Lichen sclerosus is a rare skin disease that occurs most often on the genital (vulva) area of women.  The involved areas are often very itchy. 

As the condition progresses bruising and pain may occur.  The skin affected by this condition is usually white and sometimes there is a fine, crinkling texture to it. 

If left untreated, it can cause progressive scarring.  This can cause the labia minora (the inner lips of the vulva) to disappear completely, the opening to the vagina to narrow, and scar tissue to cover the clitoris. 

Lichen sclerosus does not affect other mucous membranes and only 1 in 10 people have other areas of their skin develop the condition.  Patients who have untreated disease have a slightly increased risk of a skin cancer of the involved areas.

What causes lichen sclerosus?

We do not know the exact cause of this rare skin disease. Note that it is not contagious nor is it associated with any other disease except for rarely skin cancer as noted above.

What are the treatment options for the skin patches?

There is now excellent treatment for lichen sclerosus.  A very high potency cortisone cream or ointment will normally return skin to its original color and texture, although any scarring that may have occurred will remain. 

There is a slight increase of trivial infections during the first few months of treatment until the skin returns to normal, especially in women who are postmenopausal or in girls who are prepuberal.

Some patients will develop an allergy to one of the components in the cortisone ointment.  Therefore, brief setbacks are common during the first few months of therapy.  You should not be discouraged, because ultimately this disease responds well to treatment and produces no symptoms.  Although lichen sclerosus is not curable, it is controllable.

After your skin has returned to normal, you will typically need to have a follow-up visit every 6-12 months.  This is so any early skin cancer can be found while it is a minor problem and so that if the lichen sclerosus begins to recur, treatment can be restarted before symptoms occur.

Birth control pills often thin vulvar skin and worsen symptoms overall.  Discontinuing them may improve symptoms.

If any creams, lotions or ointments you use in the vulva area sting or burn upon application, stop using them immediately.  If they are medications that were prescribed by your dermatologist, stop using them and contact their office.

The vulvovaginal area is very prone to irritation.  This is an area that stays warm and damp and is subject to harsh conditions such as exposure to urine, perspiration, pressure (as in sitting), friction (as in walking and intercourse), and exposure to irritating substances (such as soap).  There are a number of things that you can do to decrease the irritation in this area:

1. Wear loose-fitting clothes and consider wearing thigh high hose instead of panty hose.  Wear cotton underwear that “breathes.”

2. Do not use any soap on your vulva and wash no more than once a day with clear water only using your fingers instead of a wash cloth.  Pat the area gently to dry.

3. Do not use any douches, perfumes, feminine hygiene sprays, commercial lubricants, or other substances on the vulva other than those prescribed or suggested.

4. Use lubrication if needed with intercourse, most women with chronic vulvar symptoms do not find intercourse pleasurable and therefore do not lubricate naturally. Vegetable oil is a good lubricant to use because it has no alcohol or preservatives in it.

5. Xylocaine jelly will often help to numb the area before intercourse and make sexual activity more comfortable.  This should be applied liberally 15-20 minutes before intercourse.  This medication can also be used at other times when lichen sclerosus irritation or pain is at its worst.

6. Panty liners and pads irritate some people.  Allergies to chemicals in the pads can occur and may not show up until several days after use.