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Lichen sclerosus and lichen planus
Lichen sclerosus and lichen planus are chronic skin diseases that require monitoring and therapy.
Timely recognition and adequate therapy are key to controlling symptoms and reducing the risk of long-lasting consequences.
Lichen sclerosus
Lichen sclerosus is a chronic inflammatory skin disease that most often occurs in menopause, but it also occurs in younger women and children.
The disease is most often manifested on the external genital organs and in the area of the anal opening. Skin changes are most often symmetrical, whitish and smooth.
The surrounding skin may be thinned, wrinkled or thickened. Small soars and redness may occur. Itching and discomfort are the most common symptoms.
Lichen sclerosus occurs in 14-15 out of 100,000 women.
Lichen sclerosus is a skin inflammatory disease, but the exact mechanism of the onset of the disease is not clear.
Basically, it is assumed that it is an immunological disease.
Risk factors for lichen sclerosus are:
- postmenopausal period;
- women who have some other immunological disease;
- lichen sclerosus in the family.
Linchen planus
Lichen planus is an inflammatory disease of the skin and mucous membranes that can occur in the mouth, nose, eyes, intestines, in the area of the vulva and around the anus.
Changes can be in the form of limited bumps on the skin, raised above the level of the skin, reddish or purple in color or in the form of ulcerations - small open wounds.
Whitish lines called Witcham's stretch marks may be formed.
The erosive form has a more severe clinical picture. 50% of women who have changes in the vulva and vagina also have changes in the oral cavity.
Pain, itching, burning and ulceration (sores) on the skin and vulva are symptoms of lichen planus in the genital region.
Lichen planus is a rare disease and occurs in 1-2% of the population.
Lichen planus is an autoimmune disease where T-cells attack the basal cells of the skin and lead to tissue damage.
A complication of lichen planus is the formation of adhesions and scar tissue, so that the vagina can be completely closed.
There is also a slightly increased risk for cancer of the vulva and any suspicious change requires a biopsy and histopathological analysis.
Diagnosis
Both Lichen planus and Lichen sclerosus are diagnosed by examination and histopathological analysis of the sample obtained by biopsy of the affected areas of the skin.
Sometimes it is necessary to repeat the biopsy, especially if there are additional changes.
If there are signs of the infection, a microbiological analysis is performed.
It is necessary to examine whether the patient has similar changes in other parts of the body.
No special preparation is required before a skin biopsy of the vulva.
- The procedure is performed under local anesthesia.
- Local anesthesia is given with a thin needle into the skin where the biopsy is planned.
- A small skin sample is taken with a special instrument and sent for histopathological analysis.
- Most often, it is necessary to place a surgical suture with a non -removable suture to stop the bleeding.
- Mild pain and scanty bleeding can be expected after a skin biopsy.
- In case of pain, take Paracetamol tablets, 500 mg 2 tablets up to 4 times a day.
- Showering is allowed, but bathing in the tub and pool is not recommended until the skin is completely healed.
- The usage of antiseptic agents based on iodine, chlorine and antibiotics are not recommended.
- Bleeding and infection are very rare after vulvar biopsy.
The result of the histopathological analysis is obtained within 7-10 days, and depending on the findings, therapy is determined.
Treatment
Corticosteroid creams are the basis of therapy for both diseases.
The dose of corticosteroids is gradually reduced and the treatment is repeated when the changes are reversed.
If the changes return often, corticosteroids are used all the time.
Immunosuppressive drugs can also be used.
It can also be applied phototherapy (in lichen planus)
In some cases, if the change is limited, a part of the affected skin can be surgically removed.
Possible complications
If left untreated, both diseases can lead to serious complications, including:
- the formation of adhesions, that is scar tissue, which in more severe cases can lead to the complete closure of the vaginal opening and urination disorder;
- increased risk of vulva cancer (especially with lichen sclerosus);
- bacterial infections;
- painful sexual intercourses.
Key differences between lichen sclerosus and lichen planus
| Lichen sclerosus | Lichen planus | |
|---|---|---|
| Appearance of change | Whitish, thin, wrinkled or smooth | Red, purple, ulcerative, whitish bands |
| Symptoms | Intense itching, discomfort | Pain, burning, ulceration |
| Complications | Adhesions, scars, narrowing or complete closure of the opening of the vagina, infection | Adhesions, scars, narrowing or complete closure of the opening of the vagina, infections, open wounds |
| Therapy | Corticosteroids, immunosuppressants | Corticosteroids, immunosuppressants, phototherapy |
| Cancer risk | Less than 5% of squamous cell carcinomas | Slightly increased risk of vulvar cancer |
When should you consult a gynecologist?
It is recommended that a woman consults a doctor-gynecologist as soon as she notices some changes in the skin and vulva, that is, on the external genital organs.
Expert advice: frequently asked questions
Answers by: Milan Milenković, MD, PhD
Are lichen sclerosus and lichen planus contagious?
No, they are not contagious and are not sexually transmitted.
Can lichen be prevented?
Lichen sclerosus and lichen planus cannot be prevented, but the symptoms can be alleviated with adequate hygiene and lifestyle. It is advised to:
- shower without using soap in the vulva area;
- the use of moisturizing creams and oils in the vulva area;
- avoid tight and synthetic clothes that come into direct contact with the skin;
- avoid long bicycle and motorcycle rides;
- avoid sitting in Jacuzzi tubs.
When can we expect improvement after therapy?
Symptoms usually improve after 7-10 days from the beginning of corticosteroid therapy, but long-term monitoring of symptoms and occasional reapplication of therapy are often required.
Can food affect lichen sclerosus?
Nutrition does not affect the occurrence and development of lichen sclerosus.
What is the prognosis of lichen sclerosus?
Lichen sclerosus is a chronic disease that responds well to corticosteroid therapy, but symptoms often return after the therapy is stopped. Sometimes it is necessary to take a low dose of corticosteroids all the time. It is important to start the therapy in time, before there is more damage to the tissue and the formation of scar tissue which does not react to the therapy.
Is lichen sclerosus cancerous?
Lichen sclerosus is not a malignant disease, but it increases the risk of cancer, and therefore it is necessary to take a tissue sample for diagnosis, as well as later for any clinical suspicion of malignant changes.
