Lichen Sclerosus: Diagnosis, Treatment, and Ways to Reduce Flare-Ups
- 2 days ago
- 3 min read
Lichen Sclerosus is a chronic inflammatory skin condition that most commonly affects the vulva in women. Although it can occur at any age, it is most frequently diagnosed in postmenopausal women and can significantly impact comfort, sexual function, and quality of life if left untreated. Early diagnosis and appropriate management are essential to relieve symptoms, prevent scarring, and reduce long-term complications.
At Complete Healthcare in Richland, WA, we routinely evaluate and manage vulvar skin conditions, including lichen sclerosus, with evidence-based, compassionate care.
What Is Lichen Sclerosus?
Lichen sclerosus is a noninfectious inflammatory condition that causes thinning, whitening, and irritation of the vulvar skin. The exact cause is not fully understood, but it is believed to be related to autoimmune activity, genetic predisposition, and hormonal factors.
Common symptoms include:
Persistent vulvar itching, often worse at night
Burning or soreness
White, shiny, or thin-appearing skin
Pain with intercourse
Tearing or bleeding of the skin
Progressive narrowing of the vaginal opening in advanced cases
Importantly, lichen sclerosus is not a sexually transmitted infection and is not caused by poor hygiene.
How Is Lichen Sclerosus Diagnosed?
Diagnosis begins with a careful medical history and focused vulvar examination by an experienced clinician. The skin's appearance is often characteristic, showing thin, pale, or white patches with possible fissures or architectural changes.
In many cases, a vulvar biopsy is recommended to:
Confirm the diagnosis
Rule out other conditions, such as lichen planus or vulvar dysplasia
Establish a baseline for long-term monitoring
A biopsy is a quick in-office procedure performed under local anesthesia and is generally well-tolerated.
Treatment Options for Lichen Sclerosus
Although lichen sclerosus is a chronic condition, it is very treatable. The goal of treatment is to control inflammation, relieve symptoms, prevent scarring, and reduce the risk of vulvar cancer.
High-potency topical corticosteroids are the gold standard of treatment.
Typical therapy includes:
Clobetasol propionate 0.05 percent ointment applied nightly for several weeks
Gradual tapering to a maintenance regimen, often one to two times per week
When used correctly, long-term topical steroid therapy is safe and highly effective. Education on proper application is critical to avoid under- or overuse.
Additional treatment considerations may include:
Medium-potency steroids for maintenance in select patients
Topical calcineurin inhibitors in patients who cannot tolerate steroids
Treatment of secondary infections or fissures if present
Patients should be followed regularly, even when symptoms are well controlled.
Long-Term Monitoring and Cancer Risk
Women with lichen sclerosus have a small but real increased risk of vulvar squamous cell carcinoma. With proper treatment and surveillance, this risk is significantly reduced.
We recommend:
Routine vulvar examinations at least annually
Prompt evaluation of any new lesions, ulcers, or areas that do not respond to treatment
Ongoing maintenance therapy even when symptoms improve
Ways to Reduce Flare-Ups and Irritation
While lichen sclerosus cannot be fully prevented, lifestyle and skin-care measures play an important role in symptom control.
Helpful strategies include:
Use fragrance-free, gentle cleansers or plain water for vulvar hygiene
Avoid soaps, bubble baths, wipes, and scented products
Wear loose-fitting cotton underwear
Avoid tight clothing that causes friction
Use a bland emollient such as petroleum jelly or zinc-based barrier creams
Avoid daily panty liners or pads when possible
Sexual discomfort can often be improved with consistent treatment, adequate lubrication, and addressing inflammation early.
When to Seek Care
Any woman experiencing persistent vulvar itching, skin changes, or pain should seek medical evaluation. Early diagnosis leads to better symptom control and prevents long-term complications.
At Complete Healthcare, we provide thorough evaluation, biopsy when indicated, individualized treatment plans, and long-term follow-up for women with lichen sclerosus.
If you have concerns about vulvar symptoms or have been diagnosed with lichen sclerosus and want expert care, we are here to help.
Complete Healthcare - Obstetrics and Gynecology
509-392-6700