Lichen sclerosus is a chronic skin disease that mainly affects women, although it can also occur in men. This condition is characterized by the presence of irregular, white plaques on the skin, especially in the genital area and around the anus.
Have you ever wondered “what to do if I have lichen sclerosus?” At Dermnix we tell you everything you should know about this disease. Let’s start!
Overview of lichen sclerosus.
Lichen sclerosus is a chronic, inflammatory skin disease that causes discolored patches and areas of tender skin. Although it can affect any part of the body, it is most common in the genital and anal areas. Although it can occur in people of any age, women in menopause and adolescence are at increased risk of developing this condition.
Lichen sclerosus is not contagious and is not transmitted through sexual contact. Although the exact cause is not known, it is believed to be the result of a combination of factors, such as an overactive immune system, genetic predisposition and previous skin damage or irritation (oxidative stress). In many cases I have observed that lichen sclerosus is present in mothers, daughters and sisters of the same family.
Symptoms of lichen sclerosus
Symptoms of lichen sclerosus may vary from person to person, but generally affect the genital and anal area. Some of the most common symptoms include:
1. White plaques and areas of sensitive and reddened skin.
Painful sexual intercourse.
3. Intense itching of the affected skin that awakens patients at night.
4. Irritation or burning sensation.
5. Bruises that appear easily (ruby spots on labia majora).
6. Fragile skin prone to injury from nighttime scratching.
7. Changes in the urinary tract or difficulty urinating.
8. Bleeding, blisters or open ulcers.
Did you know that some people (up to 33%) may experience no symptoms at all, while others may have more severe symptoms? If you experience any of these symptoms, it is essential to seek specialized medical attention for proper diagnosis and personalized treatment.
Diagnosis of lichen sclerosus
The diagnosis of lichen sclerosus is made by physical examination of the affected skin. In some cases, it may be necessary to perform a biopsy to rule out the presence of cancer or other pathology (lichen planus, eczema, dermatitis, etc.). During a biopsy, a small tissue sample is taken from the affected area under local anesthesia and examined under a microscope to confirm the diagnosis.
Treatment of Vulvar Lichen Sclerosus
Treatment of lichen sclerosus is aimed at relieving symptoms, preventing complications and improving the patient’s quality of life. While there is no definitive cure for this chronic disease, there are several treatment options that can provide relief and control symptoms.
Some of the most common treatment options include:
Corticosteroid ointments
Steroid medicated ointments, such as clobetasol, are often prescribed to treat lichen sclerosus. These ointments are applied directly to the affected skin and help reduce inflammation, relieve itching and restore normal skin color and texture. It is important to follow the doctor’s instructions regarding the frequency and duration of treatment.
Calcineurin Inhibitors
As a second-line treatment, calcineurin inhibitors, such as tacrolimus, may be prescribed as an ointment to treat lichen sclerosus. These medications help reduce inflammation and itching in the affected skin. However, its use is usually reserved for more severe cases or when topical steroids are not effective.
Regenerative Medicine
Regenerative medicine today offers many advantages over traditional treatments. Patients tell how the symptoms that previously prevented them from leading a normal life have disappeared, how their quality of life and their relationships with their partners have improved. The emotional benefit is enormous, they tell us that they forget that they suffer from lichen sclerosus (before they had it present all the time) because the skin no longer pulls, no longer tears, no longer has pain, burning or itching, the mucosa of their vulva has a healthy appearance, etc.
Within regenerative medicine we can use platelet-rich plasma (PRP has growth factors, but NO stem cells), specific hyaluronic acid, stem cells derived from the patient’s fat (Nanofat or SVF).
Many patients come to us saying that they have received stem cells with poor results and when they go deeper into their medical history it turns out that they have only received platelet-rich plasma. It is important to know that stem cell treatment is only given by true lichen sclerosus specialists with the appropriate experience, get informed (ulev.es).
Laser
Laser as a single treatment is not recommended for vulvar lichen sclerosus. It is recommended when there is hyperkeratosis that prevents corticosteroid creams from penetrating.
Surgery
In more advanced cases of lichen sclerosus that do not respond to medical treatment, surgery to restore the vulvar architecture may be necessary to treat problems such as phimosis of the clitoris, synechiae, narrowing of the vaginal opening, etc.
Personal care and self-care
In addition to medical treatment, there are self-care measures you can take to relieve symptoms and prevent complications. Some recommendations include:
⦁ Apply organic and natural moisturizing oils to the affected area to keep the skin hydrated, prevent dryness and have anti-inflammatory properties (such as Dermnix Vulvar Oil, formulated for women sufferingfrom VLS).
⦁ Gently wash the affected area every day with lukewarm water.
⦁ Avoid using irritating products, such as perfumed soaps or lotions containing alcohol.
⦁ Wear cotton underwear of neutral colors and avoid tight-fitting clothing that may irritate the skin.
⦁ Avoid scratching or excessive friction on the affected area. I sometimes prescribe mild antihistamines at night to prevent itching, involuntary scratching and to allow my patients to rest.
⦁ Maintain good hygiene and care of the genital area.
It is important to remember that lichen sclerosus is a chronic disease and symptoms may not disappear completely. However, with the right treatment and proper self-care, it is possible to control symptoms and improve quality of life.
Complications of VLS
Lichen sclerosus may cause complications in some cases. Some of the most common complications include:
⦁ Painful intercourse due to inflammation and narrowing of the vaginal opening, along with tearing and appearance of fissures after intercourse with their partners.
⦁ Scar formation on the skin affected by Koebner’s phenomenon, which may cause deformities or changes in appearance (disappearance of labia minora, phimosis of the clitoris, granuloma fissuratum, narrowing of the vaginal opening, etc.).
⦁ Increased risk of developing squamous cell cancer in the genital area in lichen sclerosus of long evolution and in patients not adequately treated and monitored.
⦁ Urinary problems, such as difficulty urinating or narrowing of the urinary tract.
It is important to seek specialized and experienced medical attention if you notice any of these complications in order to receive proper treatment and prevent possible long-term complications.
Conclusions
Lichen sclerosus is a chronic inflammatory skin disease of the vulvar and perianal area that mainly affects women. Although there is no definitive cure, treatment options are available to alleviate symptoms, improve quality of life, sexual function and control the progression and progression of the disease. It is important to seek medical attention experienced in the diagnosis and treatment of lichen sclerosus if you experience symptoms of lichen sclerosus in order to receive a proper diagnosis and timely treatment tailored to your particular case. In addition, self-care and self-care measures can help prevent complications, flare-ups and improve quality of life. Remember to follow your lichen sclerosus doctor’s instructions and maintain open communication to receive the best possible care.
