Understanding Lichen Sclerosus: A Chronic Inflammatory Skin Disease
Lichen sclerosus is a chronic inflammatory skin disease that affects the vulva, causing it to thin, become whitish, and lose its natural elasticity. According to Dr. Tomás Gómez, a gynecologist and medical director at Centro AIMA in Malaga, “It is not an infection, nor is it contagious.” The disease is considered underdiagnosed, as its symptoms, such as persistent itching and vulvar discomfort, are often misdiagnosed as recurrent infections, dryness due to menopause, or non-specific inflammatory reactions of the skin.
Symptoms and Diagnosis
The main symptom of lichen sclerosus is persistent and recurrent vulvar itching (pruritus), which is usually very intense and often worse at night. Dr. Gómez emphasizes that “if a woman has itching and the fungal treatment does not work, she should be evaluated by a specialist to rule out lichen sclerosus.” The skin in the affected area loses thickness and elasticity, making sexual intercourse painful, with a feeling of tightness or “cutting,” especially in the lower part of the vaginal entrance. The affected regions may also acquire a pearly-white color due to the destruction of melanocytes and changes in sclerosis and atrophy that reduce vascularization.
Alterations in the anatomy of the vulva, such as small cracks, disappearance of the labia minora, entrapment of the clitoris under the skin that covers it (phimosis), or even partial or total closure of the vaginal entrance (stenosis), can be observed in more severe cases. Dr. Gómez notes that “in most cases, the temporary symptom ends up being treated without seeing the underlying disease,” which delays the actual diagnosis.
Prevalence and Risk Factors
Lichen sclerosus is estimated to affect 1 in 70-80 women, although the real figure is likely higher. The disease occurs more frequently in girls before puberty and in women after menopause, as sex hormones have a stimulating action on the skin of the vulva. Dr. Gómez explains that “after menopause is when we diagnose it the most because the drop in estrogen can aggravate the symptoms or act as a trigger for triggering the disease in genetically predisposed patients.”
If left untreated, lichen sclerosus can progress, and there is a 5% risk of developing vulvar cancer. Treatment significantly reduces this risk, emphasizing the importance of proper diagnosis and management.
Treatment Options
Hydration with constant use of emollients and specific oils can provide symptomatic relief, but the origin of the disease is the local immune response of the vulva, and it must be acted upon to prevent progression. The best treatment is the use of high-potency corticosteroid cream, which is a lifelong treatment that requires weekly maintenance applications, increasing or decreasing the dosage depending on the symptoms.
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