Introduction

Lichen sclerosus is a chronic, inflammatory skin condition that is considered autoimmune. It is progressive, meaning it can worsen over time when it is not treated and managed correctly. Unfortunately, there is no cure for lichen sclerosus (although hopefully that will one day change). In light of this, it is essential to be on a well-studied treatment plan to keep LS from progressing, reduce symptoms and inflammation, increase quality of life, and reduce the risk of developing vulvar cancer.

However, lichen sclerosus treatment is more complex than one may think. There are many options out there. Our philosophy at Lichen Sclerosus Support Network is to present evidence-based information so you can make informed decisions about your healthcare plan.

We will review the main treatments for lichen sclerosus, some experimental/adjunct therapies, and some treatments that are in the pipeline (i.e., currently being studied, but we have no data yet).

Finding What You are Looking For

In this article, you will find information about:

• Topical corticosteroids
• Topical calcineurin inhibitors
• Experimental and adjunct therapies
  • Laser
  • Platelet-rich plasma (aka PRP)
  • Phototherapy
• Treatments in the pipeline
• Other add-ons like diet, pelvic floor PT, and more
• About the author
• Sources cited

Overview

Topical corticosteroids are the gold standard treatment for lichen sclerosus because they have the most evidence supporting their benefits and overall safety. They are also unmatched in their ability to reduce inflammation. This is critical because things like fusing (when parts of the vulva stick to other parts of the vulva), color changes (lightening of the skin), cracking, tearing, fissures, pain with sex, and itch are all due to the high levels of local inflammation in the vulva^{1 2 3 4 5 6 7 8 9 10 11}.

What Form to Use?

Topical corticosteroids are usually prescribed in cream or ointment form. However, the ointment form is preferable, according to most LS specialists, as it does a better job of getting the medication where it needs to go and, unlike the cream, does not contain alcohol in the base (this can burn if you have any open tears or fissures). 

Side Effects

Topical means applying it to the skin locally instead of taking it orally, which has full-body effects. Since topical corticosteroids are not absorbed well systemically but only into the vulvar tissue, full-body side effects are low-risk.

Regarding local side effects, the most common side effects are recurrent yeast infections, rash, and stinging upon application. However, the risk of recurrent yeast infections goes down substantially by applying your steroid properly. If you are applying your steroid properly but still experience recurrent yeast, you can manage recurrent yeast infections by reducing the potency of the steroids and/or adding a topical antifungal into your program¹⁵.

Sometimes, folks with diabetes require an oral anti-fungal; be sure to discuss this with your healthcare provider. You can manage rash by reducing the potency or frequency of the steroids (ibid). Stinging upon application typically subsides as the skin starts to heal. Still, you may discuss changing your steroid (e.g., switching to a different steroid) if you do not see improvement after a few months (ibid). 

Check out our post here for a more in-depth discussion on side effects and topical corticosteroids for lichen sclerosus.

Many folks worry about steroids thinning the skin, especially those with some skin thinning. This is a super valid concern! Luckily, skin thinning from steroids is uncommon in skin with LS, especially if you use your steroids properly. 

Not sure how to use your steroids properly? Check out the video interview with Dr. Jill Krapf below or read the blog.

A paper by Mautz et al. took a deep dive into steroid side effects for folks with lichen sclerosus. On the topic of skin thinning, they found that those reporting skin thinning as a side effect did not have lichen sclerosus; on the other hand, the papers looking at patients with lichen sclerosus reported no skin thinning as a side effect⁶.

How Often Should You Use Your Steroids?

There are a couple of general protocols for steroid application for lichen sclerosus documented in the scientific literature. The first, which is more commonly practiced in North America, is by Lewis et al., 2018¹⁷.

This protocol states that patients with vulvar lichen sclerosus are to apply their steroid medication:

The second general protocol comes from the 2021 European Guidelines, which recommends that patients apply their steroids daily for the first three months. After three months, a maintenance regime is followed. Patients will apply 1-2 times per month or 2-3 times per week, depending on the case¹⁸.

Caveats

Some important caveats need to be highlighted when discussing how often to use your steroids.

