I recently received a diagnosis for a problem I’d tried to silently manage for too long: vulvar itching. I put off going to the doctor until it was so intense it was keeping me up at night. The diagnosis came as a surprise because it’s something I had never heard of—lichen sclerosus. Can you tell me more?
If you’ve never heard of lichen sclerosus (LS), you’re not alone. This chronic, inflammatory skin condition is not rare, though it’s not common, either. Plus, it’s not the most comfortable subject of conversation: LS usually affects the genital area—around the vulva and anus in women and the head or shaft near the head of the penis in men—causing patches of skin to become thin, white, and wrinkly (akin to tissue paper) or sometimes rough and raised. The most common symptom is vulvar itching (sometimes intense, as you know), and over time the skin changes can lead to problems like pain during sex or trouble urinating.
LS can affect anyone, but it most commonly strikes women during or after menopause. Because of that, hormonal changes have been suspected as a contributing factor. But it’s more complicated than that, and researchers believe that genetic susceptibility and abnormal immune system activity play important roles: People with LS have a heightened prevalence of autoimmune diseases such as type 1 diabetes, vitiligo, alopecia areata, and certain thyroid conditions.
LS is not an infection and cannot be sexually transmitted. Nor does it have anything to do with hygiene.
While the signs and symptoms of LS can be distressing, there is good news. The condition is often relieved with high-dose corticosteroid ointment or cream (often clobetasol), which, as the first-line treatment, reduces inflammation and itching and can also improve skin appearance and prevent painful scarring. It’s applied daily for several weeks, followed by a tapering regimen. After that comes “maintenance” therapy, using ointment or cream once or twice a week (or more frequently, as prescribed by your doctor) to keep symptoms at bay.
Long-term follow-up is necessary because (the bad news), there is no cure for LS, and symptoms are likely to flare up again. Also, patients on high-potency topical corticosteroids need to be monitored because the medication can cause skin atrophy.
If topical therapy fails to do the job, intralesional corticosteroid injections—given monthly for a few months, and then on a maintenance schedule—are generally the next go-to. In some particularly stubborn cases, other topical medications, like tacrolimus (a treatment for severe eczema) or retinoids (a vitamin A derivative), may be tried. Ultraviolet light therapy can often quell symptoms in women who have tried topical therapy, but this approach is much less practical and more expensive and is reserved for more difficult cases—though few doctors’ offices offer it.
To help keep symptoms at bay, some dermatologists also recommend avoiding tight undergarments, scented soaps, and feminine sprays and trying not to scratch or rub the area (pat dry after washing).
Not surprisingly, LS can take a toll on daily functioning and well-being. A study published in PLOS ONE in 2023 found that compared with other women their age, women with LS reported more depression symptoms, less satisfaction with their sex life, and diminished productivity at work.
As for physical health complications, LS can cause scarring (which may require surgery if it impacts sexual activity, for instance) and it carries a small risk of lesions on the vulva becoming cancerous. Fortunately, those risks can be greatly reduced with timely diagnosis and treatment.
That’s why it’s critical to talk to your doctor (whether your primary care physician, gynecologist, or a specialist in the condition) about any persistent genital itching, discomfort, or skin changes. There’s no reason to be embarrassed or suffer in silence. LS is highly treatable, and additional approaches are being investigated, including new topical drugs, laser surgery, and injections of platelet-rich plasma. So in the near future, there could be more options for keeping the condition under control.
