Information from Libby Edwards, MD - Mid-Charlotte Dermatology & Research

LICHEN PLANUS

Lichen planus is a skin disease that sometimes affects the vulva, vagina, and inside of the mouth. Although lichen planus more often affects skin on the outside of the body, most patients who have lichen planus of the genital area do not have involvement of other outside skin surfaces.

Skin affected by lichen planus can either be white, or can have superficial ulcerations. The genital areas that are white are usually itchy, whereas those areas with superficial ulcerations usually are sore and painful.

The cause of lichen planus is believed to be an over-active immune system. The immune system is that part of the body that protects us from infections. Lichen planus is one of several skin diseases that occurs when the immune system becomes over-active and attacks skin.

The treatment for lichen planus is aimed at fooling the immune system so that it doesn't attack the skin. Although some medications, especially oral cortisone, or prednisone, depress the immune system a great deal and induce healing or the skin, this degree of immune suppression is dangerous when used for a long time, and leaves a patient susceptible to uncontrolled infections. Therefore, prednisone is used only briefly to help heal skin, and only if absolutely necessary. Then, we try to control lichen planus with topical cortisone creams or ointments, or other medications that do not suppress the immune system to a dangerous degree.

Before the skin heals, minor infections of the areas involved with lichen planus sometimes occur. For this reason, some patients are given medication to prevent this, or are advised to call for worsening symptoms.

For patients who do not respond well to topical cortisones applied to the area, there are other treatments that can be used. This includes topical or oral cyclosporine, and other medications that partially suppress the immune system.

Untreated or severe lichen planus sometimes produces scarring. When the vagina is involved, the vaginal walls can scar together so that intercourse is no longer possible. Because of this, either regular intercourse or the insertion of a vaginal dilator on a daily basis should be performed so that scar tissue does not close the vagina.

Often, multiple visits and several different medications are required to control lichen planus. Although the treatment of white skin caused by lichen planus is usually easy, lichen planus that has produced sores and ulcerations is sometimes difficult to treat and requires multiple visits and trial-and-error therapy. However, most patients improve significantly.