Lichen Sclerosus or Sclerosis treatment, info on lichen planus
February 17, 2014 by
Ray Sahelian, M.D.

Lichen sclerosus is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists. It affects both sexes and all age groups.  In men, the term balanitis xerotica obliterans is sometimes used to describe late and severe lichen sclerosus of the penis.  It is an often unrecognized and misdiagnosed chronic inflammatory skin condition of the anogenital area that affects quality of life, bringing severe discomfort and distress to affected men, women, and children.

Cause
The underlying cause is unknown; however, there is a strong association with autoimmune disorders, and immunogenetic studies have demonstrated a link with HLA DQ7. Genetic predisposition, infections and autoimmune factors are the most likely causes.

Symptoms of LS and signs
Symptoms include pruritis and soreness, but asymptomatic presentations are not uncommon. The classical clinical picture is of atrophic white plaques in the anogenital region. This is a chronic skin condition which affects men, women and children, and usually occurs in the anogenital area.

Under the microscope
Histopathology is specific with basal cell degeneration, upper dermal edema, homogenization of collagen and a chronic inflammatory infiltrate.

Treatment
Short courses of potent topical corticosteroids form the mainstay of treatment. The condition tends to be remitting and relapsing, with spontaneous regressions reported in a few. Scarring and progression to squamous cell carcinomas can occur in chronic LS, resulting in significant morbidity.

Steroid Cream treatment
Lichen sclerosus is a chronic inflammatory skin condition, which most commonly causes dysuria, pruritus and soreness of the vulval and perianal areas. Potent topical corticosteroids are used for the treatment of lichen sclerosus, but it is well known that they inhibit collagen synthesis and cause skin atrophy as a side effect.

Topical tacrolimus may be helpful in the management. The effective management of vulval lichen sclerosus currently depends upon the use of topical steroids and emollients. There are concerns with regard to the long-term toxicity of potent steroids and therefore is a need to consider effective alternatives. Immunomodulatory macrolactams offer an alternative to steroids in the management of some other inflammatory skin disorders and it would seem reasonable therefore to assess their activity in lichen sclerosus. A pilot study of 16 histologically confirmed cases of lichen sclerosus suggests that macrolactams have a positive pharmacological effect. A second study done in Italy also showed potential benefit for vulvar lichen sclerosus.

Am J Clin Dermatol. 2013 Feb. Diagnosis and treatment of lichen sclerosus: an update. LS is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus.
Br J Dermatol. 2006.
Lichen sclerosus is a chronic inflammatory autoimmune disease causing significant sclerosis, atrophy and pruritus. Treatment remains unsatisfactory, with potent corticosteroids being the most effective therapy. We conducted a multicentre, phase II trial to assess the safety and efficacy of tacrolimus ointment 0.1% for the treatment of lichen sclerosus with a follow-up period of 18 months at 10 university and teaching hospitals in Germany and Austria. Methods Eighty-four patients (49 women, 32 men and three girls) aged between 5 and 85 years with long-standing, active lichen sclerosus (79 with anogenital and five with extragenital localization) were treated with topical tacrolimus ointment 0.1% twice daily for 16 weeks. Results: The primary endpoint (clearance of active lichen sclerosus) was reached by 43% of patients at 24 weeks of treatment. Partial resolution was reached in 34% of patients. Maximal effects occurred between week 10 and 24 of therapy. Tacrolimus reatment led to a significant reduction of the total lesional area and to a significant decline in the total symptom score. Symptoms (e.g. itching) and findings (erythema, erosions and induration) showed significant improvement. No serious tacrolimus side effects were observed. There were three (9%) recurrences during the follow-up period. Conclusions Topical tacrolimus ointment 0.1% was safe and effective for the treatment of long-standing active lichen sclerosus.

