What happens to the skin of the vulva
With lichen sclerosus, under the influence of immune inflammation, the structure of the skin changes: the upper layer becomes thinner, and the underlying connective tissue becomes denser and sclerosed. The skin acquires a characteristic white, slightly shiny appearance, reminiscent of tissue paper, is easily injured, cracks and small hemorrhages form. Gradually, cicatricial restructuring occurs: the labia minora flatten and fuse with the labia majora, the clitoris is hidden under a fused hood, and the entrance to the vagina narrows.
- Thinning and whiteness of the skin of the vulva
- Compaction of underlying tissues
- Cracks and minor hemorrhages
- Smoothing of the labia minora
- Narrowing of the vaginal opening
- The disease can also occur in girls before puberty.
Causes and risk factors
The exact reason is unknown. The autoimmune theory is considered to be the leading one: in women with lichen sclerosus, autoimmune thyroiditis, vitiligo, alopecia areata, and also cases of the disease in relatives are more common. A local factor plays a role - chronic irritation and trauma to the skin, including urinary incontinence. The peak incidence occurs after menopause, when estrogen levels decrease, but the disease occurs in both young women and girls.
- Autoimmune predisposition
- Autoimmune thyroiditis and other autoimmune diseases
- Heredity
- Postmenopausal period
- Chronic irritation and injury to the skin
- Not associated with infection and not transmitted to a partner
Symptoms
The first and most painful manifestation is itching, which intensifies at night and disrupts sleep. Then comes burning, dryness, and a feeling of tightness of the skin. Because of the cracks, pain appears during urination, defecation and sexual intercourse. Externally noticeable are white, compacted areas, sometimes with bluish hemorrhages, and changes in the shape of the external genitalia. Over time, for some women, the itching decreases, and cicatricial contractions and pain come to the fore - this is not a recovery, but a progression of the disease.
- Excruciating itching that gets worse at night
- Burning and dryness
- White shiny areas of skin
- Cracks and soreness
- Pain during intercourse
- Changing the shape of the labia and clitoris
Diagnostics
An experienced doctor often recognizes the disease during examination by the characteristic appearance of the skin. Nevertheless, vulvar biopsy with histological examination remains the key method: it confirms the diagnosis and, most importantly, excludes precancerous changes and squamous cell carcinoma. A biopsy is required for ulcers, indurations, areas of thickening, and if there is no response to proper treatment. Additionally, thyroid function and other autoimmune markers are assessed, and infectious causes of itching are excluded.
- Vulvar examination and vulvoscopy
- Biopsy with histological examination
- Flora smear to rule out infection
- Thyroid examination
- Blood glucose
- Regular follow-up examinations
Treatment and observation
The basis of treatment is strong topical glucocorticoids, which are applied according to the schedule prescribed by the doctor: first daily, then less frequently, in maintenance courses. This approach relieves itching, stops progression and reduces the risk of cancer, and, if started in a timely manner, prevents scarring. Additionally, emollients are used, and for menopausal dryness, local estrogens are used. Surgical treatment is used only to eliminate the consequences: scar adhesions and narrowings. Careful hygiene without soap, cotton underwear and avoidance of combing are important.
- Topical glucocorticoids according to the doctor's regimen
- Maintenance therapy to control the disease
- Emollients and protectants
- Local estrogens with concomitant atrophy
- Avoiding soap, scented products and synthetics
- Surgery for scar adhesions
- Examination by a gynecologist at least once every 6–12 months
