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Lichen Sclerosus Lichen Sclerosus Lichen sclerosus (LS) is an inflammatory skin disorder of the vulva. It can occur in any age group, although more commonly seen in the middle-aged, Caucasian population. The cause of lichen sclerosus is unknown but no infectious, genetic, environmental, hormonal or immunologic etiology has been identified. Lichen sclerosus is characterized by small white areas on the dry skin of the vulva. These patches often give the skin the appearance of being thin, transparent and crinkly. Often these changes are symmetrical. Most women have intense itching associated with LS and thus the vulva can become secondarily red, irritated, thickend, ulcerated and inflamed. Other common symptoms are pain, burning and irritation. Affected skin may involve the entire vulva, perineal body (skin between vaginal and anal openings), peri-anal skin, and gluteal folds. As the skin changes progress, there is loss of normal vulvar architecture. These changes include fusion of the labia minora with the labia majora, agglutination of the labia at the midline (phimosis), and loss of mobility of the clitoral hood. The vaginal opening can become smaller, interfering with intercourse. Defecation can become painful when the inflamed, scarred skin splits and bleeds with each bowel movement. A biopsy is necessary to secure the diagnosis of lichen sclerosus, and physical exam is often supportive. Lichen sclerosus is a chronic skin condition. Symptoms can be managed, not cured. The goal of treatment is to eliminate symptoms and protect the skin from damage and progression. Commonly, the anatomic changes of LS will not reverse despite persistent and aggressive treatment. Due to the chronic nature of the disease, diligence to treatment is important to prevent further skin changes and preserve normal integrity of the skin. Treatment is with topical steroid products. Potency of the product and frequency in which it is applied will vary for each patient. Historically, testosterone cream was used to treat LS. Good research trials show that steroid products are superior for the management of this skin disorder. Recent case reports have increased interest in a new topical product. These immune system modulators (Tacrolimus) are a novel approach to the treatment of LS and are an alternative to topical steroid products. Research supports that women with LS have a slightly higher risk of developing skin cancer (squamos cell carcinoma) of the vulva. Because of the chronic inflammatory response, the skin is at greater risk for an abnormal cell development. Thus, it is important for each person with lichen sclerosus to be aware of any changes in the vulvar skin. In addition, reexamination of the skin every six months by an experienced practitioner is important to track any skin changes and to monitor treatment success. The Program in Vulvar Health • The Center for Women’s Health • Oregon Health & Science University • Last updated November 2007 • www.ohsuwomenshealth.com/vulva/ Lichen Sclerosus, continued Bracco, G.L., et al., Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. Journal of Reproductive Medicine, 1993. 38(1): p. 37-40. Bornstein, J., et al., Clobetasol dipropionate 0.05% versus testosterone propionate 2% topical application for severe vulvar lichen sclerosus. American Journal of Obstetrics & Gynecology, 1998. 178(1 Pt 1): p. 80-4. Cattaneo, A., et al., Testosterone maintenance therapy. Effects on vulvar lichen sclerosus treated with clobetasol propionate. Journal of Reproductive Medicine, 1996. 41(2): p. 99-102. Dalziel, K.L. and F. Wojnarowska, Long-term control of vulval lichen sclerosus after treatment with a potent topical steroid cream. Journal of Reproductive Medicine, 1993. 38(1): p. 25-7. Bohm, M., et al., Successful treatment of anogenital lichen sclerosus with topical tacrolimus. Arch Dermatol, 2003. 139(7): p. 922-4. The Program in Vulvar Health • The Center for Women’s Health • Oregon Health & Science University • Last updated November 2007 • www.ohsuwomenshealth.com/vulva/ .
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