Introduction

One question that comes up at almost every Lichen Sclerosus Support Network virtual meetup is, “Can supplements improve vulvar lichen sclerosus symptoms”, “should I be buying supplements”, and “if so, which ones should I buy”. So, with that, we thought, let’s write a blog about it, and here we are. In this post, we review what supplements are, important disclaimers and regulation caveats. We highlight studies looking at vulvar lichen sclerosus (VLS) and supplements and share perspectives from our medical advisory board.

*This post is evidence-based; I draw on the medical literature to share what you need to know about vulvar lichen sclerosus and supplements. Importantly, what I share is my interpretation of the science and data.

**If you found this post helpful, we’d love your support in continuing to provide important education like this. Make a donation today, volunteer with us, or share our posts in your support groups.

What are Supplements?

Supplements, also known as dietary supplements, are products intended to supplement the diet. People may take vitamins or other dietary supplements to help their bodies get the nutrients they might be missing from food. These supplements can include not just vitamins, but also minerals, herbs, amino acids, enzymes, and other stuff. They come in different forms like pills, capsules, chewable gummies, powders, drinks, and energy bars. Some of the most popular ones are vitamin D, vitamin B12, calcium, iron, herbs like echinacea and garlic, and things like glucosamine, probiotics, and fish oil.

When you buy a supplement, it comes with a label that tells you what’s in it, how much of the good stuff is in each serving, and any extra ingredients that are there to help make the supplement look or taste better. The label also suggests how much you should take, but your doctor might tell you to take a different amount based on your health needs.

While supplements can help you get the nutrients you need if you’re not eating a super healthy diet, they’re not a magic fix. You still need to eat a variety of foods to stay healthy. 

Supplements and Health Conditions

Some supplements help with health issues. For example, calcium and vitamin D are great for keeping bones strong and preventing bone loss. Folic acid can lower the risk of certain birth defects. Omega-3 fatty acids from fish oil might be good for people with heart problems. A special mix of vitamins and minerals called an AREDS formula could slow down vision loss in people with macular degeneration (National Institute of Health, Office of Dietary Supplements, Fact Sheet).

But for many other supplements, we’re not sure if they really work because they haven’t been studied enough. The government agency, the FDA that makes sure food and drugs are safe, doesn’t check to see if supplements do what they claim before they’re sold in stores (ibid)..

Important Disclaimers about Safety and Supplements

Safety Risks

Supplements can pack a punch since they’re made with active ingredients that can affect your body. It’s important to keep an eye out for any bad reactions, especially when you start taking something new.

You’re more likely to run into trouble with supplements if you take them in large amounts, use them instead of the medicines your doctor prescribed, or mix a bunch of different ones. Some supplements can make you bleed more or mess with how you react to anesthesia if you take them before surgery. They can also interfere with your medicines in ways that aren’t good. 

For example:

Vitamin K can make it harder for warfarin, a blood thinner, to do its job of preventing clots.

St. John’s wort can make a lot of medicines break down faster in your body, which means they won’t work as well. This includes some antidepressants, birth control pills, heart meds, HIV meds, and drugs for organ transplants (ibid).

Too Much of a Good Thing

Sometimes, the foods you eat, especially breakfast cereals and drinks, are already loaded with vitamins, minerals, and other supplement stuff. This means you could be getting more than you realize, and getting too much isn’t always better. It can cost you more and might even raise your chances of having side effects. For instance, too much vitamin A can lead to headaches, liver problems, weaker bones, and birth defects. Too much iron can make you sick to your stomach, and in serious cases, it can hurt your liver and other organs (ibid).

Supplements and Pregnancy

If you’re pregnant or breastfeeding, it’s best to be careful with supplements beyond the usual prenatal vitamins. The thing is, many supplements haven’t been properly tested for safety in pregnant women, nursing moms, and children (ibid).

A Word on Regulation

Unlike medicines, which need the FDA’s green light before they can be sold, supplements don’t require this approval. Companies that make supplements are supposed to make sure their products are safe and that what’s on the label is true and doesn’t mislead people. However, they don’t have to show the FDA this safety evidence before they start selling their products, as long as they don’t include any new ingredients that weren’t around before October 15, 1994 (ibid).

Supplement labels can say that their product helps with health or supports a part of your body or a function, like your heart or immune system. But they have to add a disclaimer that says the FDA hasn’t checked their claim and that the product isn’t meant to diagnose, treat, cure, or prevent any disease (ibid).

Companies have to follow good manufacturing practices (GMPs) to ensure their products are what they say they are and that they’re safe. If the FDA finds an unsafe supplement, they can take it off the shelves or ask the company to recall it (ibid).

Can Supplements Help with Vulvar Lichen Sclerosus Symptoms?

The truth is, we just do not know. There aren’t really any quality scientific studies exploring the impact of different supplements on vulvar lichen sclerosus symptoms. Search for papers on supplements and vulvar lichen sclerosus in PubMed and Google Scholar showed very few results.

Vitamin A and E and Vulvar Lichen Sclerosus

A few papers have looked at the use of topical (cream/oil applied to the skin) vitamin E and found no benefits over and above that of a traditional emollient and no support as a treatment for VLS(Przybylska et al. 2018; Singh et al., 2020). Singh et al. 2020 note vitamin E cream used as an adjunct therapy has no advantage over symptom control. They also cite a case report of genital lichen sclerosus that showed symptom improvement of oral vitamins A and E, but this paper can no longer be found, so I can’t speak on this case study.

Avocado and Soybean Extracts

A study by Borghi et al. (2014) evaluated the use of a cream with avocado and soybean extracts (ASE cream) and a nutritional supplement of vitamin E and para-aminobenzoic acid. 23 participants were enrolled in the study. The cream was used 2x a day for 24 weeks and the supplement was used during the first 12 weeks. The study was not randomized, controlled, or blinded. Researchers compared the signs and symptoms of each patient at the beginning and end of 24 weeks and found improvements in both signs and symptoms. Specifically, they found:

• 70.5% of patients who had symptoms felt at least 75% better.

• 72.2% of patients showed at least a 75% improvement based on observable signs.

• 100% of patients had at least a 50% improvement in their symptom score.

• 88.9% of patients had at least a 50% improvement in their observable signs score.

Generally speaking, the ASE cream and supplement were well torelated; therefore, the authors conclude that they could help manage VLS symptoms. 

However, since no biopsies were taken before and after, we do not know if this option was able to reduce inflammation, and therefore serve as a treatment option. To know if ASE cream and supplements are appropriate as a treatment would require randomized, blinded studies to replicate these findings, as well as compare it in a randomized controlled trial to see how it compared to the gold standard treatment, topical corticosteroids. Finally, we would want to see studies with larger participant numbers and observe the effects over more than 24 weeks.

Vitamin D and Vulvar Lichen Sclerosus

Since VLS is considered an autoimmune condition, you may be wondering about VLS and vitamin D, since vitamin D seems to play an important role in autoimmunity (Bellan et al. 2020; Harrison et al.2019; Yan et al., 2013).

Unfortunately, I was unable to find open-access scientific papers examining vitamin D for managing vulvar lichen sclerosus symptoms.

That said, Kathy and Jaclyn have heard many people in the virtual meetups state their VLS symptoms improved significantly after working with nutrition therapists and taking vitamin D supplements. Hopefully, there will be research on this in the future, however, for now, we just do not fully understand the role of vitamin D in vulvar lichen sclerosus disease progression and management. 

The Bottom Line on Can Supplements Improve Vulvar Lichen Sclerosus Symptoms

At this time, there is insufficient evidence supporting any specific supplement for improving vulvar lichen sclerosus symptoms. 

Furthermore, supplementation is very individual and complex. If you want to include supplements to promote overall well-being and health, you may choose to consult with a naturopath, registered dietician, or nutrition therapist for advice on your unique situation.

Medical Advisory Board Stand on Supplements and Vulvar Lichen Sclerosus

Dr. Erin Foster from our Medical Advisory Board notes:

“In the Pacific Northwest, I encourage everyone to take at least 2000IU vitamin D from November to May, since most of us are deficient and it seems to help many skin conditions (hair loss, psoriasis, etc). I wish I could say I have data on LS!

The vitamin E oils probably help because they are moisturizing.

For patients with atopic dermatitis/eczema and LS who want to try supplements, fish oil or omega 3s are good for dry skin.”

Conclusion on Can Supplements Improve Vulvar Lichen Sclerosus

In sum, there isn’t enough scientific proof to recommend any particular supplement for relieving symptoms of vulvar lichen sclerosus at this time That said, if you’ve found a particular supplement to be helpful in symptom relief, please share in the comments with the mindset that we are all unique and need different things to support overall health and wellbeing.

Also, deciding on supplements can be a personal and complicated matter. If you’re considering supplements to enhance your overall health and well-being, it might be helpful to speak with a naturopath, a registered dietician, or a nutrition therapist. They can provide personalized advice based on your specific health needs.

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Sources Cited

Bellan, Mattia, et al. “Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases.” Nutrients, vol. 12, no. 3, 17 Mar. 2020, p. E789, pubmed.ncbi.nlm.nih.gov/32192175/, https://doi.org/10.3390/nu12030789.

Borghi, A., et al. “Avocado and Soybean Extracts as Active Principles in the Treatment of Mild-To-Moderate Vulvar Lichen Sclerosus: Results of Efficacy and Tolerability.” Journal of the European Academy of Dermatology and Venereology, vol. 29, no. 6, 3 Sept. 2014, pp. 1225–1230, https://doi.org/10.1111/jdv.12617. Accessed 9 Jan. 2022.

Corazza, Monica, et al. “Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects.” Biomedicines, vol. 9, no. 8, 3 Aug. 2021, p. 950, https://doi.org/10.3390/biomedicines9080950.

Harrison, Stephanie R., et al. “Vitamin D, Autoimmune Disease and Rheumatoid Arthritis.” Calcified Tissue International, vol. 106, no. 1, 8 July 2019, pp. 58–75, link.springer.com/article/10.1007/s00223-019-00577-2, https://doi.org/10.1007/s00223-019-00577-2.

“Office of Dietary Supplements – Dietary Supplements: What You Need to Know.” Ods.od.nih.gov, ods.od.nih.gov/factsheets/WYNTK-Consumer/#h3.

Przybylska, Renata, et al. “Lichen Sclerosus as a Clinical Problem.” Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii, vol. 35, no. 6, 1 Dec. 2018, pp. 644–648, www.ncbi.nlm.nih.gov/pmc/articles/PMC6320482/, https://doi.org/10.5114/ada.2018.77618. Accessed 9 July 2020.

Singh, Vasundhara, et al. “Anogenital Lichen Sclerosus.” Indian Journal of Sexually Transmitted Diseases and AIDS, vol. 41, no. 1, 2020, p. 1, https://doi.org/10.4103/ijstd.ijstd_49_17. Accessed 24 July 2021.

Yang, Chen-Yen, et al. “The Implication of Vitamin D and Autoimmunity: A Comprehensive Review.” Clinical Reviews in Allergy & Immunology, vol. 45, no. 2, 29 Jan. 2013, pp. 217–226, www.ncbi.nlm.nih.gov/pmc/articles/PMC6047889/, https://doi.org/10.1007/s12016-013-8361-3.