Lichen Planus
Lichen planus (LP) is an inflammatory disorder that can affect women at any age but is most common after the menopause. Inflammation can affect the skin of the vulva, inside the vagina, in the mouth or elsewhere on the skin. We do not understand why some women get LP but it may be an autoimmune condition; where the body’s own immune system attacks itself. It is not infectious or contagious.
- Soreness of the vulval skin
- Raw appearance of skin with breakdown
- Painful intercourse
- Persistent vaginal discharge (can be bloody)
- Change in appearance of the vulva with loss of labia minora (vulval lips) and flattening of the clitoral hood
- Blockage within the vagina making sex or having a smear test impossible
- Vulval itching
Diagnosis
The diagnosis can usually be made by taking your history and performing an examination at a consultation with a vulval specialist. Occasionally, a biopsy (small piece of skin) is taken to confirm the diagnosis.
Treatment
LP is a chronic condition for which there is no cure. Treatment aims to improve symptoms and prevent further inflammatory change. The course of LP varies for each patient but often symptoms come and go. Sometimes symptoms disappear completely over time. Mainstay treatment is with steroid ointment to the skin and vaginal steroid preparations. It is important to avoid vulval irritants such as soapy and perfumed products to the area and a daily moisturiser helps improve the quality of the skin. If the condition proves difficult to treat then steroid tablets or medication to lower the immune system can be used.
When the vagina is involved, vaginal dilators and specialist physiotherapy may be recommended. It is extremely rare for surgery to be indicated in the management of LP. Division of scar tissue within the vagina is the most common indication.
Follow up
Your specialist will see you regularly until symptoms are well controlled. Women with LP have a small increase (3%) in risk of developing a cancer of the vulva. For this reason you will require long term surveillance, usually on a 6 - 12 monthly basis.
