Assessment of the Cutaneous Hormone Landscapes and Microbiomes in Vulvar Lichen Sclerosus

Vulvar lichen sclerosus (VLS) is a progressive skin disease of unknown etiology. In this longitudinal case-control exploratory study, we evaluated the hormonal and microbial landscapes in 18 postmenopausal women (mean [SD] age: 64.4 [8.4]) with vulvar lichen sclerosus and controls. We reevaluated the VLS patients after 10-14 weeks of daily topical Class I steroid. We found that groin cutaneous estrone was lower in vulvar lichen sclerosus versus controls (–22.33, 95% CI –36.96 to –7.70; P = 0.006); cutaneous progesterone was higher (5.73, 95% CI 3.74 to 7.73; P< 0.0001). Forehead 11-deoxycortisol (–0.24, 95% CI –0.42 to –0.06; P = 0.01) and testosterone (–7.22, 95% CI –12.83 to –1.62; P = 0.02) were lower in disease. With treatment, cutaneous estrone (–7.88, 95% CI –44.07 to 28.31; P = 0.62), progesterone (2.02, 95% CI –2.08 to 6.11; P = 0.29), and 11-deoxycortisol (–0.13, 95% CI –0.32 to 0.05; P = 0.15) normalized; testosterone remained suppressed (–7.41, 95% CI –13.38 to –1.43; P = 0.02). 16S rRNA V1-V3 and ITS1 amplicon sequencing revealed bacterial and fungal microbiome alterations in disease. Findings suggest that cutaneous sex hormone and bacterial microbiome alterations may be associated with VLS in postmenopausal women.