Harvard Women's Health Watch

In Brief: Vulvar lichen planus is best treated with high-potency creams

In Brief

Vulvar lichen planus is best treated with high-potency creams

Lichen planus is a relatively uncommon inflammatory condition that affects the skin, nails, mouth, and vagina, usually around midlife. One of its most troubling manifestations is erosive lichen planus of the vulva (ELPV), an often painful condition that usually starts with itchy patches on the vulva (the tissues surrounding the vagina and urethra) and in the vagina. With time, scarring develops, causing the labial and clitoral tissues to shrink and the urethral and vaginal openings to narrow. Women frequently have trouble urinating, pain with intercourse, and bleeding after intercourse. No one knows what causes ELPV, though there's some evidence that an autoimmune mechanism is at work.

There have been few studies of ELPV and no randomized trials of therapies, which has made it difficult for clinicians to advise women about the course of the disease and the best way to treat it. But new research is changing that picture. According to a study in the March 2006 Archives of Dermatology, the best way to relieve or eliminate symptoms is with strong topical corticosteroid drugs, alone or in combination with antifungal or antibacterial preparations. The research also suggests a possible link between ELPV and the development of a form of skin cancer.

In this study, British dermatologists monitored 114 women diagnosed with ELPV for an average of six years. They gathered information about symptoms, diagnosis, and response to various treatments, including surgery, oral medications, and topical corticosteroids. Most of the women were diagnosed with ELPV during perimenopause or postmenopause — on average, about five years after symptoms began. More than half also had lichen planus lesions in the mouth, a condition called vulvovaginal-gingival syndrome.

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