To finish up our review of lichen sclerosus, I want to leave you with some important points:
- Pruritus is the most common symptom, occurring in 99% of women, vulvar irritation occurs in 60%, and vulvar burning and painful sex in 30%
- High potency corticosteroids are the treatment of choice with 80% experiencing complete remission
- Clobetasol 0.05% ointment is the medication most often prescribed
- Ointments are used instead of lotions because of less irritation, and there are rarely any adverse effects with long-term use
- The treatment protocol usually entails a few months of daily use, followed by a gradual decease, then followed by use as needed
Find about more about lichen sclerosus in: Could You Have Lichen Sclerosus?
At the recent Female Sexuality conference I attended, much attention was spent discussing vaginal pain. Lichen sclerosus, a long-term skin condition which mainly affects the vulva, was a condition thoroughly discussed. I knew it was a common problem, affecting 1 in 70 women, and over my career there have been many patients who I cared for with this condition.
In women, the genital and anal areas are mostly affected but it can appear on the upper body and breasts. Females of any age can develop lichen sclerosus, but it is most common in post-menopausal women with the median age of onset at 51.
Early in the condition, it presents as small shiny smooth white spots or depigmented areas, which can be tender and very itchy. It is often misdiagnosed as a yeast infection, herpes, or vitiligo. With time, the spots can progress to bigger patches, and the skin can become thick and crinkled. The skin can tear easily as the disease progresses. When severe scarring has developed, the lips of the vagina can shrink, the vaginal opening can become narrowed, and the clitoris may be covered with scar tissue.
Continued in: Treatment for Lichen Sclerosus