Lichen Planus

Lichen planus (LP) is an inflammatory skin condition that affects the skin of the vulva and the vagina. It may also affect other skin surfaces of the body such as the scalp and nail beds. Women 30- 60 years old comprise the age group most often affected by this condition. The cause of LP is unknown but there may be an autoimmune component. There does not seem to be a relationship to established autoimmune disorders like Systemic Lupus or Rheumatoid Arthritis. Characteristically, lichen planus leads to genital lesions that cause erosions of the skin. This is most often manifested at the opening of the vagina and just inside the labia. Sometimes the skin is just inflamed, raw and red. The vagina lesions range from frank ulceration to mildly inflamed skin with a copious yellow-white discharge. Many women present with a history of recurrent vaginal infections and a sense of irritation and burning. Most have been treated repeatedly with antifungal and antibacterial medications. When the skin is eroded, a secondary bacterial infection can occur although this is less common. The chronic inflammation of the vagina and vulva lead to the symptoms of persistent discharge and irritation. Most women also experience painful intercourse as a result of the lichen planus. Other more extensive manifestations of lichen planus can occur. Most of these extensive changes result when the skin has been left untreated, often for months or years. The chronic inflammation can lead to vulvar scarring and agglutination of the vulva along the midline. The labia minora slowly diminish and become absent. The clitoral hood can scar so that it no longer retracts. This can lead to a diminution of sensation with sexual activity and difficulty achieving orgasm. The vaginal opening becomes tight, rigid and fragile so it easily tears and bleeds. Lastly, vaginal agglutination and scarring can occur so that vaginal depth is lost. Pelvic exams become increasingly difficult and penetrative sex can become impossible. Diagnosis is based on a number of factors. Patient history and physical exam is quite important. Wet mount can define the vaginal ecosystem more properly. A biopsy of the skin is often necessary to secure the diagnosis. It can be managed but not cured. Treatment is with steroid products, both on the vulvar skin and in the vagina. These products are used to decrease inflammation. Medication is used on a regular basis to maintain optimal tissue integrity and to diminish symptoms. With active, regular treatment the extensive changes of lichen planus can be avoided. Because lichen planus is a chronic condition, symptoms can only be managed and not cured. The goal of treatment is to protect the vulva and vagina along with diminishing annoying and troublesome symptoms. Occasionally, scarring in the vagina may occur, leading to a narrow canal. Dilators or surgery may be necessary. It is important to monitor changes in the vulva with self-exam and regular visits to your practitioner. Progression and regression should be monitored with a health professional who is familiar with lichen planus in order to optimally treat the disease and prevent long term changes.

Lewis, F.M., Vulval lichen planus. Br J Dermatol, 1998. 138(4): p. 569-75. Edwards, L., Vulvar lichen planus. Arch Dermatol, 1989. 125(12): p. 1677-80. Lotery, H.E. and R.P. Galask, Erosive lichen planus of the vulva and vagina. Obstet Gynecol, 2003. 101(5 Pt 2): p. 1121-5. The Program in Vulvar Health • The Center for Women’s Health • Oregon Health & Science University • Last updated November 2007 • www.ohsuwomenshealth.com/vulva/