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Lichen Sclerosus Treatment

A comprehensive guide to understanding lichen sclerosus treatment options.

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Written by: Jaclyn Lanthier

Content reviewed and edited by Jill Krapf, MD, Corey Babb, MD, and Erin Foster, MD


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 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 vulva1 2 3 4 5 6 7 8 9 10 11.

Our best research shows lichen sclerosus is caused by a local immune reaction, whereby the immune system goes into overdrive and is overactive12 13 14. Topical corticosteroids work to calm overactive immune responses and get the immune reaction to become more stable.

Of all the randomized controlled clinical trials, steroids are the best at reducing symptoms, preventing and slowing the progression of lichen sclerosus, and reducing the local levels of inflammation in the vulva.

Further, evidence supports that steroids reduce the likelihood of vulvar cancer 15 16. To date, only steroids as a treatment option seem to support this.

Learn more about the connection between vulvar cancer by reading this blog post or get Jaclyn's free eBook, where she goes into more detail.

Or, if video is more your thing, check out this video.

Graphic design image of multiple containers, tubs, and jars of ointments and creams, representing topical corticosteroids as a lichen sclerosus treatment.

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?

Graphic image of a pink calendar, with the dates in white writing, and a hand with a teal-colored pencil drawing a red X on one of the days to signify when they used a lichen sclerosus treatment.

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:

  • First month: 1x a day. 
  • Second month: 1x every other day. 
  • Third month (maintenance protocol): 2x a week 
  • The maintenance protocol is to be followed for life.

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.


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.

Topical Calcineurin Inhibitors


Topical calcineurin inhibitors (TCIs) are topical, non-steroidal immunosuppressant medications. They are currently considered second-line treatment for lichen sclerosus14 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?

Image of a person with dark brown skin, long black hair, a mustard yellow shirt, and gold earings with a chat bubble next to them reading "I can't use topical corticosteroids, I wonder if topical calcineurin inhibitors would be a good lichen sclerosus treatment for me"?

Overall, the studies are pretty promising and show that topical calcineurin inhibitors can be a good option for folks12 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.

Experimental/Adjunct Therapies

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.

Graphic design images of two different pill bottles, a yellow cab with a cell phone next to it with a taxi/uber booking, a person in blue, loose, comfy pyjamas with bright yellow lemons and an ice back.

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

Graphic images of a yellow lightbulb, a set of beakers, microscopes, syringes, and a blue textbook with the word 'science' in the middle. The title text at the top of the image reads: "What Does The Science Say"? to signify what does the science say about laser as a lichen sclerosus treatment.

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 treatment30 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.

Platelet-Rich Plasma (aka PRP)


Platelet-rich plasma (aka PRP) uses the patient's blood, which is then injected into the injured site – in this case, the vulva/anogenital skin – to help promote the healing of the tissues.

Blood is composed of two parts – a liquid and a solid part. The liquid portion is plasma, which is basically water, salt, and proteins.

The solid part is made up of red and white blood cells along with platelets.

Platelets contain growth factors that are known to tell cells in your body to do their job and stimulate tissue regeneration and healing.

Put simply, PRP is blood with a higher concentration of platelets.

Graphic image of a container with the fluid preparation for PRP with a bunch of red blood cells demonstrated to the right of the preparation.

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 sclerosus33 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.



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:

  • Chat with your dermatologist to see if they offer it.
  • If your dermatologist does not offer this, ask if they can refer you to an office that does.
  • Be mindful that this procedure is usually performed on the non-genital skin of the body, so not all practitioners will feel comfortable using it on the genitals.

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.

Treatments in the Pipeline

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

JAK Inhibitors (aka Janus Kinase Inhibitors) are currently being trialed in multiple centers across North America.

What are JAK Inhibitors, and why are they being studied as a potential treatment for lichen sclerosus?

In 2021, Tan et al. conducted a genetics study to see if they could isolate which genes were turned off and on in lichen sclerosus skin. They successfully identified these genes and the specific inflammatory pathway activated in LS39. Shortly after this publication, pharma contacted the authors and stated they already had medications – specifically JAK Inhibitors – that target that specific pathway.

