Dr Sherene Kalloo

Lichen Scle­ro­sus is a long-term skin con­di­tion that af­fects the vul­va and some­times the anal area. It caus­es thin­ning of the skin, whiten­ing, itch­ing, dis­com­fort, and in some cas­es, scar­ring.

While there is cur­rent­ly no per­ma­nent “cure,” it is a high­ly treat­able con­di­tion and most women achieve ex­cel­lent symp­tom con­trol with the right man­age­ment.

The goals of treat­ment are sim­ple and very im­por­tant:

• Re­lieve itch­ing and pain

• Re­store and pro­tect vul­val skin in­tegri­ty

• Pre­vent scar­ring and anatom­i­cal changes which may cause painful sex­u­al in­ter­course.

• Re­duce the small long-term risk of vul­var can­cer

First-Line Treat­ment: Top­i­cal Steroids (Gold Stan­dard)

The main­stay of treat­ment is a strong top­i­cal steroid oint­ment.

The most com­mon­ly used is:

• Clo­be­ta­sol pro­pi­onate

De­spite the word “steroid,” when used cor­rect­ly on the vul­va, in ex­treme­ly small quan­ti­ties, it is safe and life-chang­ing for most pa­tients.

How it is used (typ­i­cal ap­proach)

Treat­ment is usu­al­ly di­vid­ed in­to phas­es:

1. Ini­tial (in­duc­tion) phase – about 12 weeks

• Ap­plied once dai­ly (or as pre­scribed)

• A thin lay­er on­ly on af­fect­ed ar­eas

• Aimed at calm­ing in­flam­ma­tion and stop­ping ac­tive dis­ease

2. Main­te­nance phase

• Re­duced fre­quen­cy (for ex­am­ple 1–2 times week­ly)

• Pre­vents re­lapse and long-term dam­age

Cor­rect use is ex­treme­ly im­por­tant. Un­der-treat­ment is com­mon and leads to on­go­ing symp­toms, while ap­pro­pri­ate use is safe and pro­tec­tive.

Mois­turis­ers and

Skin Care Sup­port

Along­side med­ical treat­ment, gen­tle skin care is es­sen­tial:

• Use bland emol­lients (e.g., pe­tro­le­um jel­ly-based prod­ucts)

• Avoid soaps and in­ti­mate wash­es

• Wash with wa­ter on­ly or very mild cleansers

• Keep the area dry but not over-dried

• Avoid scratch­ing (eas­i­er said than done, but im­por­tant)

Emol­lients do not re­place steroids but help main­tain com­fort and skin bar­ri­er func­tion.

Treat­ment of Symp­toms

(Itch­ing and Dis­com­fort)

When symp­toms are se­vere, ad­di­tion­al sup­port may in­clude:

• Short-term an­ti­his­t­a­mines at night (to re­duce itch-scratch cy­cle)

• Bar­ri­er creams to re­duce fric­tion

• Pain re­lief if fis­sures or cracks are present

How­ev­er, con­trol­ling in­flam­ma­tion with top­i­cal steroids re­mains the most ef­fec­tive ap­proach.

When Treat­ment Needs Ad­just­ment

If symp­toms do not im­prove, a gy­nae­col­o­gist will con­sid­er:

• In­cor­rect ap­pli­ca­tion or in­ad­e­quate dose

• On­go­ing ir­ri­tants (soap, pads, tight cloth­ing, fric­tion)

• Sec­ondary in­fec­tion or der­mati­tis

• Mis­di­ag­no­sis or over­lap with oth­er con­di­tions (eg, lichen planus or VIN)

• Need for biop­sy to con­firm di­ag­no­sis

A vul­var biop­sy may be rec­om­mend­ed if there are atyp­i­cal ar­eas or a poor re­sponse to stan­dard ther­a­py.

Surgery: Rarely need­ed to­day

In the past, surgery was some­times per­formed for se­vere dis­ease. To­day, this is un­com­mon.

Surgery may on­ly be con­sid­ered for:

• Sig­nif­i­cant scar­ring caus­ing nar­row­ing of vagi­nal open­ing

• Sus­pi­cion of can­cer or pre­can­cer­ous change

• Rare se­vere anatom­i­cal com­pli­ca­tions

Most women do not re­quire sur­gi­cal treat­ment.

Long-Term Fol­low-Up Is Es­sen­tial

Lichen Scle­ro­sus is a chron­ic con­di­tion. Even when symp­toms im­prove, on­go­ing mon­i­tor­ing is im­por­tant.

Reg­u­lar fol­low-up al­lows the doc­tor to:

• Ad­just treat­ment if need­ed

• En­sure cor­rect steroid use

• De­tect ear­ly signs of skin change

• Re­as­sure the pa­tient

Most women are re­viewed every 6–12 months once sta­ble.

Can Lichen Scle­ro­sus Be Cured?

There is cur­rent­ly no per­ma­nent cure, but the con­di­tion is very con­trol­lable.

With con­sis­tent treat­ment:

• Itch­ing of­ten re­solves com­plete­ly

• Skin can re­main healthy and sta­ble

• Scar­ring can be pre­vent­ed

• Qual­i­ty of life im­proves sig­nif­i­cant­ly

Ear­ly di­ag­no­sis makes a ma­jor dif­fer­ence.

Key Mes­sage for Pa­tients

Lichen scle­ro­sus is of­ten dis­tress­ing at first di­ag­no­sis, but it is im­por­tant to know:

• It is not in­fec­tious

• It is not caused by poor hy­giene

• It is high­ly treat­able

• Long-term com­pli­ca­tions are large­ly pre­ventable with prop­er care

Women should feel com­fort­able seek­ing help ear­ly rather than silent­ly en­dur­ing symp­toms.

Dr Sherene Kalloo

MDW, MBBS, DGO, DM, FACOG

Spe­cial­ist Ob­ste­tri­cian & Gy­nae­col­o­gist