Lichen Simplex, Sclerosis, and Planus

What is it?

The word “lichen” refers to a number of medical conditions involving irritation of and changes to the skin. The presenting symptoms, and therefore appropriate treatment, differ depending on the type. The conditions discussed here refer to dermatological conditions of the genital region, though some of these types can occur on other parts of the body as well. 

Types of Lichen

Lichen Simplex

• Thickening of the skin due to the itch-scratch cycle.
  
  Symptoms

• Chronic irritation of the vulva.
• Causes a cycle of itching, scratching, and thickening of the skin.
• Vulvar skin may become weepy causing moisture in the area.
• Disrupted sleep due to itching.
• Sometimes mistaken for a yeast infection due to the intense itch.
  
  Medical Treatment

• Topical steroids applied to the affected area.
  
  

Lichen Sclerosis

• Chronic, progressive, autoimmune skin condition.
  
  Symptoms

• Itching or burning.
• Patchy, white skin.
• Scars and adhesions on the vulva.
• Skin is easily bruised or torn when rubbed.
• Clitoral tissue can adhere.
• Painful intercourse.
• Disrupted sleep due to itching.
  
  Medical Treatment 

• Prescription strength cortisone cream daily until the itching and irritation settles.
• Long-term use of cortisone cream.
• Monitoring of potential malignancy.

Lichens Planus 

• An inflammatory autoimmune disorder involving keratinized and mucosal surfaces.
  
  Symptoms 
  
  
• Itching or burning.
• Scars and adhesions.
• Involves the vulva and/or vagina.
• Painful intercourse.
• Disrupted sleep due to pain.
• Affects other mucosal membranes as well (esophageal, oral – usually occurs first).
• Significant pain.
  
  Medical Treatment 

• Topical or oral corticosteroids (prednisone).
  
  Physiotherapy Treatment
  
  Along with the necessary medical interventions, pelvic health physiotherapy can have a huge impact on the successful management of lichen simplex, sclerosis or planus. Areas of treatment in physiotherapy may include:
  
  
• Tips for vulvar care/health:
  Moisturizers
  Underwear
  Feminine hygiene brands
• Tips for intimacy:
  Lubricants
• Education on use of dilators/accommodators.
• External myofascial techniques.
• Internal myofascial techniques.
• Mindfulness/meditation:
  Pain
  Anxiety/stress/depression
  Relaxation
• Breathing techniques.
• Pain education.
• Treatment of the nervous system.
• Pelvic floor muscle training:
  Proprioceptive training
  Lengthening/relaxing muscles
  Pelvic pain
• Bowel and bladder education.
• Toileting/evacuation positioning and techniques.
• Therapeutic exercise:
  Whole body reconditioning

Treatment and management of all three of these epithelial disorders requires a whole-person approach – one that addresses medical, pharmacological, physical, and psychosocial components. By addressing the treatment areas listed above, a patient is sure to regain control and confidence over their symptoms in order to improve their everyday quality of life.