OBJECTIVE: To assess the efficacy of methylprednisolone aceponate 0.1% (MPA 0.1%) in female genital lichen sclerosus (GLS) and efficacy of MPA, tacrolimus or emollient for prevention of flares.METHODS: A single-center, retrospective study was conducted. At baseline, female patients with relapsing GLS (n = 46) were treated with MPA 0.1% applied once daily for 8 weeks. Visual Analog Scale (VAS) score for vulvar pruritus and Investigator's Global Assessment (IGA) score were recorded at baseline, weeks 8 and 20. At week 8, patients responsive to treatment (n = 38) were further treated with MPA 0.1% twice weekly (n = 15), tacrolimus once daily (n = 13) or topical emollient once daily (n = 10), as maintenance therapy until week 20.RESULT: Both VAS and IGA median score was significantly decreased from baseline to week 8 (p = 0.000). At week 20, both median VAS and IGA scores differed significantly between patients treated with emollient and patients treated with MPA 0.1% (p = 0.000) and patients treated with emollient and patients treated with tacrolimus (p = 0.000); patients treated with MPA 0.1% presented no significant difference in either median VAS score (p = 0.032) or median IGA score (p = 0.636) at week 20 compared to patients treated with tacrolimus.CONCLUSIONS: MPA 0.1% is effective in relapsing female GLS. MPA 0.1% and tacrolimus have equal efficacy in preventing relapses.