If you have associated itching and the skin feels kind of sticky with or without “paper cuts or cracks,” you probably have a condition called Lichen Sclerosus. If can be very subtle as far as the clinical signs are concerned but still very symptomatic. Unless you visit a gynecologist with a trained eye you will likely be told that ‘everything looks normal.” There may of may not be whitening or hypopigmentation of the peri-vaginal and peri-anal tissues in subtle to mild cases. The condition often goes undiagnosed for years until evaluated by a vulvovaginal specialist. These are either gynecologists or dermatologists with expressed interest in vulvovaginal conditions.

Moderate to advanced clinical signs include fusion between the labia minora (small lip) to the labia majora (large lip) and peri-clitorally. Chronic non-therapy can lead to resolution of the labia minora into the labia majora such that the labia minora disappear over time. Midline fusion often is present at the base of the vagina in the posterior fourchette commonly extending out onto the bridge of skin between the vagina and anus known as the perineal body. Fusion in this location can reduce the caliber of the vaginal opening leading to recurrent tearing with intercourse. Hypopigmentation or whitening of the skin can occur in a splotchy distribution or in a very even, symmetric distribution. When it surrounds both the vagina and peri-anal areas it is referred to as the “key hole” distribution on account that the area resembles the old fashioned skeleton key.

The diagnosis is made on visual clinical signs. While the majority of the medical literature says that the tissues should be biopsied, this is only necessary in a small percentage of cases  where there is thickening (leukoplakia) or non-healing fissures or ulceration of the skin. In this setting pre-cancer and/or vulvar cancer needs to be ruled out.

The condition is not infectious or contagious but it is chronic. Meaning there is no cure but it can be managed. The etiology (what causes the condition) is unknown but is thought to have some autoimmune propensity but not to the degree that the diagnosis justifies searching for other autoimmune disorders.

The condition has a high rate of response from a symptom standpoint with a tapered course of super-potent or intermediate potent topical corticosteriod depending on degree of the condition. In FGI’s opinion, many doctors make the mistake of treating only episodically when symptomatic. The experts in vaginalhealthCare at FGI believe lichen sclerosus is only properly treated when maintenance therapy with low potency corticosteriod is instituted after the initial course to prevent progressive changes of the skin, relapses in symptoms, and to lower the risk of developing pre-cancer/cancer. This condition requires an in-office evaluation at FGI. Come to the experts!