Vulvar Dermatoses: Lichen Sclerosus, Planus & LSC

Author: Jessica Lloyd
Senior Vulvovaginal Specialist Naturopath | BHSc(N) | ISSVD, ISSWSH, BSSM, ATMS

Last reviewed: July 30, 2026

The various types of vulvar dermatitis that arise can be confusing to the untrained eye. It is not uncommon for dermatologists to find themselves faced with vulvar dermatitis of some kind, but they are often unskilled at not only treating this very specialised area of the body but in the identification of the particular conditions.

Painful sex (dyspareunia) is the most common outcome of any type of vulvar complaint ranging from a simple case of contact dermatitis to more advanced disease with an immunological component such as lichen sclerosus.¹ Vulvar dermatoses is a differential diagnosis of sexual pain.

Understanding the uniqueness of the vulva is the first step in understanding the conditions affecting it.²

Symptoms of vulvar dermatitis

Pain
Fissuring
Bleeding
Itching
Painful sex (dyspareunia)
Lesions
Scarring
Fusion
Blistering

The vulva – why its flesh is unique

Epithelium: The skin on the vulva is different in many ways to skin on any other part of the human body – the epithelium (tissue) is from all three embryological layers.³
Immune: Specific proteins and antigens required for reproduction mean immunologically, this area of the body is responsive in some unique ways.
Labia majora: subcutaneous tissue on the labia majora is loose, allowing for oedema (swelling).

How dermatitis affects the vulva

Some variations are asymptomatic, whereas others are completely disabling. Vulvar dermatoses can be incredibly hard to treat, causing significant disruptions to the lives of the women suffering them.

Differential diagnosis (what else could it be?)

These conditions can look similar or the same as certain types of precancerous states, extramammary Paget’s disease, cancers, ulcerations from sexually transmitted infections, plasma cell vulvitis (rare), genital psoriasis, a yeast infection, or vulvar Crohn’s.

Emotional component of vulvar conditions

Treating these conditions requires extra emotional support, since losing one’s ability to receive or participate in any kind of sexual experience (which in many cases is true for any type of vulvar complaint) is a huge blow. Do not underestimate the impact.⁴

The avoidance of sexual relationships completely and a lack of discussion about the vulva problems compound the emotional toll. Grieving is important and encouraged.

Vulva hygiene and care

Cotton underwear, no g-strings (thongs)
Hypoallergenic laundry detergent and soaps
Avoid allergens and irritants (perfume, soap, any feminine hygiene products or douches)
Unscented pads and tampons
Rinse with warm water after urination
Wash and dry very gently
Use lukewarm water and just the fingers to wash vulva, outside skin only
Wear loose-fitting clothing, avoid tight garments
Do not use wipes, washes, or other cleaning products
Vaginal dilators may work to keep the vagina open
Der m atographia (an allergy to touch) may also be suggested as a possible cause of vulvar dermatitis.

Evaluations of vulvar dermatitis

A comprehensive history needs to be taken. The naturopathic evaluation focuses on different elements than standard western medical practice, however, to diagnose the condition, the standard western medical diagnosis must take place.⁵

This evaluation will include history, symptoms past and present, anything that makes it better or worse, sexual practices, sexual history, medications, and lifestyle factors such as exercise.

Physical examination of the vulva will be thorough and systematic. Photographs should be taken. Malignancies must be ruled out. A physician may see areas of pigmentation, scarring, ulceration, narrowing of the vaginal entrance, or an intractable clitoral hood (phimosis of the clitoris).

Vaginal pH and swabs will add information regarding microflora, with yeast infections and bacterial vaginosis often being present with vulvar dermatoses.

A biopsy may be very useful to determine the exact condition.⁶ The mouth, eyes and skin should also be examined – mucous membranes tend to exhibit similarities in disease. LP and LS can co-exist in the same patient.

Dermatitis (irritant or allergic) and lichen simplex chronicus

Lichen simplex chronicus in the vulva is the result of the itch-scratch-itch cycle, with underlying conditions possibly being seborrheic dermatitis, intertrigo, tinea or psoriasis, however often the cause is unknown. Any itching of the vulva can result in lichen simplex chronicus.⁷

Without an immune response, this condition is known as vulvar contact dermatitis and can result in burning, itching, and irritation. Any substance that interferes with the protective coating on the skin, the top layer of skin, or damages cell membranes can cause this type of irritation, therefore all treatments should aim to restore this layer.

Typical irritants are perfumes, soaps, detergents, fabric softeners, tampons, pads, adult diapers, wipes, sprays, deodorants, bubble baths, bath oils, coloured/scented toilet paper, and abrasive fabrics – cloths, sponges, etc, and urine and semen.

