What is the Best Treatment for Lichen Sclerosus?

Dr. Jolene BrightenPublished: Last Reviewed: Autoimmune Disease Leave a Comment

Lichen sclerosus is a chronic skin disease that results in thin, white, wrinkled patches of skin, usually on the genitals. It can be excruciating and incredibly itchy to deal with. While doctors previously believed it was rather rare, in recent years, doctors have suggested it’s more common than initially thought. By some estimates, cases have doubled between 1991 and 2011. 

In this article, we will explore the symptoms, causes, and treatments for this chronic condition. 

What Is Lichen Sclerosus?

Lichen sclerosus is an inflammatory skin condition that is ten times more common in women than in men. Lichen sclerosus creates patches where the skin becomes thin, white, and shiny.  

While it can crop up on any part of the body, it usually appears on the vulva. Post-menopausal women and prepubescent girls are the most likely to develop lichen sclerosus.  

What Are The Symptoms Of Lichen Sclerosus?

Sometimes, lichen sclerosus can be extremely painful and itchy — to the point it may cause difficulty sleeping. Other times, symptoms are mild, and the only thing present is the patches of skin that have lost their pigment.

Other symptoms of lichen sclerosus include:

  • Smooth un-pigmented patches of skin
  • Slightly raised or wrinkled patches of skin
  • Itching that becomes worse at night
  • Painful sex
  • Painful bowel movements
  • Constipation
  • Redness
  • Dull or burning pain
  • Torn or bleeding skin
  • Sores or blisters

What Causes Lichen Sclerosus?

As with so many conditions that affect the female population, lichen sclerosus hasn’t been widely studied, and therefore we don’t have a definitive cause of it, per se.

Doctors generally agree that a few things could cause lichen sclerosus.

Trauma Can Trigger Lichen Sclerosus

The medical community has recognized trauma to the area of skin as a cause of the disease.

Sometimes, activities like horseback riding, bike riding, or even waxing can irritate the vulva's delicate skin. Many women report lichen sclerosus after experiencing some sort of difficulty with an activity that created friction in the vulva area.

Sexual abuse, trauma, or under-lubricated sex can also trigger lichen sclerosus.

Is Lichen Sclerosus An Autoimmune Disease?

Some doctors also believe that lichen sclerosus could be related to autoimmunity. 

However, the connection seems to exist only in women, not men. In a study of 532 patients with lichen sclerosus, researchers found that women were likely to have another autoimmune condition, especially an autoimmune thyroid condition. The same likelihood wasn’t there for the male participants in the study. 

Some of the common autoimmune diseases that occur alongside lichen sclerosus include:

Hormonal Imbalance May Cause Lichen Sclerosus

Because lichen sclerosus is more likely to occur in girls who haven’t reached puberty yet and post-menopausal women, researchers believe there may be some connection between lichen sclerosus and fluctuating hormone levels.

To that end, there is some evidence to suggest that topical testosterone cream may help relieve symptoms of lichen sclerosus. However, in a high-quality study, it was only shown to be an effective treatment for the disease in 20% of cases and caused androgenic complications in 40% of the study participants. This leads most doctors to conclude that hormone replacement therapy is not the preferred treatment for the condition.

Lichen Sclerosus And Gut Health

As with many autoimmune conditions, gut health may lie at the root of the problem. Many functional medicine and integrative doctors have found that addressing gut issues can help to heal autoimmune disease. 

Because lichen sclerosus is at its core inflammatory, and gut dysbiosis contributes to inflammation, it may just be a root cause of the condition.  

How Is Lichen Sclerosus Diagnosed?

Generally, doctors diagnose lichen sclerosus with a physical exam. Most of the time, your doctor will be able to visually spot the telltale signs of lichen sclerosus.

Sometimes, your doctor will take a biopsy to confirm a suspected case of lichen sclerosus. Or, your doctor may order additional testing to rule out other conditions.                                          

Lichen sclerosus can be tricky because it can coexist with several other conditions that may look and feel the same. For example:

  • Lichen planus causes genital itching and can also occur alongside lichen sclerosus.
  • Vitiligo also causes the skin to lose its pigment, and can likewise exist at the same time as lichen sclerosus.
  • Low estrogen levels can cause vaginal tissues to thin and lead to discomfort, itching, and painful sex. Low estrogen levels often accompany lichen sclerosus.
  • Sexually transmitted infections can cause inflammation that underlies or coexists with lichen sclerosus. Many can also cause itching and painful intercourse

What Is The Best Treatment For Lichen Sclerosus?

Lichen sclerosus can be challenging to treat, and many women struggle with it for some time before finding relief. Conventional treatment typically focuses on the management of the symptoms and prevention of scarring. While most doctors view lichen sclerosus as a life-long condition, it is possible to put the symptoms into remission. With the right steps, many women can eventually experience total relief. It may not be an easy or straightforward road to recovery, but it is possible. 