Caveat #1

What is outlined above are two general protocols. If your doctor gave you a different protocol, please follow it or ask your doctor for further clarification if you are unsure. If you are concerned about the protocol they gave you, talk with them about why they deviated from the standard dosing schedule. There may be a good reason for this. Because this is a general protocol, this may not work for everyone.

Please remember that we are all different, so it is not uncommon for many of us to slightly deviate from that schedule. 

Caveat #2

This protocol can differ depending on where you are located in the world. Some countries have patients stop steroids once they get into remission. Each country has its own guidelines and rules they must abide by. It would help if you made this decision in conjunction with your healthcare provider. 

Caveat #3

Dr. Gayle Fischer, an LS researcher and dermatologist based in Australia, customizes one's dosing schedule and the steroid potency based on the severity of LS and how the patient responds. She is not the only doctor to take this approach – some doctors in the United Kingdom and other areas of the world have a similar approach. 

Your doctor should tell you how often and where to apply. Ideally, they will have you back after three months of treatment to re-assess and potentially readjust your application. It can take up to 6 months to get to remission in some cases, so ask your doctor about expectations with treatment and make sure to follow up because any areas that are not healing may need further attention or a biopsy.

Caveat # 4

Steroid treatment aims to get patients into remission and onto a maintenance dosing schedule. You are not meant to apply the medication daily for life.

Overview 

Topical calcineurin inhibitors (TCIs) are topical, non-steroidal immunosuppressant medications. They are currently considered second-line treatment for lichen sclerosus^{14 19 20 21 22 23 24 25}. Topical means the medicine is applied directly to the body in a cream or ointment base instead of taking an oral medication. A topical immunosuppressant medication works to keep your local immune system functioning optimally. For example, these medications can help calm an overactive immune system in the skin.

In the case of lichen sclerosus, we are dealing with a local overactive immune response. A local immune response in the bottom layer of the vulvar skin sets off a massive inflammatory reaction responsible for many of the skin changes and symptoms of lichen sclerosus. Thus, you control the inflammation by calming the overactive immune response. When you control the inflammation, you can better manage lichen sclerosus and get into remission. 

Therefore, because calcineurin inhibitors can suppress immune system activity locally in the vulva, TCIs have been studied and used to treat many immune-mediated skin conditions, such as lichen sclerosus¹².

Are TCIs as Good as Topical Corticosteroids?

Overall, the studies are pretty promising and show that topical calcineurin inhibitors can be a good option for folks^{12 14 1}.

Let us see what the science says about TCIs for lichen sclerosus and how they compare to topical corticosteroids.

A double-blind, randomized study by Goldstein et al. 2011 compared the before and after biopsies of folks with vulvar lichen sclerosus. Participants were split into two groups⁵. One group used clobetasol (steroid), and the other group used pimecrolimus (calcineurin inhibitor). Eighteen people were treated with pimecrolimus for 12 weeks, and 20 were treated with clobetasol for 12 weeks⁵. Since the study was blinded, neither group knew which treatment they used. 

Success was evaluated by comparing before and after biopsies from each patient to see whether there was a reduction in inflammation. The researchers also looked at secondary measures, including questionnaires and patient symptom reporting⁵

When comparing the two groups, they found that clobetasol and pimecrolimus effectively reduced inflammation. However, they noted that clobetasol performed slightly better in reducing inflammation. They concluded that clobetasol should be the first-line treatment and pimecrolimus should be the second-line treatment for folks who cannot tolerate or do not want to use steroids.

Side Effects

The primary documented side effects of calcineurin inhibitors are stinging and burning. Specifically, this side effect is experienced after you apply the medication. How long someone will experience the burning and stinging will vary. Some folks have told us they have no burning or stinging, and others say they did initially, but it eased up after one week of use. 

The severity of the burning or stinging will also vary per individual. This burning sensation is usually more pronounced during the first few weeks of application and often fades as you continue using it²⁶. It is essential to know this information so that you do not stop using your medication as prescribed by your doctor¹².

If the medication continues to burn and sting beyond two weeks, discuss this side effect with your healthcare provider and see their other options.

