Lichen simplex chronicus (LSC)

Contact dermatitis and resultant lichen simplex chronicus (LSC) is a vulvar skin condition where the skin thickens as a result of irritation of some sort.

Lichen simplex chronicus is treatable, but it may recur, particularly if the irritant is not removed. There is no ‘cure’ for LSC, but it can be managed and may only occur once or twice then never come back.

Lichen simplex chronicus may also be called neurodermatitis, pruritus vulvae (‘itchy vulva’), squamous hyperplasia, and hyperplastic dystrophy.

Lichen simplex chronicus is inflammation caused by an external irritant or allergen, which is very common. The reason this condition is so common is because a lot of creams, douches, laundry detergent and so on can come in contact with the vulva across a regular day. Soaps, perfumes, cosmetics, spermicides, pessaries, condoms, and menstrual products can all cause irritation.

Some medicines can also cause contact dermatitis – benzocaine, hormone creams, corticosteroids, topical antifungals, and antibiotics.

Symptoms of lichen simplex chronicus:

  • Burning
  • Itching, particularly itching that results in intense pleasure when scratched
  • Dyspareunia (painful sex)
  • Cuts, tears and fissuring around the vaginal entrance
  • Thickened skin that goes white when wet
  • Weeping sores
  • Mild redness
  • Lesions
  • Leathery skin
  • Missing pubic hair
  • Pigmentation changes
  • Abnormal collections of fluid (spongiosis)

When the itch is scratched, it can result in lichen simplex chronicus (LSC), which is a lichenoid skin condition caused by constant scratching, for example with insect bites. This is called the itch-scratch-itch cycle.

This condition must be differentiated from lichen sclerosus (LS), lichen planus (LP), tinea genitalis, or cancerous growths. 

Treatment of lichen simplex chronicus

The treatment of LSC first to remove the cause of the irritation. If this is unknown, a careful diary listing all elements that could possibly come into contact with the vulva and vagina must be made, as well as a detailed record regarding sexual and menstrual practices to try to find the trigger, including rubbing and scratching.

The purpose of these treatments are to alleviate the itching and scratching so the vulva can heal, so at-home remedies can work just as well as medications. 

Anti-inflammatory, calming, soothing to the skin and mucous membranes – oat baths and ice packs can do the trick – but if you are a sleep scratcher, more drastic action may be required, including sedatives to stop sleep scratching and short courses of super potent corticosteroids.

An ointment is used, not a cream, since creams may contain alcohol and be an irritant. A tiny amount of steroid cream should be used.

Medication should be used until skin looks normal, then it will be tapered off. Medication may be required long-term.

Medical treatments for lichen simplex chronicus

Topical steroid cream may be used to reduce inflammation (triamcinolone 0.1% ointment twice daily, or for severe cases 0.05% clobetasol ointment once per day). A 15-minute hot bath before applying the corticosteroids softens the lichenified skin and the ointment can penetrate the skin better.

Additionally, antihistamines and ice packs can help reduce itching and inflammation. Some women scratch in their sleep, and several remedies can be used for this including barriers put in place, with 10-25mg oral amitriptyline (a low-dose tricyclic antidepressant) and an ice pack having been used to stop night itching with some success.

Treatment time is as per symptoms, however, if symptoms do not abate, a rethink is in order because the cause has not been alleviated or the disease has been incorrectly diagnosed. The itch-scratch-itch cycle must be broken. Other infections must be treated.

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)