Lichen Sclerosis in GYN Care: What You Need to Know

Lichen sclerosis is a chronic skin condition that affects the genital and anal areas, especially in women. It causes thinning, whitening, and wrinkling of the skin, as well as itching and pain. Lichen sclerosis can interfere with sexual function and urination and increase the risk of skin cancer. This post will discuss the causes, symptoms, diagnosis, and treatment of lichen sclerosis.

Causes of Lichen Sclerosis

The exact cause of lichen sclerosis is unknown, but it may involve a combination of genetic, immune, hormonal, and environmental factors. Some possible triggers or risk factors are:

- Family history of lichen sclerosis or other autoimmune diseases
- Trauma, injury, or sexual abuse to the genital area
- Low estrogen levels in prepubertal girls and postmenopausal women
- Exposure to urine or other irritants
- Infections such as candidiasis (although not proven)

Lichen sclerosis is not contagious and cannot be transmitted sexually.

Symptoms of Lichen Sclerosis

Lichen sclerosis can affect any skin surface, but it is most common in the vulva (the external female genitals), the clitoris, the labia (the inner and outer lips), and the anus. The symptoms may vary from person to person, but they typically include:

- Thin, white, shiny patches of skin that may crack or bleed
- Wrinkled or crinkled appearance of the skin
- Itching, burning, or soreness in the affected area
- Pain during sex or urination
- Narrowing or scarring of the vaginal opening or foreskin (in men)
- Fissures or ulcers on the skin
- Blistering or bleeding with minor trauma

Some women may have no symptoms at all, while others may have severe discomfort and distress.

Diagnosis of Lichen Sclerosis

A GYN specialist can diagnose lichen sclerosis based on the appearance of the skin and the patient's medical history. Sometimes, a skin biopsy (a small sample of tissue) may be needed to confirm the diagnosis and rule out other conditions that may look similar, such as eczema, psoriasis, or vulvar cancer.

Treatment of Lichen Sclerosis

There is no cure for lichen sclerosis, but treatment can help control the symptoms, prevent scarring and complications, and reduce the risk of skin cancer. The main treatment for lichen sclerosis is a strong prescription cream or ointment that contains a steroid (such as clobetasol) that reduces inflammation and itching. The steroid should be applied to the affected area twice a day for 12 weeks, then as needed for maintenance therapy or flares. The steroid should not be used for longer than necessary, as it can cause side effects such as skin thinning, stretch marks, or infections.

Other treatments that may be used for lichen sclerosis are:

- Topical calcineurin inhibitors (such as tacrolimus or pimecrolimus) that suppress the immune system and reduce inflammation. These are usually reserved for patients who cannot tolerate steroids or have severe disease.
- Light therapy (phototherapy) that uses ultraviolet rays to improve the skin condition. This is usually done in a dermatologist's office under careful supervision.
- Immunosuppressants (such as methotrexate or azathioprine) that lower the immune system's activity and prevent inflammation. These are usually reserved for patients with severe diseases that do not respond to other treatments.
- Surgery that removes scarred or cancerous tissue from the vulva or penis. This is usually done as a last resort when other treatments fail or when there is a high risk of cancer.

Self-Care for Lichen Sclerosis

In addition to medical treatment, some self-care measures can help manage lichen sclerosis and prevent flares. These include:

- Keeping the genital area clean and dry
- Avoiding irritants such as soap, perfume, douches, wipes, or pads
- Using gentle moisturizers or emollients to hydrate the skin
- Wearing loose-fitting cotton underwear and clothing
- Avoiding scratching or rubbing the affected area
- Applying cool compresses or ice packs to relieve itching
- Using lubricants during sex to reduce friction and pain
- Practicing safe sex and using condoms to prevent infections
- Seeking psychological support or counseling if needed

Lichen Sclerosis Prevention

There is no way to prevent lichen sclerosis from developing, but regular follow-up with a GYN specialist can help monitor the condition and detect any changes or complications early. It is recommended that women with lichen sclerosis have a pelvic exam every six to 12 months to check for signs of scarring or cancer. Any new symptoms, such as bleeding, ulceration, or change in color or size of the lesions, should be reported to the doctor as soon as possible.

Lichen sclerosis is a chronic and sometimes debilitating condition that affects the genital and anal skin. However, with proper treatment and care, it can be managed effectively, and the quality of life can be improved. If you have any questions or concerns about lichen sclerosis, contact us today.

Complete Healthcare for Women - Obstetrics and Gynecology

509-392-6700

Richard Lorenzo, D.O.

Kortney Jones ARNP

Author

Richard Lorenzo, DO Dr. Lorenzo is also a Fellow of the American Congress of Obstetricians and Gynecologists and a Fellow of the American College of Osteopathic Obstetricians and Gynecologists. He provides gynecological and obstetric services, including prenatal care, pregnancy care, infertility, and gynecology. Dr. Lorenzo is proficient in advanced surgical techniques, including minimally-invasive procedures, as well as surgery for abnormal uterine bleeding, endometriosis, and hysterectomy. He has specialized training in high-risk obstetrics and minimally invasive surgical techniques, including minimally invasive hysterectomy.