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Suggest treatment for lichen sclerosus

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Posted on Thu, 19 May 2016
Question: My wife is 65 years old and had a total hysterectomy over twenty years ago. She has since been on hormone replacement therapy. Off and on for the past two years, she has experienced fissures between the labia and at the perineum. She doesn't suffer from lack of lubrication, but has very dry external skin and her clitoris appears to have detached and moved back into her inner pelvic area. The clitoral shaft is still palpable, but the usual extension occurring from stimulation has stopped. What do you think and what treatment would you suggest?
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Answered by Dr. Zenab Tambawala (1 hour later)
Brief Answer:
steroid cream for atleast 3 months then long term

Detailed Answer:
Hi there,
Welcome to HCM,

Your wife is suffering from Lichen sclerosis. The usual treatment for it is long term use of a steroid cream, cortizone is a good option, another option is Clobetasol propionate, which has to be applied daily for atleast 3 months and then depending on symptoms relief alternate days and then weekly.

Lichen sclerosis frequently affects the this age group and is a chronic disease. It is known to affect the clitoris. There are dedicated Vulval clinics where a long term follow up will be good.

I do not mean to scare you, but with lichen sclerosis there is a 5% chance of vulval cancer, so she needs to be alert about any changes in skin colour and any suspicion should make her see a doctor.

Another drug, if the clobetasol does not work is Pemicrolimus cream, its a immunomodulator and can be used upto 2 years.

Hope this helps.
Regards.
Above answer was peer-reviewed by : Dr. Sonia Raina
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Answered by
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Dr. Zenab Tambawala

OBGYN

Practicing since :2005

Answered : 837 Questions

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Suggest treatment for lichen sclerosus

Brief Answer: steroid cream for atleast 3 months then long term Detailed Answer: Hi there, Welcome to HCM, Your wife is suffering from Lichen sclerosis. The usual treatment for it is long term use of a steroid cream, cortizone is a good option, another option is Clobetasol propionate, which has to be applied daily for atleast 3 months and then depending on symptoms relief alternate days and then weekly. Lichen sclerosis frequently affects the this age group and is a chronic disease. It is known to affect the clitoris. There are dedicated Vulval clinics where a long term follow up will be good. I do not mean to scare you, but with lichen sclerosis there is a 5% chance of vulval cancer, so she needs to be alert about any changes in skin colour and any suspicion should make her see a doctor. Another drug, if the clobetasol does not work is Pemicrolimus cream, its a immunomodulator and can be used upto 2 years. Hope this helps. Regards.