Do TCIs Cause Cancer?

We have heard from folks in the community who say their healthcare provider will not prescribe TCIs for lichen sclerosus because they cause cancer. So let us discuss this.

Squamous Cell Carcinoma

There is a risk that calcineurin inhibitors may cause squamous cell carcinoma (SCC). A case study of a single individual using TCIs concluded with the authors stating:

If a patient with LS cannot use topical corticosteroids, it may still be safest to restrict use to TCIs because of the increased risk of SCC²⁷.

However, this is a single case study, and it was published quite a while ago, in 2007.

More recently, a 2021 review paper by Corraza et al. noted that based on the current evidence, short-term application of calcineurin inhibitors does not appear to increase the risk of squamous cell carcinoma¹².

The 2021 European Guidelines state:

“The long-term risks need to be studied because of concerns about the possibility of topical immunosuppression increasing the risk of malignancy”¹⁸.

In other words, because there is not nearly as much research on TCIs as there is on steroids, we need more research on TCIs and their potential connection to SCC.

Please note that to date, only a few papers speculate TCIs may be connected to SCC. 

However, there is no evidence of this, and most LS specialists are comfortable prescribing this medication.

Why are Calcineurin Inhibitors Considered a Second-Line Treatment?

There is agreement within the medical community that TCIs are a second-line treatment for lichen sclerosus, which is safe for both adults and children with vulvar lichen sclerosus¹². The main reason is that steroids slightly outperform TCIs in their ability to decrease inflammation¹⁴.

Another reason is that there is more research on steroids than calcineurin inhibitors. This may make some doctors more inclined to prescribe steroids over TCIs, but this is my guess and not stated in the medical literature.

We have heard doctors and LS specialists say TCIs are their second-line treatment because of the burning and stinging in some patients who use calcineurin inhibitors. The burning and stinging may cause some patients to discontinue using their medication¹².

Topical corticosteroids and topical calcineurin inhibitors are the two main approved treatments insofar as evidence-based medicine is concerned.

However, some more experimental/adjunct therapies are out there, such as laser, platelet-rich plasma, and phototherapy.

As you will see shortly, the reason they are not considered treatments proper is because they have yet to show the ability to significantly reduce inflammation, but more on that in a bit.

Experimental therapies show promise in managing a condition but have yet to be thoroughly evaluated for efficacy, safety, and acceptability. Think of it like a non-approved treatment option; it may or may not work. In the context of lichen sclerosus, when discussing experimental treatment options, we mean interventions, medications, or procedures that have not yet been shown to be fully effective as a treatment but show promise in helping with symptom management.

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.”

The following therapies are considered experimental and/or adjunctive treatment options.

Two main types of laser can be offered for lichen sclerosus.

The first and more common type is an ablative laser, such as the CO2 fractional laser (aka the Mona Lisa laser). The second, less common type, is a non-ablative laser.

Ablative Laser

Ablative lasers use a beam of light energy that creates small holes in the top layer of the skin (aka the epidermis). Further, the beam of light energy also heats the underlying skin (aka the dermis). Together, the interruption of the top layer and heat to the middle layer of vulvar skin are supposed to stimulate collagen and elastin, which trigger the skin's natural healing process²⁸.

What Does the Procedure Involve?

While it certainly sounds painful, most clinicians who offer this therapy will use a topical numbing cream to numb the vulva first. After you are numb, they will go over the surface of the vulva with their laser machine. 

Most studies on ablative lasers for lichen sclerosus say the procedure is generally well-tolerated, with most patients reporting mild discomfort and ‘heating' sensations.

We have heard some folks say it was only a little uncomfortable, and others say it was painful for them. It is always important to remember that everyone's pain tolerance is different, so always take other people's experiences with this in mind; you may have a different reaction or experience.

After the procedure, discomfort and pain are typically well-managed with a combination of acetaminophen (Tylenol, Paracetamol) and ibuprofen (Advil). Applying ice to the area may be another helpful option to calm inflammation and pain. 

You may also want to go commando and wear loose clothing a couple of days after if you experience sensitivity/discomfort.