If your doctor tells you that you have lichen sclerosus, it's crucial to maintain regular check-ups with your physician. It is considered a chronic disease and does carry an increased risk for the development of skin cancer.

Steroids For Lichen Sclerosus

The most common treatment for lichen sclerosus is steroid cream. It may not be the ideal long term treatment, but many women find it a necessary part of their lichen sclerosus protocol since the itching that comes with it can be overwhelming.

The itching gets worse at night because your cortisol naturally takes a dip at night. As cortisol goes down, inflammation rises. Many women find relief from a steroid cream, which helps them get some much-needed sleep. 

Calendula Salve For Lichen Sclerosus

I also recommend calendula salve as a natural alternative. It won’t stop the itch, but it will help with the dryness and irritation.

Calendula has anti-inflammatory, antifungal, and antibacterial properties that also may help reduce swelling and combat any infections in the affected area.

Curcumin For Lichen Sclerosus

Curcumin is the active part of turmeric. There have been studies showing the benefits of turmeric in inflammatory skin conditions

While not a cure or specific treatment for lichen sclerosus, curcumin can offer anti-inflammatory support and antioxidant protection of the skin. Learn more about the benefits of turmeric.

Address Underlying Inflammation For Lichen Sclerosus

If your body is enduring a state of chronic inflammation due to a hidden infection, food allergies, endometriosis, other autoimmune conditions, or leaky gut, it’s important to address those as part of your lichen sclerosus treatment plan.

Unfortunately, there’s no one-size-fits-all, one and done way to do that.

Testing is vital here — removing triggers and analyzing gut flora can be the right place to start.

Tightening up your diet and minimizing processed foods while increasing your intake of organic vegetables, fruits, and proteins is essential in most cases. 

Optimizing your supplement protocol with l-glutamine, aloe, and slippery elm (all ingredients found in Gut Rebuild), and professional-grade probiotics can be a good idea.

Other Important Recommendations For Lichen Sclerosus

Some of my most important recommendations for treating lichen sclerosus involve developing good habits.

Here’s my list of non-clinical things to consider if you’re battling lichen sclerosus:

Use lube for intercourse, especially if you’re post-menopausal 

Just be careful what lube you choose, what’s in commercial lubricants can be irritants or endocrine disruptors. Try selecting one that will be gentle to your already sensitive lady parts.

Wear cotton underwear, or at least with cotton on the inside 

Cotton helps your vulva to breathe and cuts down on sweat. Synthetic fabrics could lead to irritation and harbor bacteria, which could make matters worse.

Wear loose pants 

Now is not the time to rock your tightest fitting jeans. Choose fabrics that allow airflow near your delicate areas.

Always wipe front to back 

Wiping front to back helps prevent the spread of bacteria and is a habit that helps prevent urinary tract infections.

Urinate and or wash off with water after sex 

Semen is actually not the ideal pH for your vagina. After sex, a quick rinse of the area will help get things back to a normal pH.

Wash your vulva with water only — no soap required 

Your vagina is not meant to smell like vanilla sugar cookies. Please don’t buy into the myth that all women are supposed to emit a scent of champagne and berries from their lady parts. A simple rinse with water for the vulva is all you need, and there’s never a need to wash your vagina, ever.

Is Lichen Sclerosus Contagious?

Lichen sclerosus is not contagious. You cannot get it from or pass it to another person. It is not an infection, let alone a sexually transmitted infection.

Is Lichen Sclerosus Cancerous?

Women with lichen sclerosus are at a higher risk of developing squamous cell carcinoma skin cancer of the vulva.

While lichen sclerosus is not cancerous itself, it is important to address any suspected vulvar issues immediately and treat them. As with any disease, early detection and treatment are the best defenses we have against their further development.

Don’t Be Embarrassed To Talk About Your Vulva And Vagina

There are many reasons we don’t have a plethora of good information and reliable studies on lichen sclerosus, and one of them is that women often feel embarrassed because they’ve been shamed about these conversations. It is important to seek help when you’re experiencing abnormalities in your lady parts.

It’s time for this taboo to end.

We all deserve to understand how our bodies work, and we have the right (and maybe even the responsibility) to use their clinical names without an ounce of shame.

No matter what you’re experiencing, I can promise you that your doctor’s already seen it all. There’s absolutely no reason to resist seeking help if your vulva is in less than optimal condition. And in the case of lichen sclerosus, the earlier you are able to treat it, the more likely you can put it into remission and avoid the misery of the painful itching and tearing, and possibly scarring. 

If you’re looking for more answers regarding female health and sexuality, I’d love for you to download my free hormone balancing starter kit. It’s a crash course in everything you need to know about your cycle, how to get your hormones aligned, and includes a ton of great hormone-friendly recipes. If you’re a little confused and looking for a place to start, this is it. 

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.