{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:15:42Z","timestamp":1792134942635,"version":"4.4.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Advanced Fellowship","award":["NIHR301434"],"award-info":[{"award-number":["NIHR301434"]}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Lichen sclerosus (LS) is a chronic inflammatory condition that mainly affects genital skin. It causes distressing symptoms that impact daily quality of life, as well as progressive anatomical changes and a potential risk of cancer. Vulval LS is often misdiagnosed and treatment delayed. If nonexperts can be supported to identify clinical features of LS, they may diagnose the condition sooner and commence timely treatment or refer a patient for assessment and confirmatory biopsy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To reach international expert consensus on clinical diagnostic features for vulval LS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Between March and May 2023, a four-stage electronic Delphi consensus exercise was conducted. In the first three rounds, participants were asked to rate the importance of a list of clinical features. Responses from round 1 were summarized and presented in rounds 2 and 3, along with additional features suggested by participants. Any items rated as \u2018very important\/critical\u2019 or \u2018not important\u2019 that met the definition of consensus were removed from subsequent rounds. In round 4, items that were rated \u2018important but not critical\u2019 were ranked in order of their importance. Consensus was defined a priori, and all rounds were conducted anonymously.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 47 participants from 14 countries completed round 1, with 42 (89%) retained by round 3 when consensus was determined. Round 4 was completed by 36 (77%) participants. Participants completing all four rounds predominantly included healthcare professionals (n = 28\/36; 78%) and patient support group representatives (n = 7\/36; 19%). In round 1, 21 diagnostic features were rated. Participants suggested an additional 10 features, which were subsequently added to the round 2 survey. After three rounds, consensus was achieved for five diagnostic features: whiteness, itch, changes in anatomy, burying of the clitoral area and improvement in response to topical steroids. There were also 12 features rated as \u2018important but not critical\u2019 and participants subsequently ranked them in the fourth round.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Experts agreed on 5 critical diagnostic features for vulval LS in adults and an additional 12 features that may also be important. Future research should assess these clinical features for diagnostic validity through a multicentre diagnostic test accuracy study.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ced\/llae393","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T04:14:38Z","timestamp":1727928878000},"page":"590-596","source":"Crossref","is-referenced-by-count":4,"title":["Expert opinion on characteristics of vulval lichen sclerosus: initial identification of important clinical features through an international electronic Delphi consensus study"],"prefix":"10.1093","volume":"50","author":[{"given":"Rosalind C","family":"Simpson","sequence":"first","affiliation":[{"name":"Centre of Evidence Based Dermatology, University of Nottingham , Nottingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Birchall\u00ad\u00ad","sequence":"additional","affiliation":[{"name":"Centre of Evidence Based Dermatology, University of Nottingham , Nottingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Daniels","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, University of Nottingham , Nottingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Gran","sequence":"additional","affiliation":[{"name":"Centre of Evidence Based Dermatology, University of Nottingham , Nottingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudula","family":"Kirtschig","sequence":"additional","affiliation":[{"name":"Medical Health Centre Frauenfeld , Frauenfeld ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7785-7465","authenticated-orcid":false,"given":"Kim\u00a0S","family":"Thomas","sequence":"additional","affiliation":[{"name":"Centre of Evidence Based Dermatology, University of Nottingham , Nottingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"key":"2025022416231848400_llae393-B1","article-title":"EB60.0 Lichen sclerosus of vulva","author":"World Health Organization"},{"key":"2025022416231848400_llae393-B2","first-page":"477","article-title":"Prevalence of vulvar lichen sclerosus in a general gynecology practice","volume":"50","author":"Goldstein","year":"2005","journal-title":"J Reprod Med"},{"key":"2025022416231848400_llae393-B3","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/bjd.12137","article-title":"Quality