Lichen sclerosus in women presents as itchiness, vulvar pain, and pain during intercourse. Lichen sclerosus can look like porcelain white plaques and papules resembling “cigarette paper.” Other complications include fusion of vulva lips, clitoris burying, disruption of vulvar opening, and ulceration.

Lichen sclerosus can be classified as an autoimmune disease and can be seen with other autoimmune diseases, such as Hashimoto’s thyroiditis, Graves’ disease, vitiligo, alopecia areata, and pernicious anemia. Lichen sclerosus can also be genetic and is seen among family members. Sometimes lichen sclerosus can go unrecognized or misdiagnosed for several years, but over time it can lead to scarring, sexual dysfunction, and cancer. It is important to speak with your provider and seek treatment if you notice any changes as some lichen sclerosus can progress to squamous cell cancer.

The standard treatment for lichen sclerosus has included topical steroids, which have been shown to prevent malignant transformation, but produce side effects and ultimately lead to damage of the genital skin.

Recently, practitioners and researchers have started evaluating the effectiveness of using a fractional micro-ablative CO2 laser to treat lichen sclerosus. Laser treatment promotes the production of collagen and elastic fibers to help restore epithelial structure. In a recent study among women with lichen sclerosus, laser treatment was shown to improve vulvar itching, vulvar dryness, and pain with intercourse as compared to topical corticosteroids. The study also showed the laser treatment was well tolerated with no adverse effects.

Peninsula Women’s Care is fortunate to have one of these lasers in-house. The MonaLisa Touch laser is an effective way to relieve most symptoms related to lichen sclerosus.  The skin is numbed with topical ointment.  The laser is then used to treat the areas of lichen sclerosus.  The treatment is usually less than five minutes.  If you are experiencing any of these symptoms or have noticed any changes in your genital skin, please speak with your provider.

References

Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020 Jan 15;12:11-20. doi: 10.2147/IJWH.S191200. PMID: 32021489; PMCID: PMC6970240.

Pagano, T., Conforti, A., Buonfantino, C., Schettini, F., Vallone, R., Gallo, A., . . . Sopracordevole, F. (2020). Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid. Menopause, 27(4), 418-422. doi:10.1097/gme.0000000000001482