INFORMATION: LICHEN SCLEROSIS/LICHENOID VULVITIS
WHAT IS IT?
Lichen sclerosis is an unusual dermatologic condition of the vulva.
It may cause the vulvar skin to appear whitish or become thin in
appearance. This skin disease is similar to other conditions (such as
psoriasis) because it is a chronic skin problem which can "come and
go" for years.
WHAT CAUSES IT?
Little is known as to the exact cause of lichen sclerosis. Some
researchers feel it may be due to an immune disorder at the local skin
area. There may be a genetic predisposition to this condition. It is
not contagious or sexually transmitted. It occurs at any age but
classically is described in the "mature" woman. All races are
WHAT ARE THE SYMPTOMS?
Some patients with early or mild disease report no symptoms at all.
As the disease progresses, it can cause chronic vulvar itching or
burning. It also causes loss of tissue (atrophy) in the labial area
(lips of the vagina), hymen, and/or clitoris. The skin may also
become very fragile and tear with any friction or rubbing, such as
during intercourse. In some women, vulvar vestibulitis (ask for
educational material on this syndrome) can result. This disease can
be seen also around the anus, causing itching or burning of this area.
Many patients notice certain triggers that can cause symptoms to
become more noticeable, these include: stressful situations, seasons
(Spring and Fall) and weight loss.
HOW IS IT DIAGNOSED?
An examiner experienced in vulvar/vaginal disease problems can often
recognize the condition by physical signs. However, diagnosis should
be confirmed by biopsy of the vulva or vagina. Biopsies are taken
during examination in the office with a colposcope (which is like a
large microscope). The biopsies performed at WomenNow Health Care are
sent to a specialized pathology laboratory in Florida, and results
take approximately 4-6 weeks to return.
HOW IS IT TREATED?
There is no "cure" for lichen sclerosis. However, the symptoms and
disease progression can be controlled with treatment. Topical
steroids to the affected area are used to treat lichen sclerosis.
Treatment with steroids will usually cause the disease to go into
remission, and symptoms will improve. However, the disease may
"flare" and treatment will need to be restarted when symptoms return.
In the past, treatment with testosterone ointments and creams were
used. Recent studies suggest the use of such medicine is not
necessary or rarely, if ever, helps the skin condition. Other
therapeutic agents infrequently used in severe cases include retinoic
acids (ex: accutane), topical progesterone, and topical
immunosuppressant/immunomodulator therapy (ex: cyclosporine and
tacrolimus). Surgical treatment, especially with superficial laser
therapy, is unsuccessful and can cause disfigurement. Surgical
intervention can be very successful in women having vulvar
vestibulitis because of lichen sclerosis. Such surgery requires deep
removal of the major and minor vestibular glands.
ARE THERE ANY SIDE EFFECTS TO THE TREATMENT?
Steroids, when taken orally, can cause gastrointestinal disturbances
such as nausea, abdominal cramping, and gastrointestinal ulcers. When
given in high doses for long periods of time, steroids can cause loss
of bone density or osteoporosis, especially in the hip area. It is
not known whether topical steroids have the same risk of side effects
as when given orally. However, if topical steroids are used in the
correct areas in appropriate quantity, side effects are extremely
rare. Women who will be on steroids for long time periods because of
their disease should undergo baseline bone density testing due to the
potential serious risk of decreased bone mass. Using large amounts of
topical steroids (or more than is prescribed) results in thinning of
the skin and worsening of the irritation/burning. Therefore a "fine"
line exists between using the correct quantity as well as the correct
potency of steroids. (Steroids vary in potency from mild to extremely
ARE THERE ANY COMPLICATIONS IF IT IS NOT TREATED?
While lichen sclerosis is not life threatening, the symptoms can
become very bothersome if not treated. In severe cases, untreated
lichen sclerosis can cause narrowing, scarring, and constriction of
the vaginal opening, making intercourse quite painful and even
impossible. In untreated disease, symptoms of constant vulvar itching
or burning usually intensify over time, especially at the time of
menopause. Although there is some association with the possibility of
vulvar malignancy, most (the majority of) women who have been followed
for years with this disease do NOT develop any malignancy if their
disease is treated.