The vulval skin appears white and there may be some cracks. The resulting scarring leads to destruction of the normal vulval anatomy with a tendency for the labia minorae to shrink and the clitoris may become hidden. The diameter of the introitus (vaginal entrance) may be reduced so that intercourse becomes painful or impossible. The principal symptoms are discomfort and irritation. There is a relationship to autoimmune disease(Q12.17) notably of the thyroid gland.
The exact cause of this condition is not known. There have been many names applied to chronic vulval skin conditions. These have included leucoplakia, kraurosis vulvae, Bowen’s disease and Paget’s disease. At one time they were all grouped as vulval dystrophies. With lichen sclerosus, there are inflammatory cells below the skin. Biopsy of the affected vulval skin is sometimes undertaken to confirm the diagnosis although it is now considered reasonable to confine biopsy to patients who do not respond to local medication.
Although patients presenting with cancer of the vulva often have associated lichen sclerosus, most patients with lichen sclerosus will never develop vulval cancer. To provide reassurance, however, gynaecologists tend to keep patients with lichen sclerosus under review.
At times it may be appropriate to take a small vulval skin biopsy and assess it under the microscope - histopathology. Skin biopsy is discussed at http://www. Answers.com/topic/skin-biopsy?cat=health
Related Medical Abstracts - Click on the paper title:-
- Clinical review of 202 patients with vulval lichen sclerosus: A possible association with psoriasis. (2007-01)
- Lichen sclerosus. (2005-01)
- Lichen sclerosus of the vulva in women: assessment, diagnosis, and management for the nurse practitioner. (2003-01)
- Lichen sclerosus. A review. (2002-01) Lichen sclerosus (1997-01).
How is lichen sclerosus treated?
Lichen sclerosus is treated by local application of glucocorticoid steroids. There are many steroid ointments and creams for topical application grouped into four strengths very potent, potent, moderate and mild. The tendency was previously to use the weakest ointments and increase in strength until symptoms resolved. Nowadays the recommendation is to use one of the more potent ointments such as Dermovate (Glaxo) for three months and then intermittently as required. These creams should be applied sparingly. As a guide it may be suggested that you squeeze about a half inch length on to the tip of your index finger and this is all that is needed for one application.
Related Medical Abstracts - Click on the paper title:-
- Topical tacrolimus in the management of lichen sclerosus. (2006-01)
- Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus. (2006-02)
- Treatment of lichen sclerosus with antibiotics. (2006-03)
- Lichen sclerosus: a review and practical approach. (2004-01)
- Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases. (2004-02)
- Patient satisfaction after the treatment of vulvovaginal erosive lichen planus with topical clobetasol and tacrolimus: a survey study. (2004-03)
- Does treatment of vulvar lichen sclerosus influence its prognosis? (2004-04)
- Vulvar lichen sclerosus in postmenopausal women: a comparative study for treating advanced disease with clobetasol propionate 0.05%. (2002-01)
- Clobetasol dipropionate 0.05% versus testosterone propionate 2% topical application for severe vulvar lichen sclerosus. (1998-01)
- 1 What skin conditions may affect the vulva?
- 2 Which viral infections can affect the genitalia?
- 3 What problems can occur to people with herpes simplex?
- 4 What are genital warts?
- 5 What is lichen sclerosus?
- 6 How is lichen sclerosus treated?
- 7 What could be causing my vulval irritation?
- 8 How could my vulval irritation be treated?
- 9 What is a Bartholin's cyst / abscess?
- 10 How is a Bartholin's cyst / abscess treated?
- 11 What is vulvodynia?
- 12 How can my vulvodynia be treated?
- 13 What is vestibulitis?
- 14 How can my vestibulitis be treated?
- 15 Where can I obtain further information?
- 16 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
