Lichen sclerosus is a chronic inflammatory disorder of the genital region. It affects one in seventy women. It is most commonly seen in women in their 40s and 50s but 15% are seen in pre-pubertal girls. The cause of lichen sclerosus is thought to be an auto-immune disorder as it is highly associated with other auto-immune disorders. Most women will complain of vulvar itching, vulvar pain and pain with intercourse. On examination the skin will often appear thin and white, with the appearance of cigarette or tissue paper. It can cause anatomical changes in the genital region including scarring or narrowing of the vaginal opening, regression of the labia minora and scarring of the clitoral hood, among other things.
A biopsy is usually necessary to confirm the diagnosis, which can be done in the office with local anesthesia and takes just a few minutes.
The treatment that has been found to be the most successful is an ultra-potent topical corticosteroid ointment, such as clobetasol applied daily. Once the tissue has improved, the woman can use the steroid ointment once or twice a week.
It is important to remember that this is a chronic disorder and that the treatment must be continued as instructed.
And it is very important to remember that women with lichen sclerosus have a 4-6% risk of developing vulvar carcinoma, therefore it is important to follow up with your gynecologist regularly.
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