Vulvar lichen sclerosus: 11 women treated with tacrolimus 0.1% ointment.
Acta Derm Venereol. 2007.
Lichen sclerosus is a chronic relapsing disease, usually treated with ultra-potent corticosteroids. As immunological alterations are considered important aetiopathogenetic factors in lichen sclerosus, the new immunomodulating topical agents, such as tacrolimus and pimecrolimus, have been employed sporadically as alternative therapies. The aim of this study was to evaluate the therapeutic effects of tacrolimus 0.1% ointment in lichen sclerosus in 11 patients unresponsive or poorly responsive to previous treatments. Tacrolimus 0.1% ointment was applied twice daily for 6 weeks, then tapered over a further 6 weeks. Symptoms and objective parameters were evaluated and quantified at the start, after 6 weeks, at the end of the topical treatment, and at follow-up visits. Improvement or remission of symptoms was observed in the patients who completed the study, while objective parameters were poorly influenced and often were not related to symptom behaviour. Topical tacrolimus can be considered an alternative treatment for lichen sclerosus.

Topical Pimecrolimus for Lichen Sclerosus
Pimecrolimus Cream 1% in the Treatment of Lichen Sclerosus.
Gynecol Obstet Invest. 2006. Department of Obstetrics and Gynaecology, Oulu University Hospital, Lansi-Pohja Central Hospital and Oulaskangas Hospital, Oulu, Finland.
The present pilot study evaluated the efficacy and safety of pimecrolimus cream 1% applied twice daily for up to 6 months in 29 women with severe lichen sclerosus. Of the 26 subjects who completed the follow-up period, 42% were in complete remission with relief from itchiness, pain and inflammation. A 3.5-fold increase in type I collagen synthesis and a 7.5-fold increase in type III collagen synthesis of the affected areas was detected after 2 months of pimecrolimus treatment. There were no systemic adverse reactions, although mild local skin reactions were reported by 50% of the patients. Blood concentrations of pimecrolimus were checked in 10/26 patients (39%) and were undetectable in all cases. Conclusions: Patient-applied 1% pimecrolimus cream is safe and effective for the treatment of lichen sclerosus.

Ned Tijdschr Geneeskd. 2012. Topical treatment of vulvar lichen sclerosus with calcineurin inhibitors. Erasmus Medisch Centrum, afd. Gynaecologie, Rotterdam, the Netherlands. To provide an overview of the literature concerning the topical treatment of vulvar lichen sclerosus, a chronic inflammatory skin disease, with calcineurin inhibitors, such as pimecrolimus and tacrolimus. Topical calcineurin inhibitors may represent a useful second-line therapeutic option for patients for whom treatment with glucocorticoids is not effective or who do not tolerate them well.

Lichen Planus treatment
See aloe vera for information regarding the potential benefit of aloe vera for oral lichen planus.

I suffer from lichen planus on my lower legs and in the mouth, where it was diagnosed 16 months ago. Initially it took the oral form of Wickham's Striae, with slight soreness. My legs were affected 6 months later, and I began to develop occasional mouth ulcers. I started to use Xylotene as a mouth rinse, a complex sugar with antibacterial properties and a reputation for mouth healing. I firmly believe it has impeded the progression of oral lichen planus for me over the past 6 months. It is immediately soothing and quickly dispels an early ulcer. I use 1 teaspoon a day in water, leaving each mouthful in contact with the mouth for up to 5 minutes. My legs are soothed by witch hazel gel, plus a corn starch powder with zinc. This cools and stops the itch, but the condition is not improving overall.

I have Lichen Planus. and was put on the Clobetasol Propionate ointment, USP, 0.05% mfg by Taro Pharmaceuticals Inc, Brampton, Ontario Canada.. Dist by Taro etc, Hawthorne NY, as prescribed by a doctor at Loma Linda University Dental School, CA.  Clobetasol Propionate ointment totally controls the problem.

I have oral lichen planus which I am told is an auto-immune disease. I was told by my dermatoligist that it is incurable but treatable with steriods. I've read the aweful truth about steriodal treatment of this condition. Dr. Rajesh Shah of Life Force Clinic in India says he can cure the condition through homepathic treatment.
    I have not studied this topic enough to know how effective the treatment would be.

Shanghai Kou Qiang Yi Xue. December 2013. A randomized single-blind controlled clinical trial of tacrolimus mouth rinse on erosive oral lichen planus.