You should be able to work. However, everyone is different; listen to your body.

Most people can drive themselves or take public transit home after the procedure. However, if you are worried, arranging for a lift or an Uber may be a good idea.

It is important to know there is a risk of infection with laser; be sure to review the associated risks with your healthcare provider. 

Cost and Frequency

Both cost and frequency are determined on a case-by-case basis. Cost depends on where you live, the clinic's pricing structure, and whether insurance can cover some of it. In Canada, where I live, an individual laser session can run you upward of 1,000 dollars.

How often you need treatments depends on the severity of your case and how you respond to treatment. Most people have 3-5 treatments upfront and one yearly treatment as maintenance.

Non-Ablative Laser

According to the American Society for Dermatologic Surgery, non-ablative lasers use a beam of energy that can help regenerate the skin by heating the skin without injuring the top layer of the skin (aka the epidermis)²⁹. This is different from ablative lasers, which affect the top layer of the skin. Similar to ablative lasers, the heating aspect of non-ablative lasers is supposed to do the regenerative/healing work. Non-ablative lasers deliver that heating aspect through thousands of small columns into the skin. 

What Non-Ablative Laser Treatments for Lichen Sclerosus Involve?

Your clinician (ideally) should give you instructions on what to expect and how to prepare on the day of your visit. Be sure to follow those instructions.

While the non-ablative lasers are less invasive than the ablative kind, the heating sensation can cause mild pain or discomfort. Your clinician will often apply a topical numbing cream to the vulvar area before laser treatment. However, if you are concerned about this, ask them in advance if they can use the numbing cream. If they do not offer numbing cream, ask if it is OK for you to bring and apply your own. For example, in Canada, you can get Emla numbing cream over the counter at your local pharmacy and use it before your appointment.

After you are numbed up, they will go over the surface of the vulva with their laser machine. 

Post-Procedure Aftercare

Aftercare for non-ablative laser is the same as the ablative laser.

Cost and Frequency

Both cost and frequency are determined on a case-by-case basis. Cost depends on where you live, the clinic's pricing structure, and whether insurance can cover some of it. 

How often you need treatments depends on the severity of your case and how you respond to treatment. From what we have read, it does seem like multiple sessions are required during the first year, and then maintenance sessions are needed after.

What Does the Science Say about Laser Therapy for Lichen Sclerosus

Unfortunately, our current studies are limited and have yet to demonstrate a significant reduction in inflammation that many doctors look for when they counsel patients on primary treatments. For this reason, most LS specialists do not recommend laser therapy as a monotherapy or primary treatment.

A systematic review – a paper that reviews, discusses, and synthesizes information from different studies on a specific topic like lichen sclerosus – by Tasker et al., 2021, which looked at studies investigating both ablative and non-ablative lasers concluded:

“In summary, there is no high-quality evidence to support the use of lasers for the treatment of genital LS in males and females. Long-term data on laser are lacking, including its adverse side effects. High-quality RCTs are needed”⁷.

There is insufficient evidence to support using laser therapy as a primary treatment/monotherapy for lichen sclerosus. This supports our findings as well. 

In reviewing work by Hobson et al., 2019; Mitchell et al., 2021; and Ogrinc et al., 2019, it was found that none showed evidence that laser can significantly reduce inflammation, which is required for it to be deemed a treatment^{30 28 31}

Nonetheless, it is essential to note that some patients report improvement in their symptoms after laser treatment. And let us be honest, LS symptoms are awful, and symptom management and reduction are fundamental to our quality of life. 

Therefore, you may consider laser as an experimental/adjunct therapy with steroids or calcineurin inhibitors. We have, anecdotally, heard some folks tell me laser made a big difference in their symptoms and overall quality of life. Thus, there may be a place for laser for folks who cannot tolerate steroids to help manage symptoms or as an adjunct therapy.

Overview

What Does PRP Involve?

To prepare PRP, your clinician will draw some of your blood. They will then place your blood in a tube and place it in a centrifuge machine. A centrifuge machine is a device that uses centrifugal force to separate the liquid components from the solid parts of your blood. 