of life in Dutch women with lichen sclerosus","volume":"168","author":"Lansdorp","year":"2013","journal-title":"Br J Dermatol"},{"key":"2025022416231848400_llae393-B4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1111\/jdv.13136","article-title":"Evidence-based (S3) guideline on (anogenital) lichen sclerosus","volume":"29","author":"Kirtschig","year":"2015","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2025022416231848400_llae393-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0167-4943(00)00059-5","article-title":"Vulvovaginal examinations in elderly nursing home women residents","volume":"31","author":"Leibovitz","year":"2000","journal-title":"Arch Gerontol Geriatr"},{"key":"2025022416231848400_llae393-B6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1046\/j.1365-2230.2003.01211.x","article-title":"Lichen sclerosus","volume":"28","author":"Tasker","year":"2003","journal-title":"Clin Exp Dermatol"},{"key":"2025022416231848400_llae393-B7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1159\/000356163","article-title":"Prospective clinical and epidemiologic study of vulvar lichen sclerosus: analysis of prevalence and severity of clinical features, together with historical and demographic associations","volume":"228","author":"Virgili","year":"2014","journal-title":"Dermatology"},{"key":"2025022416231848400_llae393-B8","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1111\/j.1479-828X.2007.00725.x","article-title":"The impact of chronic vulval pain on quality of life and psychosocial well-being","volume":"47","author":"Sargeant","year":"2007","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2025022416231848400_llae393-B9","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/LGT.0b013e3181dc1e45","article-title":"Quality of life in the vulvar clinic: a pilot study","volume":"14","author":"Hickey","year":"2010","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B10","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1002\/ijc.30621","article-title":"Lichen sclerosus and risk of cancer","volume":"140","author":"Halonen","year":"2017","journal-title":"Int J Cancer"},{"key":"2025022416231848400_llae393-B11","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1158\/1055-9965.EPI-16-0019","article-title":"Lichen sclerosus: incidence and risk of vulvar squamous cell carcinoma","volume":"25","author":"Bleeker","year":"2016","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2025022416231848400_llae393-B12","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/ajd.12873","article-title":"Incidence of vulval squamous cell carcinoma in women with vulval lichen sclerosus in an Australian tertiary referral centre","volume":"60","author":"Meani","year":"2019","journal-title":"Australas J Dermatol"},{"key":"2025022416231848400_llae393-B13","first-page":"109","article-title":"Predictors of psychological well-being in a sample of women with vulval pain","volume":"54","author":"Sargeant","year":"2009","journal-title":"J Reprod Med"},{"key":"2025022416231848400_llae393-B14","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jamadermatol.2015.0643","article-title":"Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women","volume":"151","author":"Lee","year":"2015","journal-title":"JAMA Dermatol"},{"key":"2025022416231848400_llae393-B15","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/bjd\/ljac117","article-title":"Representation of genital dermatoses in dermatological literature","volume":"188","author":"Drumm C","year":"2023","journal-title":"Br J Dermatol"},{"key":"2025022416231848400_llae393-B16","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/bjd.16241","article-title":"British Association of Dermatologists guidelines for the management of lichen sclerosus","volume":"178","author":"Lewis","year":"2018","journal-title":"Br J Dermatol"},{"key":"2025022416231848400_llae393-B17","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1111\/bjd.17447","article-title":"Future research priorities for lichen sclerosus \u2013 results of a James Lind Alliance Priority Setting Partnership","volume":"180","author":"Simpson","year":"2019","journal-title":"Br J Dermatol"},{"key":"2025022416231848400_llae393-B18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta2030","article-title":"Consensus development methods, and their use in clinical guideline development","volume":"2","author":"Murphy","year":"1998","journal-title":"Health Technol Assess"},{"key":"2025022416231848400_llae393-B19","doi-asserted-by":"crossref","first-page":"69","DOI":"10.12968\/ijtr.2009.16.2.38892","article-title":"The Delphi technique: a review","volume":"16","author":"Vernon","year":"2009","journal-title":"Int J Ther