Emails
Q. I have been attending the dental hospital in Wales U.K. under Prof. Lewis for a Lichenoid infection on my tongue. Dr. Lewis, in desperation, to try and find some relief for my condition which was not responding well to other treatment, had seen your web site on curcumin and asked me to give it a try. I ordered curcumin and I have religiously taken two capsules a day for three months and I am so pleased with the results. Although the condition has not completely gone, it is 100 times better than it was and Prof. Lewis is really enthused with the results, and has said that I may be one of the first to try such curcumin treatment over here in the U.K.!! You can't imagine how much it means to me to be almost free from pain and able to start eating foods which are acidy and spicy, in moderation. I know that the Lichenoid infection condition has no complete cure, but at least there is hope on the horizon for the many sufferers of this unpleasant condition. Thank you so much, I will continue to take the curcumin capsules long term. Regards. PS I don't mind my name being used if you think this is worthy of your website. Judith Pearce.
   A. Thanks! We are glad curcumin may have helped you, please keep us updated. Can you tell us the actual name of the skin condition?
      Q. Thank you so much for taking the time to reply to my email, it was much appreciated, as I know how busy you must be. The medical name for my complaint in Lichen Planus, My tongue is very sore with blisters and lesions which subside at times and other times are very inflamed and extremely sore leaving me virtually unable to eat, or at best a diet of bland sandwiches!! I do find that the curcumin helps very much indeed and I would urge anyone who wants to try it, to do so and persevere over a period of three months to see the best results. I will keep you posted regarding my progress. The other advantage also of the curcumin, is that you can take it long term without having to have a "rest" period once a week. Regards, Judith.
         A. One case history does not prove anything. Curcumin may have been the herb that helped your lichen planus, and we eagerly await other reports from those with lichen planus to see if your response was an isolated case or whether in fact curcumin is helpful for lichen planus. If we do get several reports of such help, then perhaps a dermatologist or researcher may wish to investigate the role of curcumin in this skin condition.

Q. I am 49 years old from India and i am suffering from bullous lichen planus for the past one year. I was treated with steroids but in vain. Though the blisters seem to substantially reduce, i do get new ones very soon even on medication. Presently i am on Descort course. I am really worried that my condition is not getting better. I read the feedbacks in your curcumin supplement official website. Now can i take these curcumin supplements for my condition, if so should i stop my present medication. Can u please advice me on this plot.
   A. We cannot give individual advice, but only provide information that we come across.

Q.  I was diagnosed with lichen sclerosis about 6 months ago after suffering from severe itching, swelling of the vulva burning. My doctor did a biopsy and assured me that it wasn't cancer. I've been on topical steroid creams that really did nothing but stop the itching and got off them with advice from my three daughters who are all RN's. I have tried Premarin vaginal cream and gradually going to get off that if I can. Do you know of any in-depth research that might be going on about Lichen Sclerosis? All I've heard is that there is no real cure for this, true or not? I sure would appreciate any information you could give me and let me know if there might be some "natural" remedy that might cure this.
   A. We will update the information on our site regarding the natural treatment of lichen sclerosis as we come across more studies.

Q. Hello. I have been reading a lot of the supplement information on your website and find it very informative. I would like to know if you have done any research on lichen sclerosis, and/or do you have any recommendations for possible natural remedies for this devastating illness. Apparently It affects many people, although mainly post-menopausal women, but so far researchers have not been able to determine the cause or find a cure. The recommended treatment is usually highly potent topical steroids, but those who suffer from this condition (per the many online forums) are hoping that someone will soon find the cause and hopefully a cure, or at least a more natural treatment. Thank you sincerely for any advice you can offer.

Q. Lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia. I was diagnosed with the above by a biopsy of my scalp which is bald as a man's. This is very, very embarrassing for a female of 59 years. Later I had Azathioprine for one month. But I experienced severe urinary infections and my liver enzymes escalated.

Q. I  wonder if you have heard about disease called lichen aureus? My 28 yrd old son has it according to 3 skin doctors we saw. His small capillaries on his legs from knee down bleed and he has small brownish reddish patches. No other symptoms. no pain , no itching. He is otherwise in good health, never smoke or used drugs. All the blood tests done by his primary doctor came back with normal results. Do you have any ideas what else to do ? Should we use any supplements?
   A. Lichen aureus is a rare and chronic skin disease that is part of the group of pigmented purpuric dermatoses. Lichen aureus often effects younger individuals. I am not familiar enough with this skin condition to know of any natural treatments.

Q. My gynecologist suggested either a steroid cream or testosterone cream however if I don’t opt for the allopathic treatment then she recommended a biopsy since I have a prior history of basal cell carcinoma. I feel that the having a biopsy would most likely further aggravate this condition. I am considering using pure aloe vera gel as a means of soothing the irritated tissue.

