Vulvar lichen sclerosus is a chronic vulvar condition that primarily affects the skin of the vulva.

This condition, which can cause significant discomfort, is still little known among the general population.Understanding the symptoms, causes and available treatments is essential for those affected, as early diagnosis and appropriate management can significantly improve their quality of life. At Dr. María Dolores Antón's clinic, specialists in vulvar lichen sclerosus offer a comprehensive approach to the treatment of this pathology, guaranteeing safe and professional care.

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What is the vulvar lichen sclerosus?

Lichen sclerosus is a chronic inflammatory skin disease that primarily affects the genital areas, particularly the skin of the vulva.

Persistent inflammation causes visible changes in the texture and colour of the skin, making it more fragile and prone to scarring. It mainly affects postmenopausal women, although it can also appear in young women and even children. This condition is not contagious and does not pose a risk of transmission to one's partner.

Symptoms of vulvar lichen sclerosus

Vulvar lichen sclerosus manifests with characteristic symptoms that progressively affect the quality of life of those affected. Recognizing these symptoms is key to seeking medical attention in time. Some of the most common symptoms are:

  • Intense itching: one of the most annoying and persistent symptoms. The itching or pruritus can be so strong that it affects daily life and nighttime rest.
  • Burning sensation or pain: Vulvar pain, especially when urinating or during sexual intercourse, is common due to the fragility of the skin.
  • Skin changes: The skin in the vulvar area often becomes thinner, whitish in color, and wrinkled. This can lead to a “patchy” or “parchment paper” appearance.
  • Injuries and fissures: Skin fragility can cause small cracks or fissures, which cause pain and bleeding, especially after physical or sexual activities.
  • Pain during sexual intercourse: which usually appears in advanced stages of the disease.
  • Genital atrophyOver time, the affected skin may retract and lose elasticity, causing the labia minora and clitoris to shrink, which can alter the vulvar anatomy.

It is important to note that not all affected individuals present all symptoms. The intensity and progression may vary, and some may remain asymptomatic in the early stages.

Causes of vulvar lichen sclerosus

The exact causes of vulvar lichen sclerosus are not known for certain. However, medical research suggests several factors that may contribute to its development:

  • Autoimmune factors: Lichen sclerosus is associated with other autoimmune diseases, such as Hashimoto's thyroiditis. This connection suggests that the immune system may mistakenly attack vulvar skin cells.
  • Hormonal factors: The decrease in estrogen during menopause seems to be an important factor, since this pathology is more common in postmenopausal women. However, it is not limited exclusively to them.
  • Genetic predisposition: Although not directly inherited, genetics can increase susceptibility to autoimmune diseases, which in turn increases the risk of developing lichen sclerosus.
  • Trauma or irritation: Although it does not directly cause the disease, repeated rubbing or trauma to the vulvar area can worsen symptoms in predisposed individuals.

Diagnosis of vulvar lichen sclerosus

Diagnosing vulvar lichen sclerosus requires a clinical evaluation and, in some cases, a biopsy. Specialists usually perform a visual examination to identify skin changes, and in cases where the diagnosis is not conclusive, a biopsy is used to examine a sample of tissue under a microscope.

An accurate diagnosis is essential, as lichen sclerosus can be confused with other skin diseases, such as lichen planus, or even precancerous lesions. A proper diagnosis avoids incorrect treatments and allows for the implementation of the necessary interventions to relieve symptoms and prevent complications.

Complications of vulvar lichen sclerosus

Vulvar lichen sclerosus, if not treated properly, can cause complications that seriously affect quality of life:

  • Scars and tissue retraction: The prolonged inflammatory process can generate scars on the vulvar skin, causing deformations and loss of elasticity.
  • Sexual dysfunction: Pain and scarring can limit sexual relationships, leading to self-esteem issues and affecting intimacy.

Treatment of vulvar lichen sclerosus

Treatment for vulvar lichen sclerosus aims to control symptoms, prevent disease progression, and reduce complications. Although there are different options, laser treatment has proven to be the most effective solution for cases that are persistent or resistant to other therapies. The main treatment options are described below:

  1. Fractional CO2 laser treatment: Considered the most effective alternative in advanced cases of vulvar lichen sclerosus, fractional CO2 laser promotes skin regeneration, improves its elasticity and significantly reduces itching and discomfort. This procedure, performed by dermatology specialists, can offer long-lasting results and minimize the risk of scarring and vulvar tissue retraction.
  2. Autologous exosomes: which are vesicles derived from the patient's own cells, rich in regenerative factors that stimulate tissue repair, improve the skin and promote hair growth with minimal adverse reaction.
  3. Bioidentical hormone therapyIn postmenopausal women, the application of topical estrogens can help improve the health of the vulvar skin, increasing its elasticity and resistance.
  4. Skin care: Adequate hydration of the vulvar area and the use of specific non-irritating products can help reduce discomfort, complementing medical treatment.

Treatment for vulvar lichen sclerosus should be personalized and performed under medical supervision, and at Dr. María Dolores Antón's clinic, the specialized team offers a detailed evaluation to recommend the best option for each patient.

Tips for prevention and self-care

Although there is no guaranteed way to prevent lichen sclerosus, certain habits can help minimize symptoms and improve the well-being of those affected:

  • Maintain good intimate hygiene: washing the vulvar area with warm water and specific non-irritating products is essential.
  • Avoid scratching: Intense itching may lead to scratching, which worsens the inflammation. To relieve itching, you can apply a cold compress or an ointment recommended by your doctor.
  • Wear comfortable clothes: Choosing cotton underwear and avoiding tight clothing that causes friction helps reduce discomfort.
  • Avoid irritating products: avoid perfumed soaps, intimate deodorants and aggressive products that can sensitize the skin of the vulva.
  • Attend periodic check-ups: Medical follow-up is essential to detect possible complications in time, including the risk of developing vulvar cancer.

Prognosis of vulvar lichen sclerosus

With proper treatment, the prognosis for vulvar lichen sclerosus is highly satisfactory. Most people experience a marked improvement in their symptoms without the use of corticosteroids. However, as it is a chronic disease, patients should be alert to any changes in symptoms and attend regular check-ups to adjust treatment as necessary.

It is important to mention that the management of this condition is long-term, and adherence to treatment is key to keeping symptoms under control. At Dr. María Dolores Antón's clinic, specialists offer personalized care that includes both medical treatment and psychological support, since the emotional effects of this disease can affect the quality of life of those affected.

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Vulvar lichen sclerosus