Suppose JAK Inhibitors prove to be successful as a treatment for LS. This will provide a more targeted treatment approach by working on the specific inflammatory pathway versus a more broad-spectrum approach by topical corticosteroids.

The studies are currently being conducted, and we will report back when the data and the verdict are out.

Image of scientists in a lab, with white coats and light blue gloves. Safety goggles are worn by the two lab members, as they analyze samples representing scientific research and clinical trials.

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 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.

Add-Ons to your Treatment Plan

Important to Know:

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

There is little research on diet and nutrition, specifically in the context of lichen sclerosus, and the few studies out there are flawed and inconclusive at best. There is no evidence supporting this as a treatment. However, some see benefits when they look at diet and nutrition in addition to their treatment plan.

Anecdotally, we at Lichen Sclerosus Support Network hear that for some folks, certain foods are a big trigger for their LS.

We recommend working with a registered dietician or nutrition therapist to help determine what foods are triggering your symptoms and which foods will help your symptoms. Diet and LS is not a one-size-fits-all scenario. Some folks do well on a low-oxalate diet, while others do better on an autoimmune protocol diet.

Learn more about diet and nutrition on our comprehensive ‘Diet and LS' page42.

Image of a bowl of cereal with different grains and fruit, a glass of orange juice, a spoon, and an apple and orange on the plate.

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

In addition to your primary treatment plan, you may consider attending pelvic floor physical therapy to assess your pelvic floor muscles.

Many specialists, such as Dr. Krapf and Dr. Goldstein, recommend pelvic floor physical therapy/dilator work to help with tight pelvic floor muscles or vaginal narrowing43.

Pelvic floor physical therapy can also help if you have urinary incontinence/frequency/urgency, difficulty with bowel movements, hemorrhoids, constipation, pain with sex, and more.

Graphic image of a person's pelvic floor.

Further, some pelvic floor physical therapists can perform clitoral myofascial release (aka CMFR), which can help unfuse the clitoris44 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.

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About the Author

Image of Jaclyn, author of the Lichen Sclerosus Treatment post. In the image, Jaclyn has long, dark brown hair, light blue eyes with cat-winged eyeliner, and a strappy orange dress. She is looking into the camera with a soft smile.

Jaclyn Lanthier

LSSN board member, facilitator, content creator, speaker and director of the lost labia Chronicles

Jaclyn is the director and face behind The Lost Labia Chronicles, a content hub for evidence-based information and support. She is on the board of Lichen Sclerosus Support Network (LSSN) and serves as their secretary, content creator, speaker, and facilitator. Jaclyn completed her Ph.D. in philosophy of neuroscience at Western University (Canada), where she worked to develop a methodology for assessing the accuracy of scientific data in scientific papers. She is involved in a number of lichen sclerosus research projects across the world, including the University of British Columbia (Canada) and the University of Nottingham (UK). On behalf of a scholarship from Global Skin to LSSN, she is participating in an intensive patient expert training program to improve her skills as a patient advocate and patient representative with Global Skin and EUPATI (2024).

Sources Cited:

