6thFloor,GordonandLeslieDiamondHealthCareCentre2775LaurelStreet,Vancouver,BC,V5Z1M9Tel.(604)875-4111ext.63445

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VULVARLICHENPLANUS

Whatisit?

Lichenplanusisaninflammatoryskindiseasethatcanaffectmenandwomen,anddifferentskinareasonthebody.Itmaycauseanitchyrashofsmallpurplishbumps,oftenonthearms,legs,orback.Oritmaycausesoreorrawareasonthemoistskinontheinsideofthemouth,entrancetothevaginaorinsidethevagina.Insomecases,thenailsandthescalparealsoinvolved.Itispossibletohavethediseaseinonearea(eg.vulva)withouteverhavingaproblemelsewhere(eg.mouth).

Whatcauseslichenplanus?

Thecauseoflichenplanusisunknown.WeknowthatitisNOTcausedbyinfection,hormonalchangesorageing,andisnotbecauseofanythingthatyoudidordidn’tdo.Itresultsfrominflammationintheskin.Theremaybeaproblemwiththeimmunesystem,thesystemthatprotectsapersonfrominfection.Inlichenplanusthesystemisoveractiveandmakesproteinsthatcauseinflammationintheskinoronthegenitalarea.Thisisreferredtoasanautoimmunereaction.Occasionallymedicines(likehydrochlorothiazide)canstartthisreaction.Whythelesionsdevelopinsomeplacesandnotothersisnotknown.LichenplanusisNOTcontagiousandcannotbepassedtoasexualpartner.

WhatarethesymptomsandwhatdoIseeonnon-genitalskin?

Ifonlythebodyskinisaffected,therashisusuallyontheinsideofthewrist,theforearmsandtheankles.Thespotsareapurplecolorandyoumayseesomefinewhitestreaksonthetopofthespots.Asimilarwhite,lacystreakingmaybeseeninsidethemouth,buttheremaynotbeanysymptoms.Theremaybesore,red,rawareasaroundthegummargins,tongueandinsideofcheeks.

Whataboutvulvarlichenplanus?Whatarethesymptoms?

• Soreness,burningandrawnessattheentrancetothevaginaareverycommonsymptoms.Womenoftenfeelliketheyhavea“constantyeastinfection”.

• Abnormalvaginaldischarge:Somewomenhaveasticky,yelloworyellow-greendischarge,whichcanbebloodstained,especiallyafterintercourse.

• Vaginalbleedingandorspottingoutsideofyourmenstrualcycle.• Painfulsexualintercourse:Thetopofthevaginacanbeinflamedandthiswillresultinpainwith

intercourseandorbleedingafterintercourse.Ifthetopofthevaginastartstoscar,itmaybedifficulttohavepenetrativeintercourseandorhaveapelvicexaminationbythedoctor.

• Papsmearscanoftencomebackasabnormalifthevaginaandcervixareinflamed.

6thFloor,GordonandLeslieDiamondHealthCareCentre2775LaurelStreet,Vancouver,BC,V5Z1M9Tel.(604)875-4111ext.63445

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www.bcvulvarhealth.ca

Howislichenplanusdiagnosed?

Doctorsfamiliarwiththeconditionmaydiagnoseitbylookingattheskinandseeingthecharacteristicappearance.Inregardstothevulva,signsoflichenplanusmayinclude;

• Changestothevulvaranatomy–thinningandorflatteningofthesmallhairlesslipsofthevulvaandskinaroundtheclitoris.TheappearancemaybesimilartoLichensclerosusofthevulva.

• Redness,erosionsandorulcersinthevestibule(theentrancetothevagina).Sometimesonecanseeawhitelacypatternontheinsideofthesmalllipsofthevulva.

• Redness,erosionsandorulcersatthetopofthevaginaandinvolvingthecervix.Bleedingafteravaginalexamination.

