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 affected.

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 strong.)

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.