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Lichen sclerosus is a relatively common disease. Although it can occur in individuals of either sex and at any age, it is most commonly found on the vulva of women in their postreproductive years. The disease is characterized by thinning of the epithelium causing a whitish, parchment-like appearance. It is often intensely pruritic, and ulcerations due to scratching are very common. If it is left untreated, loss of the normal architecture of the vulva commonly occurs, and the introital orifice eventually may be occluded completely. In most cases, a vulvar biopsy is used to diagnose lichen sclerosus.
In years past, it was stated that lichen sclerosus was not associated with vulvar cancer. However, it now has been reported that vulvar cancer is increased in frequency in those women with untreated lichen sclerosus and itching who chronically scratch and excoriate the vulvar epithelium. Among women who have successful long-term treatment with abatement of symptoms, there does not appear to be an increase in vulvar cancer.
For many years, the preferred treatment for lichen sclerosus has been the application of a preparation of 2% testosterone propionate.
Although this may reduce symptoms, it may be associated with significant treatment side effects if overused, and it has not been shown to be more effective.
It has recently been shown that the use of ultra-high-potency steroids (such as clobetasol or halobetasol) provides much more rapid relief. These high-potency steroids should be used only until symptoms have been controlled, and then use should be stopped. If significant symptoms recur, treatment with the steroid cream can be repeated. Some clinicians use the 2% testosterone cream.