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6th Floor, Gordon and Leslie Diamond Health Care Centre 2775 Laurel Street, Vancouver, BC, V5Z 1M9 Tel. (604) 875-4111 ext. 63445 1 www.bcvulvarhealth.ca VULVAR LICHEN PLANUS What is it? Lichen planus is an inflammatory skin disease that can affect men and women, and different skin areas on the body. It may cause an itchy rash of small purplish bumps, often on the arms, legs, or back. Or it may cause sore or raw areas on the moist skin on the inside of the mouth, entrance to the vagina or inside the vagina. In some cases, the nails and the scalp are also involved. It is possible to have the disease in one area (eg. vulva) without ever having a problem elsewhere (eg. mouth). What causes lichen planus? The cause of lichen planus is unknown. We know that it is NOT caused by infection, hormonal changes or ageing, and is not because of anything that you did or didn’t do. It results from inflammation in the skin. There may be a problem with the immune system, the system that protects a person from infection. In lichen planus the system is overactive and makes proteins that cause inflammation in the skin or on the genital area. This is referred to as an autoimmune reaction. Occasionally medicines (like hydrochlorothiazide) can start this reaction. Why the lesions develop in some places and not others is not known. Lichen planus is NOT contagious and cannot be passed to a sexual partner. What are the symptoms and what do I see on non-genital skin? If only the body skin is affected, the rash is usually on the inside of the wrist, the forearms and the ankles. The spots are a purple color and you may see some fine white streaks on the top of the spots. A similar white, lacy streaking may be seen inside the mouth, but there may not be any symptoms. There may be sore, red, raw areas around the gum margins, tongue and inside of cheeks. What about vulvar lichen planus? What are the symptoms? • Soreness, burning and rawness at the entrance to the vagina are very common symptoms. Women often feel like they have a “constant yeast infection”. • Abnormal vaginal discharge: Some women have a sticky, yellow or yellow-green discharge, which can be bloodstained, especially after intercourse. • Vaginal bleeding and or spotting outside of your menstrual cycle. • Painful sexual intercourse: The top of the vagina can be inflamed and this will result in pain with intercourse and or bleeding after intercourse. If the top of the vagina starts to scar, it may be difficult to have penetrative intercourse and or have a pelvic examination by the doctor. • Pap smears can often come back as abnormal if the vagina and cervix are inflamed.

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Page 1: VULVAR LICHEN PLANUS - The BC Centre for Vulvar Health ...bcvulvarhealth.ca/wp-content/uploads/2017/05/CVH-Lichen-Planus-of... · 6th Floor, Gordon and Leslie Diamond Health Care

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

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www.bcvulvarhealth.ca

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.

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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)

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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.


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