Lichen Sclerosus is a chronic dermatologic condition that involves thinning and inflammation of the skin. It can be found anywhere on the body. However, in women it most commonly affects the vulva. Lichen sclerosus is most often seen among post-menopausal women. The cause of this disorder is unknown. People with lichen sclerosus often have a personal or family history of autoimmune disorders. The usual presentation is vulvular itching. It can also cause vulvular burning and painful intercourse. Some women are asymptomatic and the condition is found incidentally during a regular visit.
On examination, the vulvular skin appears thin and white. It is typically found on the labia minora and labia majora. With progression of the disorder, there can be fusing of the skin involving the labia with loss of the clitoral hood. Thinning of the skin can make the area sensitive and bleeding with intercourse can occur. The intense itching can lead to scratching which in turn can cause trauma to the skin of the vulva. Where there is trauma, inflammation can occur which can lead to thickening of the skin, fissures and even infection. The thickened areas of skin have been found to be a risk for developing vulvar cancer. Therefore, routine examination is recommended to monitor for changes in skin thickness.
The goal of treatment for lichen scelrosus is to control the symptoms of vulvar itching and burning. Corticosteroid ointments or creams are most commonly prescribed for lichen sclerosus. A medium to high potency steroid ointment is typically used to control symptoms. The most common steroid medication prescribed is Clobetasol ointment. If the skin is unresponsive to ointment then steroid injections can be used. Other treatments include vaginal estrogen to help keep skin healthy and tacrolimus cream to modulate the immune system and decrease inflammation.
If thickened areas are seen on exam, a biopsy may be recommended to exclude vulvar cancer and for correct diagnosis. The use of hypoallergenic agents to moisturize the skin can help prevent trauma to the underlying compromised skin. For example, Vaseline is often used to maintain moisture.
Lichen scelrosus is a skin disorder that can cause emotional and physical discomfort. With prop[er care, symptoms can be controlled with simple treatment. Regular exams to monitor for skin changes are recommended. If you think you may be suffering from symptoms if lichen sclerosus or other vulvar conditions, please schedule and appointment at McDowell Mountain Gynecology with Dr. Kimberly Hartzfeld at 480-483-9011.
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