As a vulvovaginal expert, I treat many vulvar skin conditions. One of the most common genital skin conditions that I treat is Lichen Sclerosus. Lichen sclerosus is a chronic inflammatory skin condition that primarily affects the genital area, although it can also occur in other parts of the body. It is most common in postmenopausal women, but can also affect women and men of all ages, and children too. About 3% of the population is affected by Lichen Sclerosus.
The exact cause of lichen sclerosus is unknown, but it is thought to be an autoimmune disorder, where the body’s immune system mistakenly attacks healthy tissue. It can also be triggered by hormonal imbalances, skin trauma, or genetic factors.
Symptoms of lichen sclerosus can vary but often include itching, pain with intercourse, tearing of the skin most commonly at the entrance of the vagina, and changes in the appearance of the skin. Symptoms and skin changes can flare throughout time and can progress. The affected skin may become thin, white, and wrinkled. In severe cases, scarring and narrowing of the vagina and clitoral adhesions can occur. Even if your lichen sclerosus does not seem to bother you, it is very important to see your doctor regularly for an exam as 4% of the time, the lichen sclerosus can turn into vulvar cancer. This is very treatable when found early. Make sure to regularly examine yourself with a mirror to learn what your vulva looks like. If and when you see changes, come to your doctor to evaluate them.
While there is no cure for lichen sclerosus, treatment can help manage symptoms, put this skin condition into remission, and in severe cases, surgically restore the anatomy and improve quality of life. Currently, the standard of care for treating lichen sclerosus is daily, high-dose topical steroid ointments. Other treatment options have been studied and shown to treat Lichen Sclerosus as well, and I commonly use them in my practice in conjunction with topical steroid ointments to achieve remission and prevent further progression of the disease. These options can also be used in cases where topical steroid ointment has not been helpful.
Here are other treatments that have been studied and shown to work as well and may be used in conjunction with topical steroids.
Topical estradiol and testosterone cream: Topical hormones on the vulva, for women of all ages, are very helpful and important in strengthening the tissue, and helping with lubrication, especially as topical steroid ointment can thin the skin. This is very safe and will absolutely NOT cause cancer.
Clitoral lysis of adhesions: Generally, up to 20-30% of women without lichen sclerosus have some degree of clitoral adhesions. In lichen sclerosus, it is a lot more common to have clitoral adhesions as the fusing of the labia occurs. Women can have no symptoms at all or can experience loss of clitoral sensation, difficulty with orgasm, and even clitoral pain. In my office, I perform non-surgical lysis of clitoral adhesions to help restore the anatomy.
CO2 laser treatment sessions with PRP or exosomes.
In my office, I use the MonaLisa CO2 laser in conjunction with PRP or exosomes, depending on the patient. People have had significant improvement in the appearance of the skin and considerable correction of their sexual pain. PRP (Platelet-Rich Plasma) is derived from the patient’s blood and contains a concentrated amount of growth factors, stem cells, and healing components. During the PRP therapy for Lichen Sclerosus treatment, a small sample of the patient’s blood is taken and processed to separate the PRP. The PRP is then carefully injected into the vulvar tissues, promoting cell regeneration, and stimulating collagen production and healthy tissue growth.
The quality of PRP though is only as good as the patient donating it. If someone is frail, on immunosuppressants, or generally not well, the quality of PRP is diminished. That is where Exosomes come in. Exosomes have billions of growth factor particles processed in a lab for consistent results of wound repair and remodeling every time.
Carboxytherapy, or carbon dioxide therapy, is a non-surgical treatment for a variety of skin concerns and medical conditions. During treatment, gaseous carbon dioxide (CO2) is injected into the skin or applied topically for 10 to 15 days with CO2LIFT. This works particularly well with lichen sclerosus in the anal area. The body rejects the presence of CO2 and interprets it as a lack of oxygen. Blood flows to the area to deliver a powerful oxygen boost and promote healing and tissue regeneration to combat the perceived deficiency. The process creates better blood circulation, the formation of new blood vessels, and improved metabolism while stimulating the production of the growth factors collagen and elastin for total skin rejuvenation. (if you were wondering, you can use carboxytherapy on the face too!)
Radiofrequency microneedling with or without exosomes :
Utilizing radiofrequency with microneedling is another excellent tool we can use to help treat lichen sclerosus. Studies have been very promising with consistent and exceptional results.
Although Exosomes for this purpose have yet to be studied, we can extrapolate from the data we do have, that this should be helpful. I am working on studying this now in my own office.
In addition to medical treatments, there are also lifestyle changes and natural remedies that can help manage symptoms and improve the quality of life for those with lichen sclerosus. Following these steps, along with regular check-ups with your doctor can help you manage this condition and improve your overall well-being.
- Use gentle, fragrance-free soaps and moisturizers to keep the affected area clean and hydrated. Avoid harsh chemicals or irritants that can exacerbate symptoms.
- Wear loose-fitting clothing made from soft, breathable fabrics to reduce irritation and friction on the skin.
- Practice good hygiene habits, such as keeping the genital area clean and dry. Avoid using perfumed products or douches, as they can irritate the skin. Remember, the skin of the vulva just needs water. 😉
- Some people find relief from symptoms by applying aloe vera gel, coconut oil or Emu oil to the affected area. These natural remedies can help soothe the skin and reduce itching.
- Changing your diet to avoid inflammatory foods like dairy or gluten may be helpful. Some people find low oxalate diets are helpful.
- Seeing a pelvic floor physical therapist is always a great idea. Strongly recommend a pelvic floor physical therapist to assess what areas they can help with and improve functionality.
- Keep in touch with your doctor to monitor your condition and adjust your treatment plan as needed.
Happy to see you in my office and we can make a tailored plan for you!
