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When symptoms persist after tapering to twice a week on the three month BAD guidelines treatment, what advice is given to the patient? This is a common problem on social media.

Lichenoid inflammation can take many months to resolve and it's not unusual for flares to occur which may need daily treatment for a week or two in order to re-establish control. Using steroids of an appropriate strength twice weekly eg dermovate is a good way to achieve remission. The symptoms that are persistent however need to be characterised. For example burning or pain with intercourse may suggest a diagnosis of vestibulodynia (see vulvalpainsociety.org.uk for further information). Other symptoms such as a palpable swelling need to be investigated and possibly biopsied.

Thank you for your question. We usually advise to restart the cycle of treatment of symptoms recur.
Topical protopic ointment and oral medications such as roacutane, methotrexate are alternatives.
I hope this is helpful.