There are several lichenoid conditions that affect the vulva, perineum, anal area, clitoris and/or vagina. Lichenoid conditions are not well understood and can present some complicated and distressing vulvovaginal symptoms such as fusing of the labia and destruction of tissue.
Lichenoid conditions are a form of inflammatory dermatitis affecting mucosal surfaces in the body, like the mouth and vagina/vulva. There are several lichenoid conditions that differ somewhat in their presentation. We only cover vulvovaginal lichenoid conditions here.
Types of lichenoid conditions
- Lichen sclerosus (LS)
- Lichen planus (LP)
- Lichen simplex chronicus (LSC)
Symptoms of lichenoid conditions that affect the vulva
- Itching
- Pain
- Thickened vulvar skin
- Whitening
- Fusing tissue
- Each type of lichenoid condition has slightly different symptoms
Distinguishing characteristics of each lichenoid condition
Vulvar lichen sclerosus
- Can occur at any age, but onset occurs more in young girls and postmenopausal women
- Rarely involves other areas outside of the vulva, but can
- Itch, pain, and/or burning sensation
- Porcelain-white areas
- Skin looks wrinkled or like cigarette paper
- May include fissures, ulcers, erosions, thickened areas or a purplish rash
- Does not involve the vagina (only the vulva, perineum, clitoral hood, clitoris, and can extend to the anal area and buttocks)
- Affected cells are at risk of becoming cancerous
- Scratching can make it worse
- Can cause scarring and loss of tissue/loss of tissue structure (so vulva can start to change appearance and become less clearly defined)
- Labia minora may disappear
- Vaginal entrance (introitus) may become narrower
- In girls, digestive issues may appear due to perianal involvement
- Can mimic sexual abuse signs
It isn’t properly known just how many girls and women lichen sclerosus affects, because symptoms vary incredibly and can be subtle. It’s likely that far more girls and women have lichen sclerosus than is reported, due to misidentification by doctors and lack of symptoms.
Lichen sclerosus can occur at any age but occurs more in young girls and postmenopausal women. It was once believed that lichen sclerosus could be ‘grown out of’ once a girl hit puberty, but this is no longer the case. It can spontaneously disappear, never to be seen again, but lichen sclerosus may stay with a woman for life.
The immune system appears to be involved in lichen sclerosus, but research is still ongoing and it’s not clear exactly what mechanisms are at play. Autoimmune disease is found in about 30 per cent of women with LS, with thyroid issues, alopecia areata, vitiligo and pernicious anaemia the most common. There are sometimes family links.
Read more about lichen sclerosus
Erosive lichen planus
- Only occurs post-puberty
- Can affect other areas of the body outside of the vulva
- Causes vulvar pain
- Vulvar erosions
- Affects the labia minora and vestibule
- Can affect the vagina (not just the vulva)
- Affected cells are at risk of becoming cancerous
Lichen planus is an autoimmune condition affecting both skin and mucous membranes.
Lichen simplex chronicus
- Affects all ages
- Can involve areas of the body outside the vulva
- Thickened skin
- Affects the labia majora
- Does not affect the vagina
- Does not contribute to cancerous cell development
Links to more information
References
Int J Womens Dermatol. 2017 Mar; 3(1): 58–64. Lichenoid vulvar disease: A review. R. Fruchter, BA,a L. Melnick, MD,a and M.K. Pomeranz
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