Lichen planus (LP)

What is lichen planus?

Lichen planus (LP) is a chronic, inflammatory skin disorder that causes swelling and irritation of the skin, hair, nails and mucous membranes. In women, it occurs in the vagina and on the vulva and it may also be seen together with lichen sclerosus.

The condition affects around 1% of the population, most commonly adults 40 years and above. About 50% of those with the condition have it in their mouth (which is more common in women than men).

Lichen planus is not contagious and can’t be spread through sex. It is a lifelong condition that needs to be treated and monitored.

What causes lichen planus?

The exact cause of LP is unknown. However, it’s thought that it may be an autoimmune disorder, which causes your immune system to attack cells of the skin or mucous membranes. It occurs more frequently in people who have hepatitis C.

Other factors that are associated with the condition include:

• stress
• genetics
• injury to the skin

In rare cases, it may also be associated with:

• viruses like those that cause herpes, chicken pox and shingles
• bacteria (helicobacter pylori)
• vaccines
• contact allergens such as amalgam teeth fillings, gold or copper

Signs and symptoms of lichen planus

Symptoms of LP can vary depending upon the areas affected. The most common symptoms when it affects the vulva and vagina are:

• lacy-white lesions on the vulva and in the vagina.
• reddish brown patches on the inner part of the vulva
• painful, burning sores in the vagina
• raw, red skin
• painful erosions and ulcerations
• severe itch
• disappearance of the clitoral hood
• shrinkage of the labia minora (inner lips)
• labia minora may stick together or to the labia majora (outer lips)
• scarring that narrows the vaginal entrance
• painful vaginitis (inflammation of the vagina) with vaginal discharge
• vulval bleeding that occurs easily on contact, especially after sex
• painful urination
• painful sex (dyspareunia)

How is lichen planus diagnosed?

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

Sometimes LP can be mistaken for other skin conditions, including lichen sclerosus so it may be a good idea to see a skin specialist (dermatologist) or a gynaecologist. If you have problems with your vulva, always ask your health professional to examine you, especially if you have undergone previous treatment that wasn’t effective.

Treating and managing lichen planus

There is no cure for LP and you won’t be able to get rid of it completely. Treatment aims to reduce symptoms and to prevent it from getting worse. Typical treatment involves:

1. Corticosteroid ointment — The primary treatment for LP is using potent topical corticosteroid ointment on the vulva and vagina. This aims to reduce pain, itching and inflammation and to prevent it from getting worse. This treatment is usually twice daily for around 4-6 weeks or longer.
   However, maintenance treatment is ongoing, and may involve 1-3 applications a week and you may be able to use a lower potency ointment.
2. Medications — Medications such as prednisolone, or immune suppressing medications including methotrexate (in tablet form) are sometimes used.
3. Surgery — In some cases, surgery may be required to remove scar tissue or adhesions that cover the entrance to the vagina, which makes sex difficult.

You will also continue to have regular check-ups with your doctor to monitor your condition. If you don’t respond to treatment, ask for a referral to an experienced dermatologist or gynaecologist who specialises in vulval diseases.

Other lifestyle (vulval care) measures to help reduce symptoms include:

• wash gently once or twice a day, using a soap-free wash
• avoid scented bath products and detergents that can irritate the skin
• pat your vulva dry and don’t rub
• avoid rubbing or scratching the affected areas
• wear loose-fitting clothing and underwear made of natural fibres like cotton. Avoid pantyhose and tight-fitting pants
• do not douche

For more information on vulval care go here.

Risks and complications

LP can cause scarring and lesions which can cause your clitoris to be buried/covered, your labia minora to shrink, stick to each other or stick to the labia majora, and the entrance to your vagina to narrow. This can cause sex to be difficult and painful.

LP doesn’t cause cancer. Around 1-3% of long-term cases can develop into vulval cancer.

What you can do

If you have any of the symptoms mentioned, or you notice changes in your vulva, it’s important that speak to your doctor.

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 2021.