Lichen Planus is a skin disease that can sometimes affect the vulva, vagina, and inside the mouth. Although it more often affects skin on the outside of the body, most patients who have lichen planus of the genital area do not have involvement of other outer skin surfaces.
Skin affected by lichen planus can either be white, or can have superficial ulcerations. Genital areas with white discoloration can produce itching, whereas those areas with superficial ulcerations usually cause pain.
The cause of lichen planus is believed to be an over-active immune system. The immune system is that part of the body that protects us from infections. Our white blood cells, among other things, will attack viruses, bacteria, and even cancer cells to destroy these things before they can cause serious disease. However, occasionally our immune system will become over-active and begin to attack skin in addition to infections or cancer cells, as happens with lichen planus.
The treatment for lichen planus is aimed at fooling the immune system locally so that it doesn’t try to destroy skin. Although some medications, especially oral cortisone, or prednisone, will depress the immune system a great deal and induce healing of the skin, this degree of depressed immunity leaves a patient susceptible to uncontrolled infections.
In addition, prednisone by mouth has many other serious, long-term side effects. Except for short periods, we try to only influence the immune system locally at the area of skin damage. Therefore, prednisone is used only briefly to help heal skin, and only if absolutely necessary. Then, we try to control lichen planus with topical cortisone creams or ointments.
Areas involved with lichen planus sometimes become infected with bacteria or yeast, since there are often open sores. Once cortisone is started, this increases the risk for local infections. For this reason, many patients are treated with an antibiotic by mouth for bacteria, and a medication for fungus, either to treat these infections or to prevent them, particularly during the first few months of therapy.
For patients who do not respond well to topical cortisones applied to the area, there are other treatments that can be used. This includes topical or oral cyclosporin, or other medications that will partially suppress the immune system. Untreated or severe lichen planus can sometimes produce scarring. The inner lips of the vulva (the labia minora) can disappear completely, and the clitoris can become buried beneath scar tissue.
When the vagina is involved, the vaginal walls can scar together so that intercourse is no longer possible. Because of this, either regular intercourse or the insertion of a vaginal dilator on a daily basis should be performed so that scar tissue does not close the vagina.
Often, multiple visits and several different medications are required to control lichen planus. Although the treatment of white skin caused by lichen planus is usually easy, lichen planus that has produced sores and ulcerations is usually very difficult to treat and requires multiple visits and trial-and-error therapy.