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TREATMENTS

Vulvar Lichen Sclerosus: An Uncommon But Serious Issue

When women experience pain and itching on their genitals, a rare skin condition is the furthest thing from their mind. But postmenopausal women should be aware of the signs and risks of an uncommon skin condition whose initial symptoms can be easily confused with many more common vaginal and vulvar health issues.

Vulvar lichen sclerosus is an uncommon, chronic skin condition that creates white patches of thinning skin that can easily bruise, tear and scar. It is typically seen in postmenopausal women over age 50 and is most likely to affect the vulva and anus. Even with treatment, it can last for years and cause permanent scarring and other complications.

Some people have no symptoms, while others may experience itchiness, discomfort, blistering and in severe cases scarring that can affect bodily functions. However, despite causing discomfort or pain during sex, vulvar lichen sclerosus isn't contagious and cannot be spread through sexual intercourse.

Symptoms

Signs and symptoms of vulvar lichen sclerosus affect the genital and anal areas including the vulva, labia, clitoris, perineal area and the perirectal area. Women may also see patches on the skin of the upper body, upper arms and breasts.

Signs of vulvar lichen sclerosus include:

  • Smooth white patches on vulvar skin
  • Blotchy, wrinkled patches on vulvar skin
  • Spots that grow into larger patches
  • Painful sex
  • Redness
  • Blistering or ulcerated sores
  • Itching
  • Pain
  • Skin that easily tears and bruises
  • Skin that easily becomes scarred

Women with mild vulvar lichen sclerosus may have no signs or symptoms.

Associated Risks

Complications of vulvar lichen sclerosus include painful sex, urinary retention and constipation. While lichen sclerosus does not cause skin cancer, the scarring that occurs may leave its sufferers at a higher risk for cancers such as squamous cell carcinoma. It’s important to have your doctor monitor your vulvar lichen sclerosus, so they can detect any changes that may indicate a worsening of your condition or cancer risk.   

Causes

The cause of lichen sclerosus is not fully understood. It may be an autoimmune process, in which antibodies mistakenly attack areas of the skin. This is thought to be the case because other autoimmune conditions occur more frequently in people who have lichen sclerosus. Researchers also believe this unusual condition could be tied to genetic factors, hormonal imbalances or damage related to injured skin, trauma and scarring or any combination of these factors. 

Diagnosis and Treatment

Treatment for vulvar lichen sclerosus typically begins with topical steroids or other types of topical creams. Creams may provide immediate relief from itching and irritation, but it can take a long course of treatment for the skin to return to normal. Depending on the severity of the case, physicians may also recommend calcipotriol cream, topical and systemic retinoids, or systemic steroids.

Coyle Institute has seen a measure of success in lichen sclerosus treatment with injections of platelet-rich plasma (PRP) derived from the patient's own blood, which stimulates tissue rejuvenation.

PRP is a platelet concentrate with a long history of success in speeding up healing processes in a variety of medical fields. Coyle Institute uses The O-Shot®, an all-natural, virtually painless non-surgical procedure that for many women rejuvenates and revitalizes vaginal and clitoral function without serious side effects.

Coyle Institute is also conducting a ground-breaking study in the use of erbium laser therapy as a lichen sclerosus treatment. Sciton’s profractional laser system creates a grid where the erbium laser targets tissue with a high affinity to water. Its customizable system allows us to adjust the depth of treatment for each woman to optimize healing. By using biopsies to measure the depth of a woman’s lichen sclerosus lesions before and after treatment, we can offer the most targeted, effective laser therapies and track the healing process. So far, laser treatment has been shown to improve healing and reduce painful symptoms, offering much needed relief to women most profoundly affected by the disease.

Even if they aren’t painful or itchy, patches on the genital skin should be treated to prevent scarring, which can interfere with normal urination and with sexual intercourse. In cases where deep scarring has already occurred, surgery may be necessary to allow for normal urination and sexual intercourse.

The condition does tend to recur, so long-term follow-up care may be needed. However, lichen sclerosus on upper body and arms may disappear over time without treatment. Although lichen sclerosus is an uncommon issue, our team at Coyle Institute has experience in successfully treating and managing its symptoms. With vigilance and care, women can get relief from the painful and potentially dangerous symptoms of lichen sclerosus and return to a healthier, happier life.

If you suspect you have lichen sclerosus, early treatment is urgent to help prevent scarring and its associated risks. Call our compassionate, expert team today and schedule your consultation.

©2019 Dr. Michael J. Coyle