I read an article on lichen sclerosus, pregnenolone and melatonin by Christine Kent in Albuquerque, NM who treated her condition with pregnenolone pills. Having just been diagnosed with LS (after a great deal of suffering) I was glad to find it. I personally have had a lot of success with washing the area, blow drying thoroughly and applying lots of A&D Zinc ointment. Meanwhile I'm waiting to be put on some combo of bioidentical hormone replacement as soon as I'm tested.

I know that you have absolutely no affiliation with the company that makes Perrins Blend however I also know that Dr. Sahelian is an avid researcher when it comes to investigating holistic natural products and approaches to wellness. Lichen Sclerosis is actually an auto immune conditions that affects the area of the vulva causing burning, itching and other very unpleasant symptoms. Some consider it to be a precursor to certain types of skin cancers. My sister also has L/S. She is not holistically oriented and went the allopathic route with a doctor prescribed steroid cream. She said that her condition is basically the same. In addition to L/S I also have basal cell carcinoma. I had a growth removed from my back a few years ago and currently have some growths on my face and one below my eye. I had these growths removed however the dermatologist wants me to have Mohs surgery and I am not gung ho about that for a number of reasons. I have been reading a lot about Perrins Blend a natural antioxidant and herbal formulations with grape seed extract, Reservatrol , Vit. C etc. I know that you can not make recommendations but I would be interested if you have heard about the Perrins Blend products and have heard any anecdotal information regarding the experiences that some people have had using these products for Lichen Sclerosis and B.C.C. The information on the web site seems to be presented in a very candid manner and includes testimonials which appear to be genuine especially for those with the L/S. Any suggestions you have including other possible sites that may have impartial information or reviews regarding Perrins Blend would be most appreciated. I am not a fan of steroid creams and having the MOHS surgery especially around my eye seems very dicey.
    I am not familiar with this product and don't know if it would work or not.

I saw the last entry on the web site and Perrins has a lot of talk on their web site but I felt it was of no value for lichen sclerosis. This was the biggest waste of money I spent. The most value that I have is using a Neocutis cream with PSP that took away all the pain and suffering, intermittently use estrogen/testosterone cream and Betamehasone Dipropionate cream for flare ups. Dr. Goldstein is doing a study with Neocutis cream at John's Hopkins and I was the one that contacted the company and put this information on a web site that spoke of women having to go through so much pain. This cream I used on my face after a skin laser treatment and found that it really helped my lichen sclerosis pain. I found no benefit at all from the Perrins creams, and they were difficult to use in the vaginal/renal area. The 2 acupuncturist that I saw suggestted removing gluten from the diet and this has resolved the issue for some but for me it seems to be another allergy. I have many allergies so I am removing a lot from my diet and it is getting better. I have a degree in Chemistry and worked in several areas of medical research early in my career and I am still looking at this issue but Dr. Oz thought diabetes or the thyroid might be involved in some cases causing the weakness in the immune system. Those should be ruled out. My last visit to the gynocological oncologist tried another type of anti rejection cream and that was painful. His comment of that if you remove the cancerous skin it will just grow back makes you want to do something else as this is a painful area. The heavy cortisone creams are not an answer for long term.

After months of referrals – during which time because of the bruising I assume, various consultants made unpleasant remarks/innuendoes about me being some sort of sexual deviant or maniac cyclist! I was finally diagnosed with lichen sclerosis to the vulval/genital area. What a relief ! Still I found the condition extremely upsetting, especially the bleeding under the skin which raised the skin into blood filled ridges...etc ugh! Anyway the heavenly consultant who diagnosed prescribed the usual dermovate but also said that many of the patients found Perrins” Crème Complete” helpful. Well, I ordered it from America (I’m UK), and tried it – believe me you’ll try anything with this. Anyway the stuff is freaking marvellous...ok I’ve still got LS but the improvement is amazing – the skin has lost its crepe like old quality and the bloody patches and ridges have disappeared. When I went back for my next visit I told the registrar about it and the nurse said that someone else they had seen that day had said how it had transformed their life ! LS really knocks your confidence and I feel much better about myself now which must be a relief to my long suffering husband of 18 years.