Treatments · Vulval clinic
Lichen sclerosus
Lichen sclerosus is a chronic skin condition that mainly affects the genital area in women. The skin of the vulva becomes thin and white and takes on a scar-like appearance. This can cause considerable itching, pain and discomfort.
Recognising and treating it early is important to reduce symptoms and prevent damage to the tissue.
What is it?
What is lichen sclerosus?
Lichen sclerosus is a long-term skin condition of the genital area (the vulva) that does not go away. The exact cause is unknown, but it is regarded as an autoimmune condition, in which the immune system attacks the body's own skin tissue.
The skin around the anus is often affected as well. The vagina itself is not affected. The condition is most common in women after the menopause, but it can also start at a younger age, including in girls before puberty.
15 to 20 in 100women with lichen sclerosus also have patches elsewhere on the body, such as the back or under the arm.
In figures
More common than you think, and very treatable
Lichen sclerosus is more common than most people realise. It often takes a long time before the diagnosis is made, even though treatment works well for most women.
- Up to 1 in 60women have lichen sclerosus. Depending on the group studied, estimates range from 1 in 60 to 1 in 1,000.
- 5 yearsis how long women had symptoms on average before they saw a specialist.
- 9 in 10women respond well to a 12-week course of a potent steroid ointment.
- 93%of the women who then used their maintenance treatment as advised were free of itching and pain, compared with 58% of those who did not.
Sources: Dutch guideline Lichen sclerosus (richtlijnendatabase.nl), modules on epidemiology, topical corticosteroids (Virgili et al., 2014) and maintenance treatment (Lee et al., 2015); duration of symptoms: Lee et al., JAMA Dermatology 2015.
Symptoms
Which symptoms can you have?
Typical symptoms of lichen sclerosus are:
- Itching of the labia or around the anus, often intense and particularly in bed or when you get warm
- White, shiny or papery changes to the skin
- Pain or a burning feeling, especially when passing urine or during sex
- Cracks or small wounds in the skin, including around the anus
- Shrinking or distortion of the labia or the entrance to the vagina
- Sexual problems caused by pain or fear
If you have already been diagnosed with lichen sclerosus but your symptoms are flaring up again, you are welcome here too. Symptoms vary in severity and often have a major impact on daily life and wellbeing.
Your visit
The first consultation
At Femmecare, lichen sclerosus is treated by experienced gynaecologists with specific expertise in conditions of the vulva. Lichen sclerosus is one of the conditions we treat at our Vulval clinic, a particular area of expertise at Femmecare.
From across the Netherlands and Belgium
Patients from across the Netherlands and Belgium come to Femmecare for treatment of suspected or confirmed lichen sclerosus with gynaecologist Dr. Céline Lardenoije.
Consultation and examination
During the first consultation we discuss your symptoms in detail. The doctor then examines the skin of the genital area. Usually that is enough to tell whether you have lichen sclerosus.
Sometimes further tests
If the doctor sees an area that looks abnormal, such as a painful sore or a red or greyish-white patch, a small piece of skin is removed under local anaesthetic for examination.
Treatment
What does treatment look like?
Ointment, and a fixed schedule
The main treatment is a steroid ointment that calms the inflammation. In addition you apply a greasy ointment every day, which keeps the skin supple.
The doctor draws up an application schedule with you and explains exactly how to use the ointments. At first you apply them more often; as symptoms improve, you reduce this.
If the ointment does not help enough
Sometimes the schedule needs adjusting, or a different treatment is needed. The doctor will then discuss the options with you.
Attention to sexuality
We support you with sexual problems and help you regain confidence and comfort. If needed, we work together with a specialist pelvic physiotherapist.
The aim of treatment is to control the condition and prevent lasting damage as far as possible.
Self-care
What can you do yourself?
- Keep the skin well moisturised.
- Wear cotton underwear.
- Avoid friction.
- Do not use perfumed products.
Follow-up
Why follow-up matters
With lichen sclerosus the risk of a form of skin cancer of the vulva is slightly higher. According to the guideline this affects 0.2 to 3.9 in 100 women with lichen sclerosus. That is why an annual check-up is important.
- If you have no symptoms, a check-up once a year is enough. This can also be done by your GP.
- If you do have symptoms, such as itching, pain, sores or spots that bleed, the doctor will see you more often.
- The doctor needs to see the skin, so a check-up in person is better than a telephone consultation.
Are you already under our care?
Please contact us if:
- Your symptoms get worse despite applying the ointment daily.
- You notice a new patch or a change in the skin.
- You have a sore that does not heal, or a spot that bleeds.
043 700 9773Call during opening hoursNot yet a Femmecare patient? Please see your GP first.
Our approach
What can you expect?
- Specialist gynaecological care with attention to quality of life
- Treatment aimed at fewer symptoms and preserving function
- Tailored instructions and support, including aftercare
- With timely, correct treatment: considerably less itching, pain and skin change
- Improved comfort, sexuality and confidence
See also
For GPs
Referring patients with lichen sclerosus
Diagnosis, treatment and follow-up of lichen sclerosus at our vulval clinic, by gynaecologists with expertise in vulval pathology. Patients come from across the Netherlands and Belgium to see gynaecologist Dr. Céline Lardenoije, who previously ran the vulval clinic at Maastricht UMC+.
ZorgDomein: ‘Femmecare Clinics’
Reasons to refer
- Suspected lichen sclerosus
- Known lichen sclerosus with a flare-up or insufficient response to treatment
- New or suspicious lesion in known lichen sclerosus
- Narrowing of the introitus with urinary or coital symptoms
What we offer
- Clinical diagnosis; a low threshold for biopsy of suspicious lesions (to exclude dVIN)
- Treatment with a class 3–4 corticosteroid, and tacrolimus if needed
- For treatment-resistant disease: methotrexate in collaboration with a dermatologist
- Annual review with us, where indicated and desired
Chronic, but very treatable
Lichen sclerosus is a long-term condition, but with good support and treatment symptoms can improve greatly and further damage can be prevented. Would you like an appointment? First discuss with your GP whether a referral to Femmecare is appropriate.