Vulval Lichen Sclerosus in Girls

This leaflet is designed for girls who have been diagnosed with vulval lichen sclerosus to help them and their parents/ guardians to understand the condition, its symptoms and treatment.

What is lichen sclerosus?

Lichen sclerosus (LS) is a chronic inflammatory condition which mainly affects skin of the genital (vulval) area and around the anus. It is thought to be an auto-immune condition, where the body’s immune system damages healthy cells. It may be more common if there are other auto-immune conditions within in the family, including thyroid disease, alopecia areata (which is characterised by patchy hair loss), and vitiligo which is characterised by patchy loss of pigment in the skin).

Whilst lichen sclerosus occurs most commonly in older women, it may occur in young girls before puberty.

What are the symptoms?

Some children complain of no symptoms, but most commonly they experience itching in the vulval and/or anal area, which may be sufficient to disturb sleep. There are often white patches, with red or purplish bruise-like areas. There may also be soreness or burning, particularly if there are small breaks in the skin from scratching. This can cause constipation, and there may also be scarring. Skin changes do not involve the vagina.

How is lichen sclerosus treated?

Treatment aims to settle symptoms in the affected area and prevent development of further skin changes. If there is already scarring, this may not clear, but can improve.

The most effective treatment is a very strong steroid ointment, called Dermovate (or Clobetasol propionate) ointment. This should initially be used for a full 12 weeks even if the symptoms improve. A pea-sized amount of ointment is usually sufficient to treat the involved area and your dermatologist will tell you how frequently to apply it (usually daily for one month; alternate days for one month, and then twice weekly for one month). Using a weaker cream or stopping too early will reduce the effectiveness of treatment.

Skin irritation may worsen LS in the affected area and should be avoided by following the steps below:

• Wash using a moisturiser (such as Dermol 500) instead of soap, or just warm water.
• Avoid using bubblebath.
• Use a daily moisturiser such as Epaderm which may help reduce itching, and acts as a barrier for the sensitive skin.
• Use shampoos in the shower, or at the end of a bath, to minimise the amount of time it is in contact with the vulval skin.
• Avoid tight clothing such as jeans and leotards, and wear loose cotton knickers.
• Avoid spending long times in wet swimming costumes.
• Riding a bicycle or a horse may worsen symptoms.

Swabs may be taken in clinic from the affected area to detect infection, and if necessary, this should be treated as well as LS.

Young children will need help to apply the treatments to the correct area. LS can flare up again after treatment, and steroid creams may need to be used again.

What happens longterm?

LS improves for many girls around puberty, but it may not fully disappear. Flare-ups will continue to need treatment and may persist into adulthood in a few cases.

If treated, LS should not lead to problems with periods, or the ability to have children.

For women with LS in adulthood, there is a small risk of a kind of genital skin cancer, and this will be discussed with adults with LS.

Is further information available?

• British Association of Dermatologists (opens in a new tab)
• Care of Vulval Skin
• Lichen Sclerosus in Females
• International Society for the Study of Vulvovaginal Disease (opens in a new tab)
• Vulvar Lichen Sclerosus in Children
• Published Guidelines for the management of lichen sclerosus: British Journal of Dermatology (2018) 178, pp839-853