Prescription medications are required to treat vulvar lichen sclerosus, nongenital lichen sclerosus that is causing symptoms, and lichen sclerosus of the penis that is not cured by circumcision. The treatment of choice is an ultrapotent topical corticosteroid. Daily use of these creams or ointments can stop itching within a few days and restore the skin's normal texture and strength after several months. However, treatment does not reverse the scarring that may have already occurred.
Because ultrapotent corticosteroid creams and ointments are very strong, frequent evaluation by a doctor is necessary to check the skin for side effects when the medication is used every day. Once the symptoms are gone and the skin has regained its strength, medication can be used less frequently, although use must continue indefinitely, several times a week, to keep vulvar lichen sclerosus in remission.
Young girls may not require lifelong treatment, since lichen sclerosus can sometimes, but not always, disappear permanently at puberty. Scarring and changes in skin color, however, may remain even after the symptoms have disappeared.
Because ultrapotent topical corticosteroids are so effective, other therapies are rarely prescribed. The previous standard therapy was testosterone ointment or cream, but this has recently been proven to produce no more benefit than a placebo (inactive) cream. Another hormone cream, progesterone, was previously used to treat the disease, but also has little beneficial effect. Retinoids, or vitamin A-like medications, may be helpful for patients who cannot tolerate or are not helped by ultrapotent topical corticosteroids.
Patients who need medication should ask their doctor how it works, what side effects it might have, and why it is the best treatment for lichen sclerosus.
For women and girls, surgery to remove the affected skin is not an acceptable option. Surgery may be useful for scarring, but only after lichen sclerosus is controlled with medication.
Sometimes, people do not respond to the ultrapotent topical corticosteroid. Other factors, such as low estrogen levels that cause vaginal dryness and soreness, a skin infection, or irritation or allergy to the medication, can keep symptoms from clearing up. Your doctor may need to treat these factors as well. If you feel that you are not improving as you would expect, talk to your doctor.
Because ultrapotent corticosteroid creams and ointments are very strong, frequent evaluation by a doctor is necessary to check the skin for side effects when the medication is used every day. Once the symptoms are gone and the skin has regained its strength, medication can be used less frequently, although use must continue indefinitely, several times a week, to keep vulvar lichen sclerosus in remission.
Ultrapotent Corticosteroids Available by Prescription in the United States
- betamethasone dipropionate
- clobetasol propionate
- diflorasone diacetate
- halobetasol propionate
Young girls may not require lifelong treatment, since lichen sclerosus can sometimes, but not always, disappear permanently at puberty. Scarring and changes in skin color, however, may remain even after the symptoms have disappeared.
Because ultrapotent topical corticosteroids are so effective, other therapies are rarely prescribed. The previous standard therapy was testosterone ointment or cream, but this has recently been proven to produce no more benefit than a placebo (inactive) cream. Another hormone cream, progesterone, was previously used to treat the disease, but also has little beneficial effect. Retinoids, or vitamin A-like medications, may be helpful for patients who cannot tolerate or are not helped by ultrapotent topical corticosteroids.
Patients who need medication should ask their doctor how it works, what side effects it might have, and why it is the best treatment for lichen sclerosus.
For women and girls, surgery to remove the affected skin is not an acceptable option. Surgery may be useful for scarring, but only after lichen sclerosus is controlled with medication.
Sometimes, people do not respond to the ultrapotent topical corticosteroid. Other factors, such as low estrogen levels that cause vaginal dryness and soreness, a skin infection, or irritation or allergy to the medication, can keep symptoms from clearing up. Your doctor may need to treat these factors as well. If you feel that you are not improving as you would expect, talk to your doctor.
Can People With Lichen Sclerosus Have Sexual Intercourse?
Women with severe lichen sclerosus may not be able to have sexual intercourse because of pain or scarring that narrows the entrance to the vagina. However, proper treatment with an ultrapotent topical corticosteroid should restore normal sexual ability, unless severe scarring has already narrowed the vaginal opening. In this case, surgery may be needed to correct the problem, but only after the disease has been controlled.Is Lichen Sclerosus Related to Cancer?
Lichen sclerosus does not cause skin cancer. However, skin that is scarred by lichen sclerosus is more likely to develop skin cancer. About 1 in 20 women with untreated vulvar lichen sclerosus develops skin cancer. The frequency of skin cancer in men with lichen sclerosus is not known. It is important for people who have the disease to receive proper treatment and to see their doctor every 6 to 12 months, so that he or she can monitor and treat any changes that might signal skin cancer.What Kind of Doctor Treats Lichen Sclerosus?
Lichen sclerosus is treated by dermatologists (skin doctors) and by gynecologists if the female genitalia are involved. Urologists and primary care health providers with a special interest in genital diseases also treat this disease. To find a doctor who treats lichen sclerosus, ask your family doctor for a referral, call a local or State department of health, look in the local telephone directory, or contact a local medical center. The American Academy of Dermatology also provides referrals to dermatologists in your area, and the American College of Obstetricians and Gynecologists can refer you to a gynecologist. The Directory of Medical Specialists, available at most public libraries, lists dermatologists, gynecologists, and urologists in your area.
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