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

• LP (Lichen Planus) of Vulva
• Vulvar Lichen Planus
• Vulvar LP

What is Lichen Planus of Vulva? (Definition/Background Information)

• Lichen Planus (LP) is a common, benign condition of generally unknown cause affecting the skin and mucus membranes. Classically, Lichen Planus skin lesions have been described as papule, purple, polygonal, and pruritus - the “4 P’s”. These can occur anywhere in the body and mouth
• Lichen Planus of Vulva can affect the vulva (vaginal opening), as a single lesion or multiple lesions in a ring-like pattern. It is not a sexually contracted disease
• In general, women in the 30-60 year age group are affected the most. Most lesions are asymptomatic, however some may ulcerate and cause pain
• The treatment for Lichen Planus of Vulva in symptomatic individuals may include the use of topical steroidal creams, immunosuppressive therapy, and photo-chemotherapy. The prognosis of the condition is generally good

Who gets Lichen Planus of Vulva? (Age and Sex Distribution)

• Lichen Planus of Vulva is a common condition that is typically seen in middle-aged to older women in the age group of 30-60 years
• The condition occurs worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Lichen Planus of Vulva? (Predisposing Factors)

• The risk factors for Lichen Planus of Vulva are unknown or unidentified

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones 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 Lichen Planus of Vulva? (Etiology)

• The exact cause of development of Lichen Planus of Vulva having skin and mucus membrane involvement is unknown (idiopathic), in a majority of cases
• In some cases, abnormal cell-mediated immunity may be the potential cause
• There is no definitive proof that certain types of diet may influence its development
• Lichen Planus of Vulva is non-contagious and is not sexually transmitted 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 Lichen Planus of Vulva?

Generally, the timing of development of the signs and symptoms are important in ensuring an accurate diagnosis. Lichen Planus has a slow onset; it may take days and weeks for the signs and symptoms to develop. Nevertheless, Lichen Planus of Vulva may be asymptomatic and non-itchy in many individuals. After onset of the condition, the lesions may last many months and sometimes, even for years.

The signs and symptoms of Lichen Planus of Vulva may include:

• The lesions are present on the vulva, which is the external opening of the vagina
• Single or multiple lesions may be present and a ring-like pattern may be observed (annular lesions)
• The lesions may ulcerate and cause pain
• The size of the lesion may vary from 1 mm to 10 mm
• Chronic itching and scaling of the skin that causes the skin to become thick, discolored, and leathery
• Presence of the lesions can make sexual intercourse uncomfortable

The severity of Lichen Planus of Vulva may vary; it is difficult to predict who gets mild or severe symptoms.

How is Lichen Planus of Vulva Diagnosed?

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

• A thorough physical examination and a complete medical history are very crucial. A diagnosis of Vulvar Lichen Planus may be arrived at clinically by analyzing the presentations
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• 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 tissue biopsy is performed to rule out other similar conditions
• A differential diagnosis may be considered to eliminate the following conditions:
  • Fungal infection such as ringworm        

Note: In most cases, based on the signs and symptoms, a diagnosis can be made by the dermatologist through a physical examination without a tissue biopsy.

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 Lichen Planus of Vulva?

Complications of Lichen Planus of Vulva may include:

• Bacterial and fungal infections: The condition may cause continuous itching and scaling of the skin, which creates skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive
• Rarely, squamous cell carcinoma can develop from the lesions
• Individuals may have stress and anxiety issues fearing that the condition is a sexually-transmitted infection
• The lesions can last for years resulting in self-image issues, emotional stress, and psychological trauma in some individuals
• If the emotional stress is severe, it may even lead to depression and social isolation

How is Lichen Planus of Vulva Treated?

In most individuals, Lichen Planus is a self-limiting disorder that requires no treatment. The condition subsides and goes away on its own. The symptoms are mild and symptomatic treatment is also not required.

The treatment strategies that may be adopted in the management of Lichen Planus of Vulva for those with significant signs and symptoms include:

• For mild skin conditions, self-care measures are recommended, such as washing with mild (antibacterial) soap and applying warm compress
• Use of topical steroidal creams
• Administration of systemic steroids
• Oral steroids are helpful in individuals with severe itching and cosmetic issues
• Immunosuppressive therapy, such as using cyclosporine, when it does not respond to steroidal treatments
• Photo-chemotherapy can be used in generalized Lichen Planus and those that do not respond to medications
• For severe cases, systemic retinoids may be tried
• Surgical excision may be required in some cases, if it is feasible
• Providing reassurance and helping with feelings of stress and anxiety: Some individuals may consult healthcare professionals to rule out sexually-transmitted infections (if any)
• Follow-up care with regular screening and checkups are important, since the condition can last for many months and years

Note: If any of the prescribed treatment medication or methods cause new stinging or burning symptoms, then it is important to discontinue the medication or method and immediately inform the healthcare provider.

A few self-care tips and home remedies for Lichen Planus of Vulva may include:

• Completely avoid scratching the affected areas
• A comfortable, cool bath may help soothe the skin; but, avoid excessive washing and scrubbing of the skin
• Wear smooth cotton clothes and innerwear
• Use only mild perfumes, