Vulvar lichen sclerosus is a benign, chronic, progressive skin condition.

Q: What is vulvar lichen sclerosus?

A: Vulvar lichen sclerosus is a benign, chronic, progressive skin condition that is accompanied by symptoms of vulvar itching and pain. Although lichen sclerosus is not a malignancy, it does carry an increased risk of vulvar cancer. Vulvar lichen sclerosus can occur at any age but tends to peak in perimenopausal or postmenopausal women. This disease can significantly interfere with a woman's quality of life and sense of well-being.

What causes vulvar lichen sclerosus?

The cause of vulvar lichen sclerosus remains unknown. Disorders of the immune system such as systemic lupus erythematosus, diabetes mellitus, and thyroid diseases are more common in patients with vulvar lichen sclerosus, potentially suggesting an autoimmune mechanism.

How is vulvar lichen sclerosus diagnosed?

Although sometimes asymptomatic, most patients present with characteristic clinical symptoms of vulvar itching and irritation. The skin generally appears thin and crinkled and over time involvement may extend down to the perineum and anus. Lichen sclerosus can be detected by careful examination of the vulvar. At times a vulvar biopsy may need to be performed in order to obtain the correct diagnosis. Understandably, the idea of a vulvar biopsy seems foreign; however, it is an office procedure that is well-tolerated and most times extremely helpful in the diagnosis and eventual treatment of vulvar disorders.

Chronic conditions such as psoriasis and Crohn's disease can also cause irritation of the vulvar. The changes of menopause can cause atrophic changes leading to vulvar irritation. Other less commonly known conditions such as lichen planus and lichen simplex chronicus can have similar symptoms. Thus, a biopsy may be needed to confirm the diagnosis.

How is vulvar lichen sclerosus treated?

Curative treatments are not available for vulvar lichen sclerosus. The aim is to control symptoms and prevent progression of disease and distortion of the vulvar anatomy. The first-line therapy is a super potent topical corticosteroid. Even after symptoms resolve, maintenance therapy is recommended to prevent disease recurrence. Common vulvar irritants should also be avoided.

Common vulvar irritants include adult/baby wipes, colored or scented toilet paper, dyes, laundry detergents, fabric softeners, dryer sheets, rubber products including latex, sanitary products including tampons and pads, soaps, bubble baths and salts, tea tree oil, topical medications and vulvar hygiene products including perfumes and deodorant

Dr. Angelle Brebnor is a Fellow of the American College of Obstetrics and Gynecology. Her office is located at 4701 North Federal Highway, Building B, Fort Lauderdale. For appointments, call 954-229-6000.

Angelle Brebnor, MD