Patients with vulvovaginal lichen planus most likely to need systemic immunosuppression include those younger than 60, non-Caucasians and presenting with vulval pruritus, Australian clinicians say.

Their chart review of dozens of diagnosed cases suggest the confluence of these three risk factors can predict the need for systemic treatment with a specificity of 95%.

Given that up to 40% of women with vulvovaginal lichen planus (VLP) fail to respond to first-line topical corticosteroids — and the dearth of data on the factors determining the need for immunosuppression — the authors say their findings should aid clinical decision-making.

Using data from 122 patients, Dr Gayle Fischer and Dr Ashod Kherlopian, from the Royal North Shore Hospital in Sydney, say they have identified the clinical features indicative of recalcitrant mucosal disease requiring treatment escalation.