硬化性苔藓（LS）是一种主要影响生殖器皮肤的慢性炎症。它会导致令人痛苦的症状，影响日常生活质量以及进行性解剖变化和潜在的癌症风险。外阴 LS 经常被误诊并延误治疗。如果支持非专家识别LS的临床特征，他们可以尽早诊断病情并开始及时治疗或转介专科服务进行评估和确认性活检。就外阴LS的临床诊断特征达成国际专家共识。 2023年5月，进行了四阶段的电子德尔菲共识演习。在前三轮中，参与者被要求对一系列临床特征的重要性进行评分。第一轮的答复进行了总结，并在第二轮和第三轮中提出，以及参与者建议的其他功能。任何符合“非常重要/关键”或“不重要”共识定义的项目都不会在后续几轮中再次进行投票。在第四轮中，符合“重要但非关键”共识的项目按其重要性顺序排列。共识是预先定义的，所有轮次都是匿名进行的。共有来自 14 个国家的 47 名参与者完成了第一轮，其中 42 名参与者 (89%) 在确定共识时保留到第三轮。第四轮由 36 名（77%）参与者完成。完成所有四轮的参与者主要包括医疗保健专业人员（78%，n=28）和患者支持小组代表（19%，n=7）。在第一轮中，对 21 项诊断特征进行了投票。参与者提出了额外的 10 个功能，这些功能随后被添加到第二轮调查中。三轮后，就五个诊断特征达成了共识：白度、瘙痒、解剖结构的变化、阴蒂区域的掩埋以及对局部类固醇反应的改善。还有 12 个特征被投票为“重要但不关键”，参与者随后在第四轮中对它们进行了排名。专家们就成人外阴 LS 的 5 个关键诊断特征和另外 12 个可能也很重要的特征达成了一致。未来的研究应通过多中心诊断测试准确性研究来评估这些临床特征的诊断有效性。© 作者 2024。由牛津大学出版社代表英国皮肤科医师协会出版。

Lichen sclerosus (LS) is a chronic inflammatory condition mainly affecting genital skin. It causes distressing symptoms that impact daily quality of life as well as progressive anatomical changes and potential risk of cancer. Vulval LS is often misdiagnosed and treatment delayed. If non-experts are supported to identify clinical features of LS, they may diagnose the condition sooner and commence timely treatment or refer to specialist services for assessment and confirmatory biopsy.To reach international expert consensus on clinical diagnostic features for vulval LS.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 one were summarised and presented in rounds two and three, along with additional features suggested by participants. Any items which met the definition of consensus as 'very important/critical', or 'not important' were not voted upon again in subsequent rounds. In round four, items which met agreement for 'important but not critical' were ranked in order of their importance. Consensus was defined a priori, and all rounds were conducted anonymously.A total of 47 participants from 14 countries completed round one with 42 (89%) retained by round 3 when consensus was determined. Round four was completed by 36 (77%) participants. Participants completing all four rounds predominantly included healthcare professionals (78%, n=28) and patient support group representatives (19%, n=7). In round one, 21 diagnostic features were voted upon. Participants suggested an additional 10 features which were subsequently added to the round two 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 voted as 'important but not critical' and participants subsequently ranked them in the 4th round.Experts have agreed on five 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.© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.