vol. 5, no. 4, 2014, pmc.ncbi.nlm.nih.gov/articles/PMC4171908/.
EunGuiDerm Guideline Group. “EuroGuiDerm Guideline on Lichen Sclerosus-Treatment Recommendations.” Journal of the European Academy of Dermatology and Venereology, 2024, doi:10.1111/jdv.19998.
More sources on Targeted Therapies for Vulvar Lichen Sclerosus
Fischer, G., and J. Bradford. “The Management of Vulvar Lichen Sclerosus.” Australasian Journal of Dermatology, vol. 62, no. 2, 2021, pp. 135-142.
Krapf, J. M., et al. “Biologics in Refractory Lichen Sclerosus: Case Series and Review.” Journal of Lower Genital Tract Disease, 2024.
Lee, A., J. Bradford, and G. Fischer. “Long-Term Management of Adult Vulvar Lichen Sclerosus.” JAMA Dermatology, vol. 149, no. 11, 2013, pp. 1439-1440.
Lorenz, B., et al. “Lichen Sclerosus. Therapy with Clobetasol Propionate.” Dermatology, vol. 197, no. 3, 1998, pp. 260-265.
Mauskar, R. L., et al. “Emerging Therapies for Vulvar Lichen Sclerosus.” Dermatologic Therapy, 2025.
Neill, S. M., et al. “Guidelines for the Management of Lichen Sclerosus.” British Journal of Dermatology, vol. 163, no. 4, 2010, pp. 672-682.
Papoutsaki, M., and S. Chimenti. “Biologics in Dermatology.” PMC, 2013, pmc.ncbi.nlm.nih.gov/articles/PMC3816698/.
Renaud-Vilmer, C., et al. “Vulvar Lichen Sclerosus: Long-Term Follow-up Results.” Archives of Dermatology, vol. 140, no. 7, 2004, pp. 827-831. Virgili, A., et al. “Long-Term Efficacy of Mometasone Furoate for Vulvar Lichen Sclerosus.” Acta Dermato-Venereologica, vol. 94, no. 1, 2014, pp. 31-35.
