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About Vulvar Lichen Sclerosus

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Lichen sclerosus is a chronic skin disease that mainly affects the vulva, but it can involve skin outside the genital region as well. One in 10 women with lichen sclerosus will have small patches of lichen sclerosus in other areas that do not cause symptoms. The condition is more common in women than men and can sometimes occur in children.

Patients with lichen sclerosus have a slightly increased risk of vulvar cancer and should have a vulvar exam every six months to look for any skin changes that could be early cancer.

What Causes Lichen Sclerosus?

The cause of lichen sclerosus is unknown. However, it is thought to be an autoimmune condition in which the immune system becomes overactive and causes thinning and inflammation of vulvar tissue and skin. Lichen sclerosus is most often seen in postmenopausal women but can also be present in younger people, even teens and children.

Lichen sclerosus is not an infection, is not contagious, and cannot be passed on to a sexual partner.

Symptoms of Lichen Sclerosus

  • Skin becomes more fragile, often with a white crinkled texture that tears easily and causes pain in the genital area. This effect may extend down to the anus.
  • The thin, inflamed skin can tear with any stretching, such as tampon use or sexual activity.
  • Itching is a common early symptom.
  • Scarring of vulvar tissue can occur over time if there is no treatment. Scarring changes the appearance of the vulva and can cause narrowing of the vaginal opening, which in turn may make intercourse uncomfortable.
  • Lichen sclerosus may cause satellite patches of white skin in other areas of the body, which rarely cause symptoms and do not usually require treatment.
  • Lichen sclerosus does not involve the vagina.
  • Occasionally there are no symptoms.

Treatment of Lichen Sclerosus

While there is no absolute cure for lichen sclerosus, symptoms can be controlled with topical medications so that scarring and discomfort can be prevented.

Topical steroids

Topical steroids are the most effective treatment for lichen sclerosus and can help restore normal texture to genital tissue and prevent further inflammation and changes in vulvar structures. High-potency steroids, applied once or twice a day, can be used safely in the genital area, with monthly examinations early in treatment to evaluate the patient's response. As tissue begins to return to a more normal texture, the use of steroids may be decreased to two or three times a week. However, it is important to continue treatment as lichen sclerosus can recur. While treatment can prevent further changes in genital tissue, any scarring that has already occurred is not reversible without surgery.

Comfort measures during treatment

The use of moisturizers such as Vaseline or Crisco in addition to the steroids can be helpful in controlling symptoms, especially itching. Any irritation can cause a flare-up of lichen sclerosus. Bacterial or yeast infections need to be aggressively treated, and only mild, fragrance-free products should be used in the genital area. Many women use only water when bathing the vulva, to prevent irritation from soap products, and pat to dry. In women who are postmenopausal, adding estrogen locally in the vagina helps the skin to heal.

Lichen Sclerosus and Cancer

Women with lichen sclerosus may have a 5 percent lifetime risk of developing vulvar cancer in the genital area. Although the overall cancer risk is low, women with lichen sclerosus should have an examination every six months and any new lesions or symptoms should be reported and evaluated.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.

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