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.