Lichen planus

What is lichen planus?

Lichen planus (LP) is an inflammatory skin condition triggered by the immune system. This condition affects about 1% of the population. It’s more common in women than men and it mainly affects adults aged 40 years and over. About 50% of people with the condition have it in their mouth.

LP is not contagious and can’t be spread through sex. But it is a lifelong condition that will need to be treated and monitored.

Lichen planus and lichen sclerosus (LS) can occur together.

Symptoms

Symptoms of LP vary depending on the areas affected. When LP affects the vulva and vagina, you may notice:

• lacy, white lesions on your vulva and at your vaginal opening
• reddish brown patches on the inner part of your vulva
• painful, burning sores in your vagina
• red, raw skin around your vulva
• scarring
• the sides of your vagina sticking together.

You may also have:

• painful erosions and ulcerations
• severe itching
• painful vaginitis (inflammation of the vagina) with vaginal discharge
• vulval bleeding that happens easily on contact, especially after sex
• pain when weeing
• pain during sex (dyspareunia).

Causes

It’s thought that lichen planus is an autoimmune disorder. These conditions cause the immune system to attack the body’s own tissues.

Other factors associated with LP include:

• stress
• genetics
• injury to your skin (e.g. after scratching)
• Hepatitis C
• viruses like those that cause herpes varicella (chicken pox) and herpes zoster (shingles)
• bacteria (Helicobacter pylori)
• vaccines and medicines.

Diagnosis

LP is usually diagnosed via a clinical examination. Your doctor will ask about your symptoms and medical history. They should examine your vulva and affected areas. They may also take a small sample (biopsy) of vulval skin and send it to a laboratory for testing.

Your doctor may refer you to a skin specialist (dermatologist) or gynaecologist who specialises in vulval diseases.

Treatment and management

There is no cure for LP – and you won’t be able to get rid of it completely – but treatment should reduce symptoms and stop the condition from getting worse.

Treatments may include:

• corticosteroid ointment (applied on your vulva and in your vagina) to reduce pain, itching and inflammation
• immune-suppressing medicines and ointments (to help reduce the body’s immune response)
• surgery to remove scar tissue or adhesions that cover the entrance to your vagina – surgery is rare.

The ointments will provide symptom relief, reduce inflammation and limit the risk of adhesion and scarring. It’s important to use the ointments long-term and as prescribed. Your doctor will need to review this treatment regularly.

What you can do

It’s important to take extra care of your vulva and vagina when managing this condition. For example, use a soap-free wash, avoid tight-fitting clothes and try not to rub or scratch affected areas.

Learn more about vulval care.

Risks and complications

LP can lead to changes in your vulva and vagina, including:

• disappearance of your clitoral hood
• shrinkage of your inner lips (labia minora)
• your inner lips sticking together
• scarring that narrows your vaginal entrance.

LP doesn’t cause cancer, but it is associated with an increased risk of vulval cancer.

When to see your doctor

See your doctor if you notice any symptoms. Sometimes LP can be mistaken for other skin conditions, including lichen sclerosus, so it’s important to get the right diagnosis and treatment. If you are diagnosed with LP, you will need to have regular, ongoing check-ups with your doctor to monitor your condition.

Related resources

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This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2023.