Lichensclerosus is an autoimmune condition that most commonly affects the skin of the vulva, although it can also, much less commonly, affect other areas of the skin. It is far more common in women than in men. It is not contagious.
Lichensclerosus most commonly causes intense itching, burning, and stinging. It begins as white patches that become confluent around the area of the vulva and anus. They have a shiny smooth appearance. This thin skin is dry and crinkled and tears easily on the surface, and the deeper dermis loses elasticity and becomes scarred and contracted over time. The scarred tissue can cover the clitoris, and causes oversensitivity or no sensitivity. The labia minora (inner lips) begin to disappear and become confluent with the surrounding tissue. Bright red and purple bruises are common. Sex can become difficult or impossible. Urination may be affected.
If advanced, it can be diagnosed by simply visualizing it. Most often though, a biopsy is recommended, since the medications used to treat it are potent corticosteroid ointments which could potentially make an infection worse, if Lichensclerosus were misdiagnosed as a yeast infection, for example. The area is anesthetized and a tiny 1 to 3mm biopsy is taken and sent to pathology.
Once confirmed, the condition is typically treated with a tapering dose of high potency corticosteroids. Dr. Ravasia typically recommends Clobetasol twice daily for 3 weeks, then once daily for three weeks, then twice weekly for three weeks. It is usually reassessed at that time, and a decision made to continue the Clobetasol if still severe, vs switching to a more mild daily hydrocortisone topical. Lichensclerosus of the genital skin should always be treated to avoid the severe scarring that can develop if not treated.
Lichensclerosus should also be closely looked at on a yearly basis for signs of dysplasia. Lichensclerosus does not cause skin cancer but squamous cell cancers are more likely to develop in area of the vulva and anal areas scarred by lichensclerosus. If you have lichensclerosus, the area should be carefully examined by your physician, usually by colposcopy, on a yearly basis for any changes.
Lichensclerosus may wax and wane over time. Sometimes, especially if mild and postmenopausal hormonal changes are not also happening at the same time, the condition may resolve spontaneously, and not recur, or not recur for many years. More often though, the measures instituted slow down, but do not halt completely, the progression of lichensclerosus. Keeping the vagina and vulva well estrogenized, and avoiding allergens, and using adequate lubrication can all be helpful measures, in addition to the steroid ointments. Treating urinary incontinence, so that the area does not become chapped from constantly being exposed to urine and pads can also be helpful.