Rehabil"},{"key":"2025022416231848400_llae393-B20","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/bjd.12334","article-title":"Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise","volume":"169","author":"Simpson","year":"2013","journal-title":"Br J Dermatol"},{"key":"2025022416231848400_llae393-B21","author":"Simpson"},{"key":"2025022416231848400_llae393-B22","article-title":"Topical interventions for genital lichen sclerosus","volume":"2011","author":"Chi","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025022416231848400_llae393-B23","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/LGT.0000000000000361","article-title":"Development of the adult vulvar lichen sclerosus severity scale\u2013a Delphi consensus exercise for item generation","volume":"22","author":"Sheinis","year":"2018","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B24","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/LGT.0000000000000547","article-title":"Vulvar lichen sclerosus: outcomes important to patients in assessing disease severity","volume":"24","author":"Green","year":"2020","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B25","first-page":"10","article-title":"The Delphi technique: making sense of consensus","volume":"12","author":"Hsu","year":"2007","journal-title":"Pract Assess Res Eval"},{"key":"2025022416231848400_llae393-B26","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1111\/j.1743-6109.2012.02814.x","article-title":"Clinical scoring system for vulvar lichen sclerosus","volume":"9","author":"Gunthert","year":"2012","journal-title":"J Sex Med"},{"key":"2025022416231848400_llae393-B27","author":"Kirtschig"},{"key":"2025022416231848400_llae393-B28","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1093\/asj\/sjz342","article-title":"Development and validation of a clinical grading scale to assess the vulvar region: the vulvar architecture severity scale","volume":"40","author":"Almadori","year":"2020","journal-title":"Aesthet Surg J"},{"key":"2025022416231848400_llae393-B29","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/LGT.0000000000000627","article-title":"The \u201cCIV classification,\u201d a new proposal for the architectural grading of vulvar lichen sclerosus","volume":"25","author":"Boero","year":"2021","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B30","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/LGT.0000000000000534","article-title":"Adult vulvar lichen sclerosus: can experts agree on the assessment of disease severity?","volume":"24","author":"Sheinis","year":"2020","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B31","first-page":"271","article-title":"Presenting symptoms and diagnosis of vulvar lichen sclerosus in premenopausal women: a cross-sectional study","volume":"26","author":"Krapf","year":"2022","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B32","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/LGT.0000000000000634","article-title":"The SWIFT model for lichen sclerosus among premenarchal girls","volume":"26","author":"Wang","year":"2022","journal-title":"J Low Genit Tract Dis"},{"key":"2025022416231848400_llae393-B33","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1111\/bjd.20583","article-title":"Is urinary incontinence associated with vulval lichen sclerosus in women? A cross-sectional study","volume":"185","author":"Kirby","year":"2021","journal-title":"Br J Dermatol"},{"key":"2025022416231848400_llae393-B34","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1001\/archderm.140.6.702","article-title":"Does treatment of vulvar lichen sclerosus influence its prognosis?","volume":"140","author":"Cooper","year":"2004","journal-title":"Arch Dermatol"},{"key":"2025022416231848400_llae393-B35","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1001\/archderm.140.6.709","article-title":"Vulvar lichen sclerosus: effect of long-term topical application of a potent steroid on the course of the disease","volume":"140","author":"Renaud-Vilmer","year":"2004","journal-title":"Arch Dermatol"},{"key":"2025022416231848400_llae393-B36","author":"University of Nottingham"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ced\/advance-article-pdf\/doi\/10.1093\/ced\/llae393\/59548138\/llae393.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/50\/3\/590\/59548138\/llae393.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/50\/3\/590\/59548138\/llae393.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T16:23:39Z","timestamp":1740414219000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/article\/50\/3\/590\/7808425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,10,3]]},"published-print":{"date-parts":[[2025,2,24]]}},"URL":"https:\/\/doi.org\/10.1093\/ced\/llae393","relation":{},"ISSN":["0307-6938","1365-2230"],"issn-type":[{"value":"0307-6938","type":"print"},{"value":"1365-2230","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2024,10,3]]}}}