Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, and wrinkled, and often causes itching and pain. LS usually occurs in postmenopausal women, although men, children, and premenopausal women may be affected. It can develop on any skin surface, but in women it most commonly occurs near the clitoris, on the labia (the inner and outer genital lips), and in the anal region.
In 15 to 20 percent of patients, LS lesions develop on other skin surfaces, such as the thighs, breasts, wrists, shoulders, neck, and even inside the mouth. It is not clear exactly how many people have LS. Estimates for LS involving the female genitals vary from 1 in 30 older adult women seen in general gynecology offices to 1 in 300 to 1,000 patients referred to dermatologists.
The cause of lichen sclerosus (LS) is not clear. It is thought that genetic factors and autoimmune factors may contribute. An infectious organism has thus far not been identified, and LS is not contagious.
Lichen Sclerosus (LS) Signs and Symptoms
Features of genital LS in women — Some women with genital LS feel dull, painful discomfort in the vulva, while other women have no symptoms. The most common symptoms include:
- Vulvar itching – The most common symptom of LS is itching. It may be so severe that it interferes with sleep.
- Anal itching, fissures, bleeding, and pain
- Painful sexual intercourse (dyspareunia) – This can occur as a result of repeated cracking of the skin (fissuring) or from narrowing of the vaginal opening due to scarring.
- Typically, women with genital LS have thin, white, wrinkled skin on the labia, often extending down and around the anus. Purple-colored areas of bruising may be seen. Cracks (also known as fissures) may form in the skin in the area around the anus, the labia, and the clitoris. Relatively minor rubbing or sex may lead to bleeding due to the fragility of the involved skin. If genital LS is not treated, it may progress and change the appearance of the genital area as the outer and inner lips of the vulva fuse (stick together) and cover the clitoris. The opening of the vagina can become narrowed, and cracks, fissures, and thickened, scarred skin in the genital and anal area can make sexual intercourse or genital examination painful. LS does not affect the inner reproductive organs, such as the vagina and uterus.
- Features of genital LS in men — In men, LS may appear on the head of the penis. Men who develop LS are usually uncircumcised (they have not had the foreskin of the penis removed), and the foreskin can become tight, shrunken, and scarred over the head of the penis. Men with LS may also have problems pulling back the foreskin and may experience decreased sensation at the tip of the penis, painful erections, or problems with urination
- Features of LS in other areas — LS may also cause lesions to occur in areas outside the genitals, especially the upper body, breasts, and upper arms. These lesions tend to be white, flat or raised, and are not as itchy as the affected skin of the genitals and anus.
Lichen Sclerosus Diagnosis
To confirm a suspected diagnosis of LS, a biopsy is recommended. A small piece of the affected skin will be removed and sent to a pathologist to be examined with a microscope. This is important to exclude other conditions which can mimic LS, and to rule out squamous cell skin cancer.
Lichen Sclerosus Treatment
Topical steroid ointments such as clobetasol have previously been the mainstay of treatment, but require daily application and have significant side effects. In many women, there is only partial symptom control.
At Renew MediSpa, we utilize platelet rich plasma (PRP) to treat LS effectively. We have been able to get patients off of steroid creams, symptom free, and even reduce scarring.
- You must have had a biopsy confirming the diagnosis
- If extensive scarring is present, surgical revision may be recommended prior to PRP intervention
- Steroid cream should be discontinued
- Premedication will be discussed, if taken you will need to have someone drive you to your appointment. We do use topical numbing agents and a small lidocaine injection as well for the procedure.
- First session- The standard O shot will be performed, and an additional quantity of PRP will be injected into the regions of skin involved with LS.
- A second injection (external) is scheduled for 6 weeks later. Thereafter, subsequent external treatments are on an as needed basis (range 3 times a year or less in most cases)
- You MUST continue to be followed by your specialist (ObGyn, Dermatology), with surveillance biopsies to monitor for squamous cell skin cancer- there is a slightly higher incidence of this skin cancer in LS patients.
Consider Also: ThermiVa Vaginal Rejuvenation
The Science of Heat- ThermiVa treatments use radiofrequency energy to gently heat both the internal and external vaginal structures, generating tissue rejuvenation including new collagen, without discomfort or downtime. Non-invasive, Non-surgical, No anesthesia required! Dr. Vuich is proud to have been the first physician in New Hampshire to offer ThermiVa.
If your Lichen symptoms are accompanied by symptoms of vaginal atrophy, we will recommend that you combine ThermiVa with PRP therapy/O Shot.
Preparing for Your Procedure:
- Avoid the use of anti-inflammatory medication before and after the procedure (ex: ibuprofen/motrin/aleve/naprosyn/aspirin/prednisone and other steroids including topical creams). Tylenol (acetaminophen) products are fine.
- Please arrive early to review and sign paperwork and complete payment.
- If you are having ThermiVa vaginal rejuvenation, this will be done first.
- Then, in preparation for the PRP procedure, a topical numbing agent will be applied . Your blood will be drawn and carefully prepared for administration.
- Our PRP preparation kit is sterile, FDA approved, and produces one of the highest available concentrations of platelet & growth factors in a pure plasma suspension, without red blood cells.
- For the O shot, a single internal injection and single external injection are performed. Discomfort is minimal.
- In the case of Lichen Sclerosus treatment, additional injections are placed into the affected areas.
- There are no activity restrictions after any of these procedures.
While we cannot guarantee a particular outcome, we find these procedures extremely helpful for the vast majority of women we treat. Lichen Sclerosus is a chronic condition and it is expected that maintenance sessions will usually be required.
The determination of which service(s) are recommended will be based on the initial exam and consultation. We are not able to bill your insurance company. We can provide documentation should you wish to pursue possible reimbursement from a Flex Spending Account or Health Savings Account.
O Shot only (including injection of Lichen involved area): $1695
Subsequent Lichen injections only (after initial O Shot): $795
Repeat O Shot within 6 months (including injection of Lichen involved area): $1350
ThermiVa series of 3 sessions (internal plus external): $2650- Add Oshot for $795
ThermiVa Subsequent sessions, each:
- External only: $525
- Internal + External: $995