• Changestotheappearanceofthecervix(entrancetothewomb).Scarringofthevaginalvaultandorstrictureswithinthevagina.Theremaybealossofdepthofthevagina.

Thediagnosismaybeconfirmedbybiopsybutoftentheskinisveryinflamedanderodedandthebiopsymaynotbediagnostic.

Howislichenplanustreated?

Thereisnocureforlichenplanus.However,insomecases,lichenplanusseemstocomeandgoofitsownaccordanditispossiblethatitwilldisappearcompletely.Thegoaloftherapyistocontrolthesymptomsandpreventchangestothevulvarandvaginalanatomy.

• Pleasefollowourskinrecommendations.• Generally,mild-moderateanti-inflammatories(eg.topicalsteroids)areusedforminimalsymptoms.• Forflare-upsmoderate-strongsteroidsareappliedtothevulvarandorwithinthevagina.• Dilatorsmaybeneededto“stretch”anyscarringthatisaresultoftheskincondition.Rarelysurgery

maybenecessary.Themedicationswillcontrolbutoftenwillnotcurethelichenplanus.Youwillneedtoworkwithyourhealthcareprovidertofindatreatmentregimenthatisacceptabletoyouandeffectiveincontrollingyourskincondition.Ingeneral,youwillneedtoseeyourdoctorevery6monthsuntilyourconditionisstable.

WhatshouldIwatchfor?

Aslichenplanusisachronicinflammatoryskincondition,thereisaverysmallriskofdevelopinglocaltypesofskincancerinthearea.Theriskisabout2%.Anynewraisedornon-healingareasinyourgenitalareashouldbereportedtoyourhealthcareprovider.Itisimportantthatyourlichenplanusistreatedandyouarefollowedbyyourhealthcareproviders–dentist,andfamilydoctor.Ifyouarenotsexuallyactiveandormenstruating,youmayneedtoinsertadilatorintothevaginaonaregularbasistocheckthatitisstillopen.(eg.Pureromancesilicondilators)

6thFloor,GordonandLeslieDiamondHealthCareCentre2775LaurelStreet,Vancouver,BC,V5Z1M9Tel.(604)875-4111ext.63445

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www.bcvulvarhealth.ca

LichenPlanus:TherapeuticOptions

Followskincarerecommendations.Useabarrierontheexternalskinifusingintravaginaltherapy.

Maintenance(Yoursymptomsareminimal)–Yourphysicianmayrecommendoneofthefollowing

� Hydrocortisone2.5%applydaily.� Mometasonefourate0.1%ointmentapply2-3timesperweek.

� Betamethasonevalerate0.1%ointmentapply2-3timesperweek.

� Clobetasolproprionate0.05%ointmentapply2-3timesperweek.

� Tacrolimus0.1%ointmentorpimecrolimusointmentapplyeveryotherday.

� Hydrocortisone25mgvaginalsuppositoriesorcream1-2applicationsperweek.

� Localestrogenreplacement(eg.Vagifem10ugtwiceperweek)

� Monthlyvaginaldilatortherapy(ifnotsexuallyactive)

Flare-ups–outsidehurts(Youareverysymptomaticandthesymptomsareinterferingwithdailyactivitiesand/orsexualactivities)yourphysicianmayprescribeoneofthefollowing:

� TopicalClobetasolproprionate0.05%ointmentusednightlyforupto1month.

� Topicaltacrolimus0.1%ointmentapplyeveryotherdayandincreasingtotwiceperdayfor6weeks.

Flare-ups–withheavydischarge,bleedingandvaginalinvolvement

� Hydrocortisonecream25/50/100mgatbedtimeeverydayfor14daystheneveryotherdayfor14days.Thismaybetapereddownbutcontinuedfor4-6weekstillthereisadefiniteresponse.

� Hydrocortisone100mgsuppositories(orcream)nightlyfor3months

� Vaginaldilatortherapynightlytomaintainthelengthanddepthofvaginaandpreventpermanentscarring.