Vulvar Health: Lichen Sclerosus


What is LS?


Lichen sclerosus (LS) is a benign, chronic, progressive condition affecting the skin of the vulva, which is characterized by severe inflammation, changes to skin thickness (thinning or thickening) and hypo-pigmentation (loss of pigment), scarring down of the vulvar tissues such as the clitoral hood, and loss of vulvar anatomy (including partial or total resorption of the labia minora) if left untreated. These skin and anatomical changes are accompanied by symptoms of itching, burning and pain. Women with vulvar LS are at increased risk of developing squamous cell cancer (SCC) of the vulva.


LS typically occurs in the ano-genital area: with 85-98% of cases affecting the vulva, perineal, and peri-anal area, but it can occur on other skin areas. Vulvar LS can occur at any age, from infancy to elder age, but usually two peaks of onset: pre-pubertal girls and peri-menopausal or post-menopausal women.


Once present, condition is chronic and lifelong: there is no cure, but there are safe, effective, and well-established treatments. Early diagnosis and appropriate treatment is important to prevent transformation to cancer of the vulva, and also to prevent pain, scarring, psychosocial distress and sexual dysfunction that often accompanies the disfiguring physical changes and discomfort associated with untreated LS. These changes can be prevented, and in some cases reversed (to a certain degree) with treatment.


What Causes LS?


The cause of LS is unknown. Proposed mechanisms include genetic factors, hormonal factors, auto-immunity, and cell- and vulvar-specific factors.


How is LS Diagnosed?

LS may be diagnosed clinically based on a physical exam by a physician, who may take a small biopsy to confirm the condition.


How is LS Treated?


The treatment with the best evidence for safety and efficacy is topical corticosteroids (of appropriate strength), prescribed based on the severity and course in the disease, which usually needs to be used life-long, at a frequency recommended by your physician, in conjunction with regular follow-up.


On her podcast, The Vulva Diaries, Toronto-based gynaecologist and President of the International Society for the Study of Vulvovaginal Disease (ISSVD), Dr. Amanda Selk weighs in with dermatologist and expert in lichen sclerosus, Dr. Gayle Fischer, about the new and best treatments for this chronic condition. Bottom line? Topical steroids remain the treatment of choice. Newer treatments such as topical calcineurin inhibitors, laser therapy, platelet rich plasma injections do not have the same level of evidence for effectiveness to support their use as first-line treatment. There is no evidence to support the use of natural remedies to treat LS.