We are excited to start a monthly series where we dive into a different topic in women’s health each month. The overall goal is to increase awareness around various conditions, to normalize experiences that so many of us encounter, and to offer accessible solutions.
This month we are talking about Lichen Sclerosus- a chronic inflammatory condition that predominantly affects the vulvar and perianal region in postmenopausal women. In Lichen Sclerosus, the vulvar tissue can show white patches and thin tissue, and can result in itching, discomfort, and painful intercourse.
Overview
Lichen Sclerosus is a chronic inflammatory condition that predominantly affects the vulvar and perianal region in postmenopausal women. The vulvar tissue in Lichen Sclerosus can show white patches and thin, fragile tissue and can result in itching, discomfort, and painful intercourse. As the disease advances, there can be fusion of the vulvar lips and narrowing of the vaginal opening.
Lichen Sclerosus is classified as an autoimmune disease and can often present with other autoimmune conditions. It is unclear what causes Lichen Sclerosus, and is likely a combination of genetic components and immune system involvement.
Treatment
The tissue changes and symptoms associated with Lichen Sclerosus can be distressing and are the main targets of treatment. Early treatment can relieve the discomfort and slow or inhibit tissue changes. The standard of care for Lichen Sclerosus is topical corticosteroids due to the inflammatory nature of the condition. However, there are patients who don’t respond to corticosteroids and long term use of corticosteroids can create its own problem, such as thinning of the tissue, highlighting the need for other additional treatment options.
There are other ways to address Lichen Sclerosus, including dietary changes, nutraceuticals and laser therapy.
Dietary Considerations
One component of addressing Lichen Sclerosus is through a gluten free diet. Gluten is a protein found in wheat, and eating gluten can lead to a condition called leaky gut, where large proteins from our food are able to leave the gut and get into the bloodstream, resulting in inflammation. Gluten looks structurally similar to some of our own tissues, and so when our immune system is alerted to attack the gluten, it can result in the attack of our own tissues, leading to autoimmune disease. Since Lichen Sclerosus is an autoimmune disease, it can be very advantageous to try eliminating gluten. Casein, a protein in dairy, looks similar to gluten and so people may benefit from eliminating dairy as well. Reducing sugar in the diet is another way to reduce inflammation, improving symptoms and minimizing disease progression.
Nutraceuticals
Another component of treating Lichen Sclerosus is by modulating the immune system. In autoimmune conditions, the immune system is overactive and attacks the body’s own tissues. Some ways to modulate immune system function is through supplementation with plant sterols or taking low-dose naltrexone. Plant sterols have been shown to help down-regulate an overactive immune response by balancing Th-1 and Th-2, two types of white blood cells that comprise our immune system. It’s when Th-1 and Th2 cells are out of balance with each other that autoimmune disease can result. Additionally, low-dose naltrexone (LDN) works by keeping our immune system in balance and reducing inflammation. LDN has been shown to help with a wide range of inflammatory conditions, including dermatological conditions such as Lichen Sclerosus. Applying it topically may provide relief of itching and discomfort.
Laser Therapy with MonaLisa Touch
Laser therapy is an emerging treatment for Lichen Sclerosus. Laser is used to deliver energy to the vulvar and perianal area, rejuvenating the cells and restoring the tissue. One type of laser studied in the treatment of Lichen Sclerosus is MonaLisa Touch. MonaLisa Touch is a fractional CO2 laser that stimulates deep layers of the tissues to promote circulation and collagen growth, helping reduce symptoms of itching, discomfort and pain during intimacy. MonaLisa Touch has been found to be very advantageous in cases of Lichen Sclerosus that don’t respond to corticosteroids. It is a non-surgical, painless option that can directly address the tissue changes in Lichen Sclerosus.
A diagnosis of Lichen Sclerosus can feel overwhelming. There are ways to not only mitigate symptoms but alter the disease process by supporting the immune system, addressing inflammation, and supporting the tissue. Dr. Sumner specializes in women’s health and is versed in helping women with Lichen Sclerosis. In addition to helping uncover what may be causing the lichen sclerosus, Dr. Sumner offers MonaLisa Touch laser therapy at Amber Wellness Group, and would love to answer any additional questions that you have.