Lichenoid Dermatoses
Lichen sclerosus (LS) and lichen planus (LP) are both immunologically mediated diseases with a preference for the genitalia. The basic principles of management of vulval LS and vulvovaginal LP are the same and involve explanation of the disease, emphasizing the chronic nature of the condition and outlining treatment options. The main difference between the two conditions is that LP has a propensity to involve the mucous membranes including the mouth and vagina which are rarely affected in LS. 1,2
Lichen sclerosus (LS)
Lichen sclerosus is a chronic inflammatory autoimmune skin disease that predominantly affects the anogenital region.
Although it has been reported in patients of all age groups and in both sexes, lichen sclerosus is most common among postmenopausal women, although it may also appear in childhood (15%).
In girls, it typically improves with age but can persist into adulthood.
The exact prevalence of vulvar LS (VLS) is unknown but is estimated to range between 0.1% and 3% in the pre-pubertal and postmenopausal periods. There is also an increased risk of genital cancer. Women affected with VLS have a lifetime risk of developing a squamous cell carcinoma estimated to be 2–5%, while up to 65% of vulvar carcinomas arise in a background of VLS.
Lichen Planus (LP)
Lichen planus is an inflammatory skin disease that can affect any area of the skin or mucous membranes. The presentation varies depending on severity, the stage of development of the lesions, and the site affected. LP may be localized to the vulvovaginal area, or it may affect this area in the context of more extensive disease.
It is estimated that the vulva is affected in approximately 50% of women with oral lichen planus.
Treatment options
Potent and very potent topical corticosteroids are commonly used for LS and LP treatment.
Side effects of long-term use associated with topical corticosteroids are telangiectasia (skin transparency), skin atrophy, Striae (stretch marks) formation, rebound reactions, reactivation of human papilloma virus (HPV) and herpes simplex virus infection (HSV).
Topical corticosteroids should be discontinued if no improvement is seen after regular follow-up and treatment for 6 months.
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