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

LICHEN SCLEROSUS

Lichen sclerosus is a skin disease that occurs most often on the vulva. The cause is unknown. However, many physicians believe that it occurs when the immune system, that part of your body that fights off infection, becomes overactive and attacks the skin.

Lichen sclerosus usually causes itching, and in later stages, easy bruising, tearing, and pain. Skin affected by lichen sclerosus is usually white, and sometimes there is a fine, crinkled texture. If untreated, lichen sclerosus often causes scarring, and the opening of the vagina can narrow. Usually, lichen sclerosus does not affect other skin, but about one woman in ten has a few scattered white spots in other areas. Those spots almost never itch or cause symptoms in any way.

In the past, lichen sclerosus was treated with testosterone ointment, which was not very useful for most women. Fortunately, there is now excellent treatment of this disease. A very high potency cortisone ointment usually returns the skin to its original color and texture, although it does not reverse scarring. The usual medications are clobetasol propionate, difluorasone diacetate, betamethasone dipropionate in augmented vehicle, or halobetasol, used once or twice a day. There is a slight increase of trivial infections during the first few weeks until the skin returns to normal, especially for women who are postmenopausal and not receiving estrogen replacement, and in girls before puberty. Also, the medication can irritate some patients. Therefore, brief setbacks are common during the first month or two, but don't get discouraged. Ultimately, women with lichen sclerosus do extremely well.

Most women need three to five months of daily ultrapotent cortisone treatment. Women are generally examined every month while using this medicine daily, because sometimes the skin can thin from too much cortisone. After the skin has returned to a normal texture, the cortisone is used about three times a week to prevent return of lichen sclerosus. Also, women should follow-up with a doctor every 6 months. This is to watch for return of lichen sclerosus or signs of side effects from the cortisone. Also, patients with untreated lichen sclerosus have a slightly increased risk of skin cancer in the vulvar area. With regular checkups and use of the topical steroid, this should not become a problem.