  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[][][][]
  8. Kirtschig, G, Becker, K, Günthert, A, Jasaitiene, D, Cooper, S, Chi, CC, et al. Evidence-based (S3) guideline on (anogenital) lichen sclerosus. J Eur Acad Dermatol Venereol. (2015) 29:e1–e43. doi: 10.1111/jdv.13136[]
  9. Papini, M, Russo, A, Simonetti, O, Borghi, A, Corazza, M, Piaserico, S, et al. Mucous membrane disorders research group of SIDeMaST. Diagnosis and management of cutaneous and anogenital lichen sclerosus: recommendations from the Italian Society of Dermatology (SIDeMaST). Ital J Dermatol Venerol. (2021) 156:519–33. doi: 10.23736/S2784-8671.21.06764-X[]
  10. Smith, YR, and Quint, EH. Clobetasol propionate in the treatment of premenarchal vulvar lichen sclerosus. Obstet Gynecol. (2001) 98:588–91. doi: 10.1016/s0029-7844(01)01496-x[]
  11. Cooper, SM, Gao, XH, Powell, JJ, and Wojnarowska, F. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. (2004) 140:702–6. doi: 10.1001/archderm.140.6.702[]
  12. Corazza M, Schettini N, Zedde P, Borghi A. Vulvar lichen sclerosus from pathophysiology to therapeutic approaches: evidence and prospects. Biomedicine. (2021) 9:950. doi: 10.3390/biomedicines9080950, PMID[][][][][][][]
  13. De Luca DA, Papara C, Vorobyev A, Staiger H, Bieber K, Thaçi D, Ludwig RJ. Lichen sclerosus: The 2023 update. Front Med (Lausanne). 2023 Feb 16;10:1106318. doi: 10.3389/fmed.2023.1106318. PMID: 36873861; PMCID: PMC9978401[]
  14. Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020 Jan 15;12:11-20. doi: 10.2147/IJWH.S191200. PMID: 32021489; PMCID: PMC6970240[][][][]
  15. 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/[][]
  16. Vieira-Baptista P, Pérez-López FR, López-Baena MT, Stockdale CK, Preti M, Bornstein J. Risk of Development of Vulvar Cancer in Women With Lichen Sclerosus or Lichen Planus: A Systematic Review. J Low Genit Tract Dis. 2022 Jul 1;26(3):250-257. doi: 10.1097/LGT.0000000000000673. Epub 2022 Mar 11. PMID: 35285455[]
  17. 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[]
  18. Van der Meijden, W I et al. “2021 European guideline for the management of vulval conditions.” Journal of the European Academy of Dermatology and Venereology: JEADV vol. 36,7 (2022): 952-972. doi:10.1111/jdv.18102[][]
  19. De Luca DA, Papara C, Vorobyev A, Staiger H, Bieber K, Thaçi D, Ludwig RJ. Lichen sclerosus: The 2023 update. Front Med (Lausanne). 2023 Feb 16;10:1106318. doi: 10.3389/fmed.2023.1106318. PMID: 36873861; PMCID: PMC9978401[]
  20. 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[]
  21. Hengge, Ulrich R, W Krause, Heinrich Hofmann, Rudolf Stadler, Gerd Gross, Michael Meurer, Thomas Brinkmeier, et al. 2006. “Multicentre, Phase II Trial on the Safety and Efficacy of Topical Tacrolimus Ointment for the Treatment of Lichen Sclerosus.” British Journal of Dermatology 155 (5): 1021–28. https://doi.org/10.1111/j.1365-2133.2006.07446.x.[]
  22. Virgili A, Lauriola MM, Mantovani L, Corazza M. Vulvar lichen sclerosus: 11 women treated with tacrolimus 0.1% ointment. Acta Derm Venereol. 2007;87(1):69-72. doi: 10.2340/00015555-0171. PMID: 17225019[]
  23. KIM, Gun-Wook, Hyun-Je PARK, Hoon-Soo KIM, Su-Han KIM, Hyun-Chang KO, Byung-Soo KIM, and Moon-Bum KIM. 2011. “Topical Tacrolimus Ointment for the Treatment of Lichen Sclerosus, Comparing Genital and Extragenital Involvement.” The Journal of Dermatology 39 (2): 145–50. https://doi.org/10.1111/j.1346-8138.2011.01384.x.[]
  24. Mazzilli S, Diluvio L, Di Prete M, Rossi P, Orlandi A, Bianchi L, Campione E. Tacrolimus 0.03% ointment for treatment of paediatric lichen sclerosus: a case series and literature review. J Int Med Res. 2018 Sep;46(9):3724-3728. doi: 10.1177/0300060518778219. Epub 2018 Jul 29. PMID: 30058419; PMCID: PMC6136000[]
