Lichen Sclerosus Treatment Versus Adjunct Therapy

Introduction

We are switching gears a little for today. This post will discuss the difference between treatment and adjunct therapies and what this means for your lichen sclerosus journey.

This is an opinion piece. You are welcome to share your thoughts in the comment section at the end. I learn so much from this beautiful community, and you never stop teaching me; I am grateful for that.

Defining Treatment, Adjunct Therapy, and Cure

First of all, let us define some key terms:

Treatment: The definition of treatment is, “Medical treatment means the management and care of a patient to combat condition or disorder” (University of Wisconsin). Treatment can either manage a condition or cure the condition.

Primary Treatment: A primary treatment is the main treatment used to manage or cure a condition. It is often the one that has the most scientific evidence behind it and the best success rate.

Adjunct Therapy: According to the NIH and the National Cancer Institute, adjunct therapy is “Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. Also called adjunctive therapy”.

Cure: According to the NIH and the National Cancer Institute, a cure means “To heal or restore health; a treatment to restore health.” If a condition or disorder is cured, it would mean the patient no longer has the condition or disorder. This differs from remission when signs and symptoms temporarily resolve, but you still have the condition.

A Note on Lichen Sclerosus and a Cure

When I write this, there is no cure for lichen sclerosus; I hope we will have one someday. Any company that markets a product as a cure is unethical; same for any clinic that markets laser or PRP as a cure. They are not cures; there is no evidence they are cures.

Lichen Sclerosus Treatment

Lichen sclerosus treatment aims to manage symptoms, slow the condition's progression, and reduce the likelihood of developing vulvar cancer. To do so, treatment needs to be able to reduce the local inflammation in the vulvar tissues. 

The gold standard and first-line treatment for lichen sclerosus are topical corticosteroids (Corazza et al., 2021; Krapf et al., 2020; Goldstein et al., 2011). They are one of the few treatment options shown to significantly reduce inflammation, which is required to treat and manage lichen sclerosus. Calcineurin inhibitors are the only other treatment option available thus far that has also demonstrated the ability to reduce inflammation significantly. Learn more about steroids here and here and about calcineurin inhibitors here.

To date, other treatments on the market, such as CO2 fractional laser and PRP, are not effective at significantly reducing inflammation and therefore are not considered first-line treatment by most specialists (Goldstein et al., 2019; Mitchell et al., 2021).

We will have future content on different types of laser, PRP, fat grafting, and more in the future, so be sure to subscribe to our newsletter and check off blogs and videos so you get notified when that goes out.

In the meantime, I review PRP, laser, and other modalities in my FREE eBook, which you can get here.

Adjunct Therapies for Lichen Sclerosus

Here are some examples of adjunct therapies for lichen sclerosus; this list is not exhaustive.

• Platelet Rich Plasma
• Fat Grafting
• Laser (both ablative and non-ablative types)
• Phototherapy/light therapy
• Pelvic floor physical therapy
• Topical testosterone and estrogen
• Emollients and barrier creams
• Therapy and counseling
• Stress management
• Nutrition Therapy

See Chapter 1 of my FREE LS eBook here to learn more about these topics.

None of these options have the scientific evidence behind them to show the reduction in inflammation needed for it to be considered a primary treatment. However, studies on platelet-rich plasma, laser, phototherapy, and fat grafting have shown that patients felt an overall improvement in their symptoms, and patients and clinicians felt the skin looked healthier.

What does this mean for you?

Remember that adjunct therapy is “Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. Also called adjunctive therapy”. This means it can be something that you add to your primary treatment plan to boost effectiveness or to get more relief.

Not everyone gets 100% relief with topical corticosteroids or calcineurin inhibitors. Therefore, some of those adjunct treatments like platelet-rich plasm or laser may be used as an adjunct therapy – i.e., used in addition to steroids or calcineurin inhibitors to try to maximize symptom relief.

Stacking the Cards in Your Favor

Furthermore, and this is my personal philosophy, I am a big fan of stacking the cards in my favor.

What do I mean by that?

Well, I mean, you can throw all the steroids in the world at your vulva, but if your stress levels are through the roof, you are not sleeping properly, your pelvic floor muscles are tight, etc., you will have a more challenging time getting into remission and feeling better.

Though they are not a treatment, things like barrier creams and emollients can help soothe itch, soreness, discomfort, and dryness.

Similarly, pelvic floor physical therapy can help improve pelvic health, which can help with burning and pain during sex. However, it is also not a treatment.

Further, when I talk about living with LS, it is not all about treatment. It is about finding things that make me comfortable and making certain activities more accessible. An ice pack for the vulva can help temporarily take the edge off pain and itch, but it is not a treatment or cure; it is a way to soothe and manage symptoms.

These are things that can help manage symptoms, but are not treatments. Both are important and both have their place. However, it is critical to ensure that you do follow a treatment plan and not just manage symptoms.

Adjunct Therapy and the Strep Throat Analogy

Think about strep throat. Strep throat is an infection in the throat and tonsils caused by bacteria. Since it is a bacterial infection, it is treated with an antibiotic such as penicillin or amoxicillin.

The antibiotic is the treatment. However, your symptoms will not completely disappear after you swallow your first pill. Therefore, you may make some lemon tea with ginger, suck on a lozenge, or use a numbing benzocaine rinse to soothe the pain in your throat. In this example, tea, lozenges, and rinses are not the primary treatment but adjunct therapies. They are things you add to your primary treatment – i.e., the antibiotic – to help soothe and relieve symptoms as you wait for the antibiotic to treat the infection. 

Further, in addition to tea, lozenges, and rinses, you may drink more fluids and get more rest. Fluids and rest themselves are not working as the primary treatment, but they will help you feel better faster. 

This is what I mean when I say stacking the cards in your favor. 

How Can Adjunct Therapies Help with Your Lichen Sclerosus Journey

Adjunct therapies can help alleviate symptoms and help you get the most out of your treatment plan.

Everyone is different in which primary treatment and which adjunct therapies work best for them. Some folks thrive when they do nutrition therapy and steroids. Others thrive by adding emollients, stress management, and pain education to their primary treatment.

My primary treatment is Clobetasol propionate ointment. I use it 2x a week as maintenance, even though I have been in remission for over three years. As adjuncts, I do the following:

• Pelvic floor physical therapy
• Pelvic health yoga
• Dilators (use them more for maintenance now)
• Stress management (I focus on stimulating my vagus nerve)
• Exercise and proper sleep
• Emollients and barrier creams

Conclusion

In sum, adjunct therapies can be a great way to get the most out of your primary treatment plan and enhance your quality of life. Lichen sclerosus is an individualized condition, and what works for one person may not work for another. Explore your options and find what works best for you and your body.

Let us know what adjunct therapies you use in the comments below.

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Sources Consulted and Cited

NIH/National Cancer Institute

Bracco, G.L.; Carli, P.; Sonni, L.; Maestrini, G.; De Marco, A.; Taddei, G.L.; Cattaneo, A. Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. J. Reprod. Med. 1993, 38, 37–40

Corazza M, Schettini N, Zedde P, Borghi A. Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects. Biomedicines. 2021; 9(8):950. https://doi.org/10.3390/biomedicines9080950

Franic D, Iternička Z, Franić-Ivanišević M. Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: A case report. Case Rep Womens Health. 2018;18:e00062. Published 2018 Apr 16. doi:10.1016/j.crwh.2018.e00062 

Funaro, D.; Lovett, A.; Leroux, N.; Powell, J. A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. J. Am. Acad. Dermatol. 2014, 71, 84–91.

Goldstein, A.T.; Creasey, A.; Pfau, R.; Phillips, D.; Burrows, L.J. A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J. Am. Acad. Dermatol. 2011, 64, e99–e104.

More Sources

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Lee, A. and G. Fisher (2018). “Diagnosis and Treatment of Vulvar Lichen Sclerosus: An Update for Dermatologists”. American Journal of Clinical Dermatology. DOI/10.1007/s40257-018-0364-7 https://pubmed.ncbi.nlm.nih.gov/29987650/ 

Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, Brackenbury F, Mohd Mustapa MF, Exton LS. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018 Apr;178(4):839-853. doi: 10.1111/bjd.16241. PMID: 29313888. 

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Mitchell L, Goldstein AT, Heller D, Mautz T, Thorne C, Joyce Kong SY, Sophocles ME, Tolson H, Krapf JM. Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):979-987. doi: 10.1097/AOG.0000000000004409. PMID: 33957648; PMCID: PMC8132913. 

Tedesco M, Garelli V, Bellei B, Sperduti I, Chichierchia G, Latini A, Foddai ML, Bertozzi E, Bonadies A, Pallara T, Romani C, Morrone A, Migliano E. Platelet-rich plasma for genital lichen sclerosus: analysis and results of 94 patients. Are there gender-related differences in symptoms and therapeutic response to PRP? J Dermatolog Treat. 2020 Dec 6:1-5. doi: 10.1080/09546634.2020.1854650. Epub ahead of print. PMID: 33226278. 

Terras S, Gambichler T, Moritz RKC, Stücker M, Kreuter A. UV-A1 Phototherapy vs Clobetasol Propionate, 0.05%, in the Treatment of Vulvar Lichen Sclerosus: A Randomized Clinical Trial. JAMA Dermatol. 2014;150(6):621–627. doi:10.1001/jamadermatol.2013.7733