Vulvar itching or pruritus is more common than it may seem among women. But what happens when despite countless treatments for candidiasis, tremendous spending on moisturizers and millions of home remedies seen on networks, you still have an itchy vulva? In this case it is very likely that we are dealing with a case of vulvar lichen sclerosus.
Many women come to my office because of this constant itching because, after a long time of enduring it, they notice how it affects their quality of life and want to solve it. In this article I leave you with all the information you need to know about vulvar lichen sclerosus.
Vulvar lichen sclerosus is a chronic pathology of possible autoimmune origin that, as I have mentioned, negatively affects the quality of life of women who suffer from it.
It is a pathology that mainly affects the skin of the vulva, although on many occasions it can affect the perianal area and the vestibule (entrance) area of the vagina.
This condition is progressive and benign. In addition, outbreaks may occur when the patient is at a stage in her life when estrogen levels are lower. For this reason it is mostly associated with perimenopausal or postmenopausal women and prepubertal girls, although it is increasingly being diagnosed in patients of any age.
The true prevalence is not known, but various studies have estimated it at 1 in 30 adult women and 1 in 1,000 prepubertal girls. Currently, the clinical perception of lichen is increasing as more and more women are diagnosed with it every year.
The most common symptom of lichen sclerosus is vulvar itching or pruritus, which may prevent the patient from sleeping. This feature is not unique and specific to lichen as it is present in most vulvar disorders, so a thorough workup must be done to diagnose it.
The following symptoms may also occur:
There are asymptomatic patients in whom the disease is detected by the color and shape of the vulva; generally, these are the most complicated cases because they are the ones that take the longest to diagnose.
To diagnose a case of vulvar lichen sclerosus it is necessary to observe the characteristic symptoms of the pathology and to perform an in-depth clinical examination of the patient. We can accompany it with a vulvoscopy to help us with the diagnosis.
Although not all cases require a confirmatory biopsy, it is the most useful to confirm the diagnosis or reevaluate it. When we talk about vulvar biopsy we refer to a simple test that is performed in consultation since it is only necessary to perform a punch of about 4mm and administer a small amount of local anesthesia. Sometimes it is not even necessary to give a point of approach. Recovery and return to routine is almost immediate.
The treatment of vulvar lichen sclerosus is aimed at reducing the symptoms of itching and pain, as well as the fissures, hyperkeratosis or ecchymosis caused by the pathology.
It is best to start treatment as soon as possible to alleviate the patient’s discomfort. Early treatment can reverse many of the skin changes, such as pallor.
The first therapy to be applied to the patient is education about lichen sclerosus: what it is, what it consists of, how to live with it, the treatment to apply…
Alongside this essential education is medical therapy, which is currently based on the use of topical corticosteroids. Treatment with high potency topical corticosteroids varies from patient to patient. Clobestasol propionate is usually started by applying clobestasol propionate for 6 to 12 weeks. After this time, the patient is re-evaluated and long-term maintenance therapy is prescribed to maintain normal skin color and texture, as well as to soothe itching.
The results of the first phase are usually favorable, with reduced itching, pain and dermatological symptoms.
It is recommended that treatment reviews be performed every 6 months, and if the patient does not undergo maintenance therapy, every 3 months.
I have spoken of the medical treatment that currently remains the main treatment for this pathology; however, integrative gynecology is still the main treatment for this pathology.
gynecology treats lichen sclerosus taking into account the woman as a whole. It not only focuses on the vulva, but also takes into account your emotions and lifestyle.
The integrative consultation takes into account:
In addition, if no changes are observed with medical and integrative treatments, it is possible to resort to the latest and most advanced technology of regenerative treatments.
Soy la doctora Bárbara Fernández del Bas, ginecóloga especialista en sexología, ginecología integrativa, funcional y medicina antienvejecimiento. Gracias a mi formación, la aproximación a mis pacientes siempre es de forma global. Soy consciente de que somos más que mamas, útero y ovarios. Somos un todo. Por eso, siempre busco los últimos avances científicos para ponerlos a disposición de toda mujer que los necesite