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shirley asked...

I have recently been diagnosed with lichen sclerosus which involves skin of the vulva...

I have recently been diagnosed with lichen sclerosus which involves skin of the vulva. I have Dermovate ointment to use sparingly once a day as needed. I also note that anti-depressents can help, I am on Amytriptiline. Okay, so the problem is I am away and have an awful flairup, really painful when I urinate. I have been using the cream for a week. Taking baths (epsom salt only in water) but it isn't getting any better. Not sure what to do, I don't see the point of going to a doctor .... can i use the dermovate twice a day? is there anything else I can do? (I have tried vaseline which only irritates it more)

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The answer

Thank you for contacting Health at Hand

It must be very uncomfortable for you to have this condition and you may know that there isn’t a cure.

However if you look after the skin that is affected you can reduce and prevent any flare up. Dermovate cream can certainly help with flare up and can be used once or twice daily so you can increase it to twice a day. Prolonged and repeated use of Epsom salts can damage the surrounding skin so this may be aggravating it. We suggest you stop using this and instead use a moisturising shower gel or a bath emollient. We do think that you should see a doctor to check you do not have any complications of this condition.

We have included more detailed information below to help you.

What is lichen sclerosus?

Lichen sclerosus is a long-term skin condition that affects the genital areas which include vulva, penis and anus. Changes in the skin in these areas become inflamed, itchy and sore which can then lead to problems with passing urine and having sex. Women are mostly affected although it can occur in men and children.

What causes lichen sclerosus?

What actually causes it is unclear. Experts think that changes in the immune system or hormones are likely to be responsible because many people who have lichen sclerosus also have other auto immune conditions such as thyroid disease, pernicious anaemia or vitiligo.

Can you catch Lichen Sclerosis?

Lichen Sclerosus is not catching, you cannot give someone lichen sclerosus including when having sex.

What can aggravate Lichen sclerosus?

  • Irritants such as soap, detergents, shower gels, bubble baths can aggravate lichen sclerosus, so using these irritants should be avoided.
  • Friction or damage to the skin can make it worse so overzealous washing and drying the vaginal or anal area should be avoided.
  • Irritation from urine leakage can also make the problem worse. It is a good idea to dry yourself thoroughly using a good soft toilet tissue. Avoid using toilet wipes.

Inflamed areas of skin tend to flare up from time to time and then tend to settle down. The severity and duration of flare-ups varies from person to person and from time to time in the same person.

However if you follow a strict hygiene regime you can greatly reduce the flare up.

How can you treat or manage Lichen sclerosus?

Use a moisturising wash such as shower gel or bath emollient such as;

  • Oilatum shower gel
  • Oilatum shower gel
  • Doublebase shower gel
  • Hydromol shower gel
  • Oilatum bath additive
  • Cetraben bath additive
  • Doublebase bath additive
  • Hydromol bathadditive
  • E45 wash

Or any other moisturising cleaning agent prescribed by your doctor.Emollient bath additives are added to your bath water. By soaking for 10-20minutes in this water will greatly help to hydrate the delicate skin of the vagina, vulva, and anus.

It is very important to dry your skin thoroughly after your bath or shower including the ano genital area, not only with a dry towel but a cool setting on the hair dryer.

Once the area is dry then you can apply a moisturising cream or ointment such as;

  • Diprobase
  • Doublebase
  • Oilatum
  • Cetraben
  • Zerobase

Or any other moisturising agent prescribed by your doctor. Generally ointments are stickier than creams, but they stay on longer so help maintain moisture in the skin for longer.

Steroid creams and ointments

During flare ups, applying steroid creams help to reduce the inflammation. Clobetsol Propionate also known as Dermovate has been found to be very effective in treating Lichen sclerosus flare up.

Dermovate cream can be used once or twice a day.

Betamethasone dipropionate 0.05% has also been shown to be safe and effective for both genital and surrounding areas.

For some people who cannot use these steroid creams or have found that they are not managing their symptoms Picrolimus or tacrolimus can be used as an alternative.

For some people Retinoid creams may be required. Some people may need photochemotherapy or photodynamic therapy.

Other medications

Taking an antihistamine tablet will help to stop the itching and reduce the urge to scratch. When you scratch the skin it becomes irritated, increasing your risk of infection and making the eczema worse.

Vulvadynia may be a complication of Lichen sclerosus. This is when you have burning, stinging or pain the vulva. This is usually caused by nerve pain also known as neuropathic pain. Amitriptyline is used to help manage neuropathic pain.

You may be prescribed clotrimazole in case of thrush.

Complications of Lichen Sclerosus

We're sure you are aware but it is important to keep an eye out for any unusual changes of the genital skin and the surrounding area such as thickening of the skin, bleeding or blistering of the skin of the vaginal areas because cancer of the vulva can be linked to Lichen sclerosus. Checking once a month for any changes is recommended . Any changes need to be reported straight away because if it is cancer the earlier you detect it the greater your chances of effective treatment.

Further information

Further information can be found on the websites below:

Vulvodynia - NHS

Lichen sclerosus leaflet - Patient information

Lichen sclerosus - Health information

Lichen sclerosus - British association of dermatologists

Other Treatments

For some people Retinoid creams may be required. Some people may need photochemotherapy or photodynamic therapy. Surgical treatments are only used in those with severe scarring or those who have cancer.

For details of these treatments or any other questions please feel free to contact us at Health at Hand on 0800 003 004.

Answered by the Health at Hand nurses