Over-cleaning, trapped sweat/moisture, and sports or activities that cause friction on the vulva (horse-riding, bicycles) can be triggers.⁸

Vulvar allergic contact dermatitis is a hypersensitivity reaction causing inflammation after direct contact with an allergen, within 12-24 hours. Allergens can include nickel (zips, snaps), preservatives, perfumes and latex. Medication is also a common trigger.⁹

It is important to note that lichen simplex chronicus may also be known as:

Neurodermatitis
Pruritus vulvae
Vulvar dystrophy
Vulvar atypia
Atrophic dystrophy
Mixed dystrophy
Vulvar intraepithelial neoplasia
Squamous hyperplasia
Hyperplastic dystrophy

As you can see with the plethora of names for this condition, diagnosis and cross-referencing with other practitioners can get complicated. Be clear when receiving your diagnosis.

These names all mean different things to pathologists, dermatologists and gynaecologists. This condition occurs from scratching or rubbing, and with the application or contact with irritants.

Lichen sclerosus (LS)

Lichen sclerosus has no known cause, tends to affect postmenopausal women (indicating unconfirmed hormonal link), with oral contraceptives possibly causing early onset in susceptible younger women, due to antiandrogenic properties.¹⁰

Research into infections and viruses has proved inconclusive. LS is linked with autoimmunity and genetics, but weakly so – around 21 per cent of LS sufferers have an autoimmune disease, most often a thyroid disease.

Over 40 per cent of sufferers have one or more autoantibodies and 22 per cent have a family history of the disease. Damage to skin (infection, friction, irritation, trauma) can trigger LS, with recurrence near vulvectomy scars common.

Erosive lichen planus (LP)

Vulvovaginal gingival syndrome (severe lichen planus)
Papulosquamous lichen planus (LP)
Hypertrophic lichen planus

Treating vulvar dermatoses

For lichen sclerosus and lichen planus, the mainstay of treatment is a potent topical corticosteroid, such as clobetasol propionate, used exactly as your doctor directs. This is well evidenced: it controls symptoms, helps prevent scarring and fusion, and – importantly – reduces the risk of vulval cancer that untreated lichen sclerosus carries (a lifetime risk of roughly 4–5% for vulval squamous cell carcinoma). Many people need ongoing maintenance treatment and regular check-ups to keep both the condition and that cancer risk under control.^2,6

For lichen simplex chronicus, the priority is breaking the itch-scratch cycle: treating any underlying condition, removing irritants, and using a topical steroid to calm the inflammation so the skin can recover. Contact and irritant dermatitis are treated by identifying and removing the trigger and restoring the skin barrier.

Gentle skin care and whole-body support can sit alongside all of this – but for the lichenoid conditions in particular, these complement medical treatment rather than replace it. Please do not stop prescribed steroids without medical advice, as under-treated lichen sclerosus and lichen planus can scar and carry that raised cancer risk.

Lichenoid conditions are lifelong but can be treated if caught early.¹¹ If you suspect you have a lichenoid condition, please see your doctor promptly for a proper diagnosis and treatment, then look at the best ways to support your immune system and overall health alongside it.

Frequently asked questions

What is the difference between lichen sclerosus, lichen planus and lichen simplex chronicus?

All three are vulval skin conditions that itch and can look similar. Lichen sclerosus causes thin, white, fragile skin and scarring. Erosive lichen planus can cause raw, painful erosions and can affect the mouth too. Lichen simplex chronicus is thickened skin from a persistent itch-scratch cycle. A biopsy often helps tell them apart.

Is lichen sclerosus linked to cancer?

Untreated lichen sclerosus carries a small but real risk of vulval squamous cell carcinoma, around 4 to 5% over a lifetime. Using topical steroids as prescribed and having regular check-ups lowers that risk and catches any changes early, which is exactly why ongoing treatment and monitoring matter.

How are vulvar dermatoses treated?

Lichen sclerosus and lichen planus are treated mainly with a potent topical corticosteroid such as clobetasol, often with ongoing maintenance. Lichen simplex chronicus needs the itch-scratch cycle broken. Gentle skin care, avoiding irritants and whole-body support help alongside – but not instead of – medical treatment.

Can vulvar dermatoses be cured?

The lichenoid conditions are usually lifelong rather than curable, but they can be very well controlled with the right treatment, especially when caught early. The aim is to keep symptoms settled, prevent scarring, and reduce cancer risk – which is realistic for most people who stay on treatment.

This article is general information, not medical advice. Vulvar dermatoses can look like one another and like precancerous conditions or cancer, so a proper diagnosis – often including a biopsy – is essential. Lichen sclerosus and lichen planus need medical treatment and ongoing monitoring, so please see a doctor or dermatologist rather than trying to manage these conditions on your own.