What are the other Names for this Condition? (Also known as/Synonyms)

• Genital ELP
• Genital Lichen Planus, Erosive type

What is Genital Erosive Lichen Planus? (Definition/Background Information)

• Lichen planus is a common benign condition of generally unknown cause affecting the skin and mucus membranes. Erosive lichen planus (ELP) is described as a subtype of lichen planus chronically affecting the mucus membranes resulting in severe pain and ulcerative lesions. In a vast majority of cases, the involvement of the oral cavity surfaces and genitalia is noted
• Genital Erosive Lichen Planus typically involves the penis in males, and both the vulva and vagina in females. It an autoimmune disorder of T-lymphocytes (a type of white blood cells) with the skin manifestations being an inflammatory response of the body. The condition is more common in adult women
• The treatment for Genital Erosive Lichen Planus is often difficult and challenging. The treatment measures may include the use of topical steroidal creams, immunosuppressive therapy, systemic medications, and surgery, if needed. The prognosis is dependent on a variety of factors; although in many, the condition is longstanding and causes long-term distress

Who gets Genital Erosive Lichen Planus? (Age and Sex Distribution)

• Genital Erosive Lichen Planus may be seen in middle-aged and older adults in the age group of 40-80 years. The condition is rarely observed in children
• It can affect both males and females, although women are affected more than men
• The condition occurs worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Genital Erosive Lichen Planus? (Predisposing Factors)

In many cases, the risk factors for Genital Erosive Lichen Planus are not well-established.

• Use of certain medications causing drug reactions are reported in some cases
• An abnormal response of the skin microflora to some antifungal creams is also implicated

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Genital Erosive Lichen Planus? (Etiology)

Genital Erosive Lichen Planus, a subtype of genital lichen planus, is a severe autoimmune skin condition. It involves the T-cells (T lymphocytes) of the white blood cells and may be caused by damage of the skin cell layer termed the basal epithelial cell layer. However, the exact cause of development of this autoimmune disease remains unknown.

• A few cases of Genital Erosive Lichen Planus are drug-induced that gets better on ceasing usage of the offending medication. Some reports also inform that the condition may occur from viral infections or exposure to metals
• Some cases of lichen planus are known to develop through abnormal cell-mediated immunity; an association of the condition with other autoimmune diseases, such as alopecia areata, autoimmune thyroiditis, and vitiligo is noted

In general, erosive lichen planus is non-contagious and is not transmitted sexually from one individual to another; one cannot contract the condition through close physical interaction with the affected individuals.

What are the Signs and Symptoms of Genital Erosive Lichen Planus?

The signs and symptoms of Genital Erosive Lichen Planus may include:

• Presence of raw and tender lesions on the glans penis in men. In women, the outer and inner lips and vaginal entrance may present lesions
• The lesions are typically red and with clearly-defined borders
• Discharge and oozing from the lesions may be noted; the discharge is foul-smelling
• The lesions are very itchy, chronic, and painful
• They are known to bleed, ulcerate, and heal with scarring
• Burning sensation of the vulva (vulvodynia)
• The condition may present severe discomfort while passing urine
• Difficulty in having sex; bleeding following sexual intercourse
• Desquamative vaginitis: The lesions are present deeper in the vaginal layers causing inflammation and ulceration

How is Genital Erosive Lichen Planus Diagnosed?

The following are the diagnostic methods and tests that may be used for Genital Erosive Lichen Planus:

• A thorough physical examination and a complete medical history are very crucial
• Examination of the genitalia
• Culture studies
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A biopsy is performed to rule out malignancies and other similar conditions

A differential diagnosis is important to exclude skin disorders that present similar signs and symptoms. These may include:

• Atrophic vaginitis
• Plasma cell vulvitis
• Vulvar intraepithelial neoplasm

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Genital Erosive Lichen Planus?

The following complications of Genital Erosive Lichen Planus may be noted:

• Cosmetic concerns
• Individuals may have stress and anxiety issues fearing that the condition is a sexually-transmitted infection
• Persistently painful lesions resulting in severe emotional and psychological stress
• If the emotional stress is severe, it may even lead to depression and social isolation
• Superimposed bacterial (from Staphylococcus aureus) and fungal (Candida albicans), and viral (Herpes simplex virus) infections are commonly noted
• Sexual distress
• Vaginal stenosis (narrowing)
• Permanent vulvar scarring upon healing
• Decreased quality of life
• Vulvar cancer (squamous cell carcinoma) can develop from chronic and persistent lesions
• Treatment complications and side effects

How is Genital Erosive Lichen Planus Treated?

The healthcare provider may adopt both topical agents and systemic medications in managing Genital Erosive Lichen Planus since it is a persistent and challenging condition to treat.

The following treatment measures may be considered:

• Maintaining good personal hygiene
• Use of topical steroidal applications (hydrocortisone) and/or calcineurin inhibitor creams and ointments
• Administration of systemic steroids such as prednisone
• Medications such as methotrexate
• Immunosuppressive therapy, such as using cyclosporine, when it does not respond to steroidal treatments
• Oral antibiotics, antifungals, or antiviral medications for secondary infections, as required
• Surgical procedures to improve the symptoms that may include:
  • Perineotomy and perineoplasty
  • Vaginal dilation
  • Scar tissue removal via Fenton procedure
• Providing reassurance and helping with feelings of stress and anxiety
• If erosive lichen planus is medication-induced, stopping the causative medicine can help resolve the condition

Follow-up care with regular screening and checkups are important since the condition can last for many months and years.

A few self-care tips and home remedies for Genital Erosive Lichen Planus may include:

• Completely avoid scratching the affected areas (keep fingernails trimmed)
• Washing the area using mild (non-soap) cleansers
• A comfortable and cool bath may help soothe the affected region
• Avoid excessive washing and scrubbing of the skin
• Wear smooth cotton clothes and underwear
• Use only mild perfumes, soaps, and detergents
• Drinking lots of water or fluids

How can Genital Erosive Lichen Planus be Prevented?

• Currently, there are no specific methods or guidelines to prevent Genital Erosive Lichen Planus
• A careful and periodic monitoring or follow-up of the condition is recommended

What is the Prognosis of Genital Erosive Lichen Planus? (Outcomes/Resolutions)

• The prognosis of Genital Erosive Lichen Planus depends on a variety of factors such as:
  • Age and health status of the individual; immunocompromised individuals have a much worse prognosis
  • Severity of signs and symptoms and development of complications
  • Response of the condition to treatment
  • Whether any transformation to malignancies is noted
• In many individuals, the condition is longstanding and persistent despite appropriate therapy; also, relapses are frequently noted
• The risk for squamous cell carcinoma formation is high in the following situations:
  • In chronic smokers
  • In individuals with a poor immune system due to various conditions
  • Infection by certain types of human papillomavirus (HPV); some HPV strains carry a high risk for cancer development

Additional and Relevant Useful Information for Genital Erosive Lichen Planus:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition

The presence of dirt on the body does not cause the condition. However, it helps to be clean and hygienic, which will help the condition from getting worse