Vaginal lichen planus belongs to a family of autoimmune disorders where the body’s defense system mistakenly attacks its own tissues. This condition specifically targets the vaginal area and can extend to the vulva, creating persistent inflammation that significantly impacts women’s health and quality of life.

While less common than other vaginal conditions, it typically appears in women during or after menopause, though younger women may also develop it.

The hallmark signs often start subtly – mild irritation or discomfort that women might initially dismiss as typical vaginal problems. However, as time passes, the symptoms intensify. Patients often notice unusual discharge, burning sensations during urination, and pain during intimate moments.

The vaginal tissues may develop a distinctive appearance, showing white, lacy patterns or areas of redness and rawness. In more severe cases, scarring can occur, potentially leading to changes in the vaginal structure.

What makes this condition particularly challenging is its chronic nature. Unlike temporary infections that clear up with short-term treatment, lichen planus in vagina requires ongoing management. The condition tends to flare up and calm down in cycles, often triggered by stress, hormonal changes, or other factors that medical science hasn’t fully mapped out yet.

Symptoms

The symptoms of vaginal lichen planus often develop gradually and can be both physically and emotionally challenging for women who experience them. Let me walk you through how these symptoms typically present and progress.

The early signs often start with mild discomfort that many women might initially mistake for common vaginal irritation. You might notice a slight burning sensation or itching that doesn’t go away with regular care. This discomfort tends to persist and gradually intensifies over time.

As the condition progresses, the vaginal tissues undergo noticeable changes. The vaginal walls may develop a distinctive appearance – imagine a delicate, white, lace-like pattern across the tissue. Some women notice patches that look similar to small paper cuts or raw areas. The tissue might appear shinier than usual or take on a slightly purple hue in certain areas. Here are the most common symptoms you might get:

• Itching: Often one of the first and most persistent symptoms, the itching can range from mild to severe and can interfere with daily activities and sleep.
• Pain or Burning: This might occur both internally in the vagina and externally on the vulva. The sensation can be constant or triggered by touch, urination, or sexual intercourse.
• Discomfort During Sex: Pain or discomfort during sexual activity is common, which might lead to avoidance of intimacy.
• White Patches or Plaques: The skin or mucous membranes might show white, lacy patterns or thick, white patches. These areas can sometimes be slightly raised.
• Redness and Swelling: The affected area can appear red and swollen, which might be more pronounced after irritation or scratching.
• Erosions or Ulcers: In more severe cases, there can be open sores or erosions, making the area very tender and sore.
• Scarring: Over time, especially in untreated or chronic cases, scarring can occur, leading to changes in the anatomy of the vulva or vagina, like narrowing or fusion of the labia or vaginal opening.
• Vaginal Discharge: While not always present, some women might experience changes in vaginal discharge, though this symptom is less specific to lichen planus compared to others.
• Bleeding: Minor bleeding can occur if the skin is very thin or if there are erosions, especially after sexual activity or from scratching.
• Dysuria: Pain or a burning sensation during urination can occur if the inflammation extends to the urinary opening.

In more advanced cases, the inflammation can lead to structural changes. The vaginal tissues might begin to stick together, potentially causing narrowing of the vaginal canal. Some women develop small tears in the tissue that can be quite painful and heal slowly due to the ongoing inflammation.

Diagnosis

The diagnosis of vaginal lichen planus typically involves several components:

Clinical examination

The healthcare provider will look for characteristic physical findings including reddish-purple patches or a lacy white pattern (known as Wickham’s striae) on the vaginal and vulvar tissues. In vaginal cases, there may be discharge, scarring, and adhesions that can cause the vaginal walls to become narrowed or even sealed (vaginal stenosis). The vulvar area might show erosions, burning, and intense itching.

Biopsy

A small tissue sample is usually necessary to confirm the diagnosis. Under microscopic examination, lichen planus shows distinctive features:

• A band-like inflammatory infiltrate in the upper dermis
• Damage to the basal cell layer
• Increased numbers of lymphocytes
• Hyperkeratosis (thickening of the outer layer of skin)

Differential diagnosis

Several conditions need to be ruled out, including:

• Lichen sclerosus
• Candidal infections
• Bacterial vaginosis
• Autoimmune conditions
• Precancerous changes

Other testing

Additional tests might be needed to:

• Rule out infections
• Check for other autoimmune conditions
• Assess for any precancerous changes
• Evaluate the extent of scarring

What is the treatment?

Treatment for vaginal lichen planus, particularly when it involves the vaginal area, focuses on symptom relief, reducing inflammation, preventing complications like scarring, and managing the condition long-term. Here are the primary treatment options:

Medical treatments

• Topical Steroids: These are typically the first line of treatment. High-potency corticosteroids like clobetasol propionate are often used initially to reduce inflammation and manage symptoms. You should apply it directly on the areas affected by lichen planus. The treatment might start with daily application and then move to a maintenance schedule, perhaps once or twice weekly, depending on symptom severity and response.
• Topical Calcineurin Inhibitors: Medications like tacrolimus or pimecrolimus can be used if steroids are not effective or if there are concerns about long-term steroid use. These suppress the immune response locally, helping to manage symptoms without the side effects associated with prolonged steroid use.
• Vaginal Steroid Preparations: For internal vaginal symptoms, steroid suppositories or creams can be prescribed. These might include hydrocortisone foam or other steroid-containing products specifically designed for vaginal use.
• Oral Medications: In severe cases where topical treatments aren’t sufficient, oral corticosteroids might be used for short periods to manage acute flares. Immunosuppressive drugs, like methotrexate or cyclosporine, could be considered for very resistant cases, though this involves systemic side effects and careful monitoring.
  Intralesional Injections: For localized, hard-to-treat areas, injections of corticosteroids directly into the lesions might be an option.

Home remedies

• Avoid Irritants: Use of fragrance-free, hypoallergenic products for personal hygiene. Avoid soaps, bubble baths, and harsh detergents.
• Moisturizing: Regular use of emollients or barrier creams can help maintain skin integrity and reduce irritation.
  Cool Compresses: Applying something cool can soothe itching and burning sensations.
• Clothing: Wear loose-fitting, cotton underwear to minimize friction and allow air circulation.
• Avoidance of Aggravating Factors: Spicy foods or anything acidic might irritate if there’s oral lichen planus alongside vaginal symptoms; avoiding these can help.
• Vaginal Dilators: In cases where scarring leads to narrowing or stenosis, using dilators as advised by a doctor can prevent or manage this complication.

Severe cases treatment

• Regular Monitoring: Since lichen planus can increase the risk of squamous cell carcinoma, regular check-ups are crucial. Women should be vigilant about any changes in symptoms or new lesions.
• Surgery: In cases of significant scarring or architectural changes, surgical interventions might be considered, but this is more about managing complications rather than treating the condition itself.
• Combination Therapy: Often, a combination of treatments is used, tailored to the individual’s response and the severity of symptoms.

What’s the difference between lichen planus and lichen sclerosus?

If you’re confused about lichen planus and lichen sclerosus, here’s the straight scoop:

Lichen Sclerosus is another autoimmune issue, mainly hitting the genital and anal regions, more in women post-menopause.

• Symptoms: Intense itch, white, patchy, shiny skin, pain during sex or urination, fragile skin.
• Cause: Autoimmune, possibly genetic or hormonal.
• Treatment: Strong steroid creams, long-term maintenance, surgery for severe scarring.

Key Differences:

• Appearance: Lichen planus – lacy, red; Lichen sclerosus – white, paper-like.
• Location: Lichen planus can be widespread; lichen sclerosus is mostly genital.
• Cancer Risk: Higher with lichen sclerosus if untreated.
• Age: Lichen sclerosus more common in postmenopausal women or kids; lichen planus at any age.
• Treatment: Both use steroids, but lichen sclerosus often needs ongoing care.

When to See a Doctor:

• Persistent symptoms in the genital area.
• You experience no improvement after using various home treatments.
• New or changing skin lesions.

Key takeaways

1. Chronic inflammatory condition: Vaginal lichen planus is a rare autoimmune disease that causes inflammation and painful sores in the vaginal area, often leading to scarring and discomfort.
2. Symptoms and diagnosis: It can present with itching, burning, pain during intercourse, and vaginal discharge. Diagnosis typically involves a pelvic exam and biopsy to confirm.
3. Treatment and management: Management includes corticosteroids, immune-modulating therapies, and proper hygiene. Moisturizers, avoiding irritants, and stress management can also help.