  25. Goldstein AT, Marinoff SC, Christopher K. Pimecrolimus for the treatment of vulvar lichen sclerosus in a premenarchal girl. J Pediatr Adolesc Gynecol. 2004 Feb;17(1):35-7. doi: 10.1016/j.jpag.2003.11.013. PMID: 15010037[]
  26. Corazza M, Schettini N, Zedde P, Borghi A. Vulvar lichen sclerosus from pathophysiology to therapeutic approaches: evidence and prospects. Biomedicine. (2021) 9:950. doi: 10.3390/biomedicines9080950, PMID[]
  27. Fischer G, Bradford J. Topical immunosuppressants, genital lichen sclerosus and the risk of squamous cell carcinoma: a case report. J Reprod Med. 2007 Apr;52(4):329-31. PMID: 17506377[]
  28. 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[][]
  29. American Society for Dermatologic Surgery[]
  30. Hobson, Julia G et al. “Recalcitrant Vulvar Lichen Sclerosus Treated With Erbium YAG Laser.” JAMA dermatology vol. 155,2 (2019): 254-256. doi:10.1001/jamadermatol.2018.4461[]
  31. Bizjak Ogrinc U, Senčar S, Luzar B, Lukanović A. Efficacy of Non-ablative Laser Therapy for Lichen Sclerosus: A Randomized Controlled Trial. J Obstet Gynaecol Can. 2019 Dec;41(12):1717-1725. doi: 10.1016/j.jogc.2019.01.023. Epub 2019 Apr 11. PMID: 30981618[]
  32. Goldstein AT, Mitchell L, Govind V, Heller D. A randomized, double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2019 Jun;80(6):1788-1789. doi: 10.1016/j.jaad.2018.12.060. Epub 2019 Jan 11. PMID: 30639885[]
  33. 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[]
  34. 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[]
  35. Villalpando BK, Wyles SP, Schaefer LA, Bodiford KJ, Bruce AJ. Platelet-rich plasma for the treatment of lichen sclerosus. Plast Aesthet Res. 2021;8:63. doi: 10.20517/2347-9264.2021.86. Epub 2021 Dec 5. PMID: 34950752; PMCID: PMC8694569[]
  36. American Academy of Dermatology, 2023[][]
  37. “About Your Procedure”, Memorial Sloan Kettering Cancer Center[]
  38. Kreuter A, Gambichler T, Avermaete A, Happe M, Bacharach-Buhles M, Hoffmann K, Jansen T, Altmeyer P, von Kobyletzki G. Low-dose ultraviolet A1 phototherapy for extragenital lichen sclerosus: results of a preliminary study. J Am Acad Dermatol. 2002 Feb;46(2):251-5. doi: 10.1067/mjd.2002.118552. PMID: 11807437[]
  39. Tan X, Ren S, Yang C, Ren S, Fu MZ, Goldstein AR, Li X, Mitchell L, Krapf JM, Macri CJ, Goldstein AT, Fu SW. Differentially Regulated miRNAs and Their Related Molecular Pathways in Lichen Sclerosus. Cells. 2021 Sep 2;10(9):2291. doi: 10.3390/cells10092291. PMID: 34571940; PMCID: PMC8465596[]
  40. Almadori A, Hansen E, Boyle D, Zenner N, Swale V, Reid W, Maclane A, Butler PEM. Fat Grafting Improves Fibrosis and Scarring in Vulvar Lichen Sclerosus: Results From a Prospective Cohort Study. J Low Genit Tract Dis. 2020 Jul;24(3):305-310. doi: 10.1097/LGT.0000000000000520. PMID: 32205767[][]
  41. British Association of Dermatologists.” 2023. Bad.org.uk. 2023. https://www.bad.org.uk/statement-on-the-use-of-borax-as-a-home-remedy-for-lichen-sclerosus/[]
  42. Lichen Sclerosus and Diet, Heather Cooan for Lichen Sclerosus Support Network[]
  43. Goldstein, Andrew, Caroline Pukall, Irwin Goldstein, and Dr. Jill Krapf. 2023. When Sex Hurts. Hachette Go.[][]
  44. Kilgore, Rachel. “Specific Myofascial Release as a Treatment for Clitoral Phimosis”. Herman & Wallace Pain Rehabilitation Institute, 2016[]
  45. The Use of Specific Myofascial Release Techniques by a Physical Therapist to Treat Clitoral Phimosis and Dyspareunia[]