Lichen sclerosus
Lichen sclerosus is one form of vulvar dystrophy. With lichen sclerosus,
the skin of the vulva is too thin.
Clinically, women with lichen sclerosus complain of chronic vulvar itching
and irritation. Tissues may be fragile, tear easily and result in superficial bleeding.
Using only casual observation, the vulva may appear normal, but closer inspection will
reveal a whitish discoloration and loss of anatomic differentiation of the vulvar
structures.
It may be difficult, without a vulvar biopsy, to distinguish lichen
sclerosus from the other forms of vulvar dystrophy (hypertrophic vulvar dystrophy and
mixed dystrophy). For this reason, women suspected of having lichen
sclerosus usually
undergo vulvar biopsy to confirm the diagnosis.
Lichen sclerosus can occur in any age group, is not related to lack of
estrogen, and its' cause is not known.
Strong topical steroids, such as clobetasol or
betamethasone have been studied in multiple centers, and in general are
probably the most effective currently-available treatment:
-
0.05% clobetasol propionate cream is applied to the vulva twice daily
for one month, than at bedtime for one month and then twice a week for three months. It is
then used as needed one or two times per week. Using this approach, 95% of patients will
notice significant improvement and 75% will report complete remission of symptoms.
In the past, the most effective available
treatment consisted of topical testosterone. This treatment can still be
effective, but the percentage of responders is less than with strong
topical steroids.
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