Further, the concentration of platelets is increased in addition to separating the liquid from solid components. For example – and this example is entirely arbitrary and simplistic to illustrate the point – let us say your blood sample initially contains 30 platelets. The centrifugation process will increase the number of platelets from 30 to 150. 

Once the centrifugation process is complete, your blood and the increased number of platelets are placed inside a syringe. Your clinician will then numb the vulva and inject your blood/platelet sample into various parts of your vulva.

PRP promotes healing by stimulating and releasing growth factors and cytokines (proteins that, when released, tell the body to do its job). For example, if you tore a ligament, the body's job, so to speak, is to heal that ligament and restore function to the area. Thus, in this example, the growth factors and cytokines will tell the body, “Hey, see that torn ligament? Yeah. That one. We will need you to work hard to heal that area”.

What Does the Research Say?

Unfortunately, much like laser therapy, PRP has not yet been shown to be an effective treatment for lichen sclerosus. It has not been proven to significantly reduce the inflammation caused by lichen sclerosus³².

Further, many of the scientific papers on PRP and lichen sclerosus could be of better quality. For example, Franic et al., 2018 and Tedesco et al. 2020 investigated PRP as a treatment for lichen sclerosus^{33 34}. However, their papers suffered from many methodological problems, making it difficult to trust the conclusions from these papers.

A systematic review – a paper that reviews, discusses, and synthesizes information from different studies on a specific topic like lichen sclerosus – by Villalpando et al., 2021, stated that at this point, we need more and better research³⁵. The authors mention that most studies on platelet-rich plasma are of poor quality, so we cannot take much away from them. Finally, the authors note that more research and standardization of preparation and treatment are required for lichen sclerosus.

Overview

Phototherapy (also known as light therapy) reduces skin cell growth and treats underlying inflammation via ultraviolet light. Phototherapy is used in several skin conditions, including psoriasis, eczema, cutaneous T-cell lymphoma, etc³⁶. Like laser and PRP, phototherapy is considered experimental therapy because it does not have enough research behind it and has not proven to be an effective treatment for LS.

Who Performs Phototherapy

Some, but not all, dermatologists can perform this procedure in the office. If you want to try phototherapy:

Before getting phototherapy, your dermatologist will assess your skin and medical history to determine if you are a good candidate. Be sure to tell your doctors about any medications and supplements you are taking, such as retinoids and antibiotics, because they can make your skin more sensitive to ultraviolet light from phototherapy³⁷.

What About Hand-Held Devices?

Some studies provided hand-held devices for patients to bring home and use. However, many of the hand-held devices you find online are not well-studied and do not have data on genital use. For your safety, we recommend getting approval from your healthcare provider before using this on your genitals.

What to Expect

Phototherapy can leave the skin red, itchy, and dried out. It is important to apply a barrier cream such as Vaseline or Aquaphor afterward to help the skin from drying out³⁶. If you experience pain, discussing this with your healthcare provider is essential. 

Is Phototherapy Effective for Lichen Sclerosus?

Study #1

While there is some evidence (Kreuter et al., 2002) that phototherapy may be beneficial for extragenital lichen sclerosus (i.e., lichen sclerosus that affects the rest of the body, like chest, abdomen, and thighs), it is unclear whether it would be beneficial (and safe) for the genital skin³⁸.

Study #2

In 2014, Terras et al. conducted a randomized study comparing the efficacy of phototherapy versus clobetasol for vulvar lichen sclerosus. The study took 30 patients and randomized them into two groups: the phototherapy and clobetasol groups.⁷

The findings showed that while the phototherapy group found some relief of symptoms (but not all), the clobetasol group outperformed phototherapy regarding symptom relief and showed a significant reduction of inflammation from pre and post-biopsy samples. That is, the phototherapy group did not show a significant reduction in inflammation⁷.

Conclusion on the Terras et al. Study

The authors conclude that while there are benefits to phototherapy for vulvar lichen sclerosus, it is not nearly as effective overall as clobetasol. These studies show that ultrapotent topical corticosteroids should still be considered the gold standard, the first line of treatment, with phototherapy as a potential second-line treatment. However, more research is needed on the risks and benefits of phototherapy. We also need research comparing different devices.

