VULVAR LICHEN PLANUS - The BC Centre for Vulvar Health ... ?· 6th Floor, Gordon and Leslie Diamond…

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<p>6thFloor,GordonandLeslieDiamondHealthCareCentre2775LaurelStreet,Vancouver,BC,V5Z1M9Tel.(604)875-4111ext.63445</p> <p> 1</p> <p>www.bcvulvarhealth.ca</p> <p>VULVARLICHENPLANUS</p> <p>Whatisit?</p> <p>Lichenplanusisaninflammatoryskindiseasethatcanaffectmenandwomen,anddifferentskinareasonthebody.Itmaycauseanitchyrashofsmallpurplishbumps,oftenonthearms,legs,orback.Oritmaycausesoreorrawareasonthemoistskinontheinsideofthemouth,entrancetothevaginaorinsidethevagina.Insomecases,thenailsandthescalparealsoinvolved.Itispossibletohavethediseaseinonearea(eg.vulva)withouteverhavingaproblemelsewhere(eg.mouth).</p> <p>Whatcauseslichenplanus?</p> <p>Thecauseoflichenplanusisunknown.WeknowthatitisNOTcausedbyinfection,hormonalchangesorageing,andisnotbecauseofanythingthatyoudidordidntdo.Itresultsfrominflammationintheskin.Theremaybeaproblemwiththeimmunesystem,thesystemthatprotectsapersonfrominfection.Inlichenplanusthesystemisoveractiveandmakesproteinsthatcauseinflammationintheskinoronthegenitalarea.Thisisreferredtoasanautoimmunereaction.Occasionallymedicines(likehydrochlorothiazide)canstartthisreaction.Whythelesionsdevelopinsomeplacesandnotothersisnotknown.LichenplanusisNOTcontagiousandcannotbepassedtoasexualpartner.</p> <p>WhatarethesymptomsandwhatdoIseeonnon-genitalskin?</p> <p>Ifonlythebodyskinisaffected,therashisusuallyontheinsideofthewrist,theforearmsandtheankles.Thespotsareapurplecolorandyoumayseesomefinewhitestreaksonthetopofthespots.Asimilarwhite,lacystreakingmaybeseeninsidethemouth,buttheremaynotbeanysymptoms.Theremaybesore,red,rawareasaroundthegummargins,tongueandinsideofcheeks.</p> <p>Whataboutvulvarlichenplanus?Whatarethesymptoms?</p> <p> Soreness,burningandrawnessattheentrancetothevaginaareverycommonsymptoms.Womenoftenfeelliketheyhaveaconstantyeastinfection.</p> <p> Abnormalvaginaldischarge:Somewomenhaveasticky,yelloworyellow-greendischarge,whichcanbebloodstained,especiallyafterintercourse.</p> <p> Vaginalbleedingandorspottingoutsideofyourmenstrualcycle. Painfulsexualintercourse:Thetopofthevaginacanbeinflamedandthiswillresultinpainwith</p> <p>intercourseandorbleedingafterintercourse.Ifthetopofthevaginastartstoscar,itmaybedifficulttohavepenetrativeintercourseandorhaveapelvicexaminationbythedoctor.</p> <p> Papsmearscanoftencomebackasabnormalifthevaginaandcervixareinflamed.</p> <p>6thFloor,GordonandLeslieDiamondHealthCareCentre2775LaurelStreet,Vancouver,BC,V5Z1M9Tel.(604)875-4111ext.63445</p> <p> 2</p> <p>www.bcvulvarhealth.ca</p> <p>Howislichenplanusdiagnosed?</p> <p>Doctorsfamiliarwiththeconditionmaydiagnoseitbylookingattheskinandseeingthecharacteristicappearance.Inregardstothevulva,signsoflichenplanusmayinclude;</p> <p> Changestothevulvaranatomythinningandorflatteningofthesmallhairlesslipsofthevulvaandskinaroundtheclitoris.TheappearancemaybesimilartoLichensclerosusofthevulva.</p> <p> Redness,erosionsandorulcersinthevestibule(theentrancetothevagina).Sometimesonecanseeawhitelacypatternontheinsideofthesmalllipsofthevulva.</p> <p> Redness,erosionsandorulcersatthetopofthevaginaandinvolvingthecervix.Bleedingafteravaginalexamination.</p> <p> Changestotheappearanceofthecervix(entrancetothewomb).Scarringofthevaginalvaultandorstrictureswithinthevagina.Theremaybealossofdepthofthevagina.</p> <p>Thediagnosismaybeconfirmedbybiopsybutoftentheskinisveryinflamedanderodedandthebiopsymaynotbediagnostic.</p> <p>Howislichenplanustreated?</p> <p>Thereisnocureforlichenplanus.However,insomecases,lichenplanusseemstocomeandgoofitsownaccordanditispossiblethatitwilldisappearcompletely.Thegoaloftherapyistocontrolthesymptomsandpreventchangestothevulvarandvaginalanatomy.</p> <p> Pleasefollowourskinrecommendations. Generally,mild-moderateanti-inflammatories(eg.topicalsteroids)areusedforminimalsymptoms. Forflare-upsmoderate-strongsteroidsareappliedtothevulvarandorwithinthevagina. Dilatorsmaybeneededtostretchanyscarringthatisaresultoftheskincondition.Rarelysurgery</p> <p>maybenecessary.Themedicationswillcontrolbutoftenwillnotcurethelichenplanus.Youwillneedtoworkwithyourhealthcareprovidertofindatreatmentregimenthatisacceptabletoyouandeffectiveincontrollingyourskincondition.Ingeneral,youwillneedtoseeyourdoctorevery6monthsuntilyourconditionisstable.</p> <p>WhatshouldIwatchfor?</p> <p>Aslichenplanusisachronicinflammatoryskincondition,thereisaverysmallriskofdevelopinglocaltypesofskincancerinthearea.Theriskisabout2%.Anynewraisedornon-healingareasinyourgenitalareashouldbereportedtoyourhealthcareprovider.Itisimportantthatyourlichenplanusistreatedandyouarefollowedbyyourhealthcareprovidersdentist,andfamilydoctor.Ifyouarenotsexuallyactiveandormenstruating,youmayneedtoinsertadilatorintothevaginaonaregularbasistocheckthatitisstillopen.(eg.Pureromancesilicondilators)</p> <p>6thFloor,GordonandLeslieDiamondHealthCareCentre2775LaurelStreet,Vancouver,BC,V5Z1M9Tel.(604)875-4111ext.63445</p> <p> 3</p> <p>www.bcvulvarhealth.ca</p> <p>LichenPlanus:TherapeuticOptions</p> <p>Followskincarerecommendations.Useabarrierontheexternalskinifusingintravaginaltherapy.</p> <p>Maintenance(Yoursymptomsareminimal)Yourphysicianmayrecommendoneofthefollowing</p> <p> 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)</p> <p>Flare-upsoutsidehurts(Youareverysymptomaticandthesymptomsareinterferingwithdailyactivitiesand/orsexualactivities)yourphysicianmayprescribeoneofthefollowing:</p> <p> TopicalClobetasolproprionate0.05%ointmentusednightlyforupto1month. Topicaltacrolimus0.1%ointmentapplyeveryotherdayandincreasingtotwiceperdayfor</p> <p>6weeks.</p> <p>Flare-upswithheavydischarge,bleedingandvaginalinvolvement</p> <p> Hydrocortisonecream25/50/100mgatbedtimeeverydayfor14daystheneveryotherdayfor14days.Thismaybetapereddownbutcontinuedfor4-6weekstillthereisadefiniteresponse.</p> <p> Hydrocortisone100mgsuppositories(orcream)nightlyfor3months Vaginaldilatortherapynightlytomaintainthelengthanddepthofvaginaandprevent</p> <p>permanentscarring.</p>