Lichen sclerosus (LS) is an inflammatory skin condition of unknown cause 1. Research studies have discovered the immune system in an abnormal response produces anti-bodies to components of the skin in the tissues that nourish and support it called the extracellular matrix. These antibodies initiate a complex cascade of cellular factors and chemical mediators (cytokines) that in normal circumstances, heal damaged skin and tissues. This process once triggered results in the classic symptoms of itching and soreness. After a time, this ongoing inflammatory process causes noticeable changes in the skin, click on the links below to see photos of what this can look like. The skin becomes much paler with white areas, the skin can split (fissure), some areas can become thickened and raised, the inner lips fo the vagina(labia minora) can become fused together “burying” over and sealing up the clitoris, figure 4. This skin changes make penetrative sex painful and difficult. If left untreated and unobserved there is a risk of about 1 in 20 of developing a type of skin cancer called squamous cell carcinoma.
Symptoms of Lichen Sclerosus – How to Check if You May Have It
If you have gone through the menopause and develop itching of the skin around the lips of the vagina, an area called the vulva you may have lichen sclerosus. If you are still having periods, itching is more likely to be a symptom of thrush, caused by a yeast called candida that can be treated with either oral tablets or vaginal pessaries. Sometimes itching when you have gone through the menopause is due to lack of local oestrogen and this can be relieved with a course of oestrogen cream or oestrogen pessaries. You can also check the colour of the skin of the around the opening of the vagina. If this appears white and the skin of the labia are stuck together you could have lichen sclerosus. Penetrative sex can be both painful and difficult and the skin at the opening of the vagina can split, causing burning and stinging.
If in doubt, consult a medical professional for a full diagnosis.
General Advice to Help with Symptoms of Lichen Sclerosus
As a general rule, avoid contact with soap, shampoo and bubble bath as the chemicals in these products can irritate and trigger an inflammatory response of the skin and a “flare up” of symptoms. Instead simple emollients can be used as a soap substitute (such as Dermol lotion, aqueous cream, E45 wash) and a general moisturiser (such as Balneum, Cetraben, Diprobase, Oilatum cream E45 and Doublebass.) Also avoid tight fitting garments which may irritate the area and also spermicidal lubricated condoms, which again can irritate the skin. If you’re not sure, always consult a trained doctor.
How to Treat Lichen Sclerosus
Lichen Sclerosus if left untreated is a horrible chronic skin condition that can really affect the quality of your life and have a major impact on intimacy with your partner. It can often leave you embarrassed, not listened to, tearful, frustrated and at your wits end. However for the majority of patients when diagnosed and treated appropriately your symptoms can be managed and controlled and you can still enjoy being intimate with your partner.
Ultra-potent topical steroids such as Clobetasol proprionate (one common branded version is Demovate) are the mainstay of treatment and are commonly prescribed in various regimens. A typical regime is to use daily for one month, alternate days for one month and twice weekly for one month. It can then be used as needed depending on symptoms. There is no evidence on the optimal regimen. Occasionally the steroid cream can give a burning sensation when first applied, but this generally disappears after 10 minutes. Ointments are often prescribed over creams, these tend to be “greasier” but don’t dry the skin and can be more soothing.
What Happens if Lichen Sclerosus is Left Untreated?
Lichen sclerosus is a type of chronic skin condition that can turn into skin cancer. In one Finnish study which looked at 7616 women with lichen
sclerosus the risk of a skin cancer called a squamous cell carcinoma was
up to 5% or a risk of 1 in 20 Lichen sclerosus and risk of cancer.
Studies have also found a small increased risk of vaginal cancer. It is
therefore important that you seek treatment for your lichen sclerosus.
There are no national guidelines about the frequency of follow up and
review, but if your symptoms worsen and your skin changes then report
this to your doctor. It is my current practise to offer all patients
with lichen sclerosus an annual check up.
What causes lichen sclerosus to flare up?
The exact cause of lichen sclerosus is unknown and this makes it hard
sometimes to understand why you can get a flare up of your symptoms from time to time. Some patients report perfumed soaps, certain types of
washing powders, detergents or bubble baths can trigger a flare up. For
some it is heat, tight fitting clothes or friction from sexual
intercourse. It is thought that lichen sclerosus has an autoimmune
element to it, so anything that can affect the autoimmune system in an
adverse way such as stress, may also play a part. For a lot of patients
who suffer with lichen sclerosus, frustratingly flare ups often occur
for no apparent reason.
Mona Lisa Touch Therapy for Lichen Sclerosus
There is now emerging evidence that Mona Lisa Touch can be used to successfully treat lichen sclerosus as an alternative to topical steroids or to disease that is unresponsive. One study in 20201 published results of 72.5% improvement, with a statistically significant reduction in vaginal pain, itching, painful sex and pain on passing urine. Another study2 published in the same year in the Menopause Journal followed up 100 women who had not responded to long term ultra-potent steroids. The research reported a significant improvement in itching, dryness and pain after two CO2 cycles. They reported no systemic or local adverse effects during or following laser treatment and reported “Fractional micro-ablative CO2 laser treatment is a safe and effective rescue procedure for patients suffering from lichen sclerosus who fail to respond to long-term ultra-potent topical corticosteroid treatment.”
So don’t despair.
If you think you might have lichen sclerosus or the treatment plan you have been prescribed is not working then ask your doctor to be referred to a Gynaecologist at your local hospital. Alternatively, as a trained Gynaecologist with over 25 years’ experience, Mr A Alexander Taylor can provide treatment and advice for a range of women’s health concerns including lichen sclerosus. Based privately in Bournemouth, contact Mr Taylor to arrange an appointment.
What Does Lichen Sclerosus Look Like?
1 2014 UK National Guideline on the Management of Vulval Conditions Clinical Effectiveness Group British Association for Sexual Health and HIV https://www.bashh.org/documents/UK%20national%20guideline%20for%20the%20management%20of%20vulval%20conditions%202014.pdf
2 Balchander D, Nyirjesy P. Fractionated CO2 Laser as Therapy in Recalcitrant Lichen Sclerosus. J Low Genit Tract Dis. 2020 Apr;24(2):225-228.
3 Pagano T, Conforti A, Buonfantino C, Schettini F, Vallone R, Gallo A, Avino L, Alviggi C, De Placido G, Sopracordevole F. Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study. Menopause. 2020 Apr;27(4):418-422.