Let us chat briefly about some treatments that are in the pipeline.

In the pipeline means scientists and researchers are currently investigating the efficacy and safety of new, potential treatments. However, the studies still need to be finished, which means we have limited data to speak on yet. They could outperform topical corticosteroids, be on par with topical corticosteroids, or not be a good treatment option for lichen sclerosus; the jury is still out.

JAK inhibitors

If you are interested in learning more about the trial and potentially joining, click here.

If you want to monitor new/recruiting lichen sclerosus, click here.

Fat Grafting

A clinical trial is being designed, led by Dr. Aurora Almadori in the UK, to investigate the role of fat grafting in improving scarring (fusing, scar tissue build-up, stiff, thickened skin) and helping with symptoms and quality of life.

The results from her 2020 study can be found here⁴⁰.

At present, this intervention seems to be more of a potential adjunctive therapy. However, it is too early to tell, and it is possible it could be a treatment option down the line.

Where We Are So Far with Fat Grafting for Lichen Sclerosus

A prospective cohort study by Almadori et al. (2020) investigated whether fat grafting (aka lipotransfer) could help with scarring (fusing) and fibrosis (thick, rigid skin) from lichen sclerosus to help symptoms and quality of life⁴⁰.

What Did the Study Involve?

The study included 33 patients with VLS over 18 years old with biopsy-confirmed lichen sclerosus.

Fat tissue was harvested from patients and then underwent centrifugation to separate oil, fluid, and blood from the fat tissue, the adipose-derived stem cells, and the progenitor cells. The fat tissue, the adipose-derived stem cells, and the progenitor cells were transferred into a syringe. The clinician would then slowly inject the fat tissue into the labia majora, minora, clitoral, fourchette, and perineum.

Patients received one fat grafting transfer and an average of 2 ml of fat tissues. The average time of follow-up was 3.5 months.

The authors measured the success of the transfer via several validated measures – such as the Female Sexual Function Index and the Pain Anxiety Scale. 

Results

Results showed a significant improvement in overall sexual function with improvements in desire, orgasm, sexual satisfaction, and sexual pain. Symptom-wise, patients reported improvement in itching, burning, and soreness post-transfer. A significant improvement in pain was also reported. Patients also reported improvement in their mental health and quality of life.

In terms of the scarring and fibrosis, improvements were reported by clinicians. However, it is important to note that this skin assessment was not done by comparing pre and post-intervention biopsies. Clinicians used their trained eye and visual scales to make the judgment.

The authors note that improvement may be due to the slight ‘padding effect,' which occurs with fat grafting whereby the tissue increases in volume/bulk, as well as the regenerative effect of adipose-derived stem cells. The mechanism behind this regenerative effect is still being explored.

What's the Verdict

Overall, the authors note this is a promising result, and fat grafting may have an adjunct role for folks with scarring and fibrosis that cannot be reversed with steroids alone. 

Studies are currently underway to see if there is a place for fat grafting in the future. There are limitations to this study, such as it was not blinded (meaning patients and clinicians knew they were receiving fat transfer), so it is possible that bias skewed the results. There was no control group to compare the fat grafting group against to see if the results were significant.

The randomized control trial that is currently being designed will help offset some of the limitations of the 2020 study and shed light on whether fat grafting could be a potential treatment down the line or, at least, a promising adjunct therapy to add to your primary treatment plan.

The following are not considered treatment plans, either primary or secondary, in the medical field. Further, some of these points, such as diet, have yet to be explicitly studied in the context of LS (although there are scientific papers on autoimmunity and diet).

Emollients & Barrier Creams

Emollients (e.g., coconut oil) are essentially moisturizers for your vulva. They can help soothe, hydrate, and protect the vulvar skin. Barrier creams are essentially thicker versions of emollients (think petroleum jelly, aka Vaseline). Due to their thickness, they can help create a protective barrier between your skin and the external environment (e.g., urine, sweat, chlorine in a pool).

Borax & Boric Acid Supplements

Borax is a hot topic in many support groups. While anecdotally, many folks say they experience symptom relief and even remission from using borax alone, there are currently no substantial scientific papers on borax and its benefits/risks for lichen sclerosus.

The British Association of Dermatology issued a statement on borax and lichen sclerosus, which you can read here. Briefly, they do not recommend it as a treatment or adjunct for lichen sclerosus⁴¹.

Since Lichen Sclerosus Support Network speaks from an evidence-based perspective or lived experience, and since there is no evidence, and no one at Lichen Sclerosus Support Network uses borax, we cannot speak from lived experience.

Our philosophy is to present you with evidence-based information to help you make an informed decision about your body and healthcare plan. 

Boric acid suppositories also get some discussion in the LS community. Boric acid suppositories, however, are different from borax, and these suppositories are usually prescribed for bacterial vaginosis and yeast infections. These suppositories are not currently recommended for lichen sclerosus.

Diet & Nutrition

Hormone Therapy

Sometimes, topical hormones such as estrogen or estrogen/testosterone creams and gels are prescribed in addition to your primary treatment plan.

Topical hormones are not meant to be used as a treatment; they are, however, something you may add to your current treatment plan to help the texture of your skin.

For example, some LS specialists prescribe a combo of estrogen/testosterone gel to help “…increase moistness, elasticity, and lubrication of the vulvar skin…”⁴³.

Pelvic Floor Physical Therapy

Further, some pelvic floor physical therapists can perform clitoral myofascial release (aka CMFR), which can help unfuse the clitoris^{44 45}.Learn more about how CMFR can help unfuse your clitoris in this video featuring Dr. Ashlie Crewe here.

Learn more about the benefits of pelvic floor physical therapy for lichen sclerosus here.

Stress Management

Stress can be a huge trigger for many with Lichen Sclerosus. Exploring different stress reduction techniques can help patients achieve remission faster and remain in remission longer.

Practicing mindfulness and meditation practices, shaking and dancing, exercise, yoga, baking, essential oils, listening to music, and painting/drawing are all ways to manage stress.

I (Jaclyn) have a webinar on stress, lichen sclerosus, and the vagus nerve to help educate folks about the role of stress and LS and share vagus nerve activation techniques to help reduce stress and calm the nervous system. 

Learn more here.

Therapy & Counseling

Lichen sclerosus can profoundly impact our mental health and quality of life. You are not alone. If you find your mental health is suffering, consider working with a therapist, counselor, sex therapist, or pain therapist to help support your mental health journey with lichen sclerosus.

1. De Luca, David A., Cristian Papara, Artem Vorobyev, Hernán Staiger, Katja Bieber, Diamant Thaçi, and Ralf J. Ludwig. 2023. “Lichen Sclerosus: The 2023 Update.” Frontiers in Medicine 10: 1106318[↩][↩]
2. 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 Jul;71(1):84-91. doi: 10.1016/j.jaad.2014.02.019. Epub 2014 Apr 3. PMID: 24704090[↩]
3. Krapf, Jill M., Leia Mitchell, Michelle A. Holton, and Andrew T. Goldstein. 2020. “Vulvar Lichen Sclerosus: Current Perspectives.” ProQuest, 11–20. https://doi.org/10.2147/IJWH.S191200[↩]
4. Lee A, Bradford J, Fischer G. “Long-term Management of Adult Vulvar Lichen Sclerosus: A Prospective Cohort Study of 507 Women”. JAMA Dermatol. 2015 Oct;151(10):1061-7. DOI: 10.1001/jamadermatol.2015.0643. PMID: 26070005[↩]
5. Goldstein AT, Creasey A, Pfau R, Phillips D, Burrows LJ. A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2011 Jun;64(6):e99-104. doi: 10.1016/j.jaad.2010.06.011. Epub 2011 Feb 25. PMID: 21353334[↩][↩][↩][↩]
6. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev. 2021 Jul 2:S2050- 0521(21)00033-0. doi: 10.1016/j.sxmr.2021.03.006. Epub ahead of print. PMID: 34226161[↩][↩]
7. 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[↩][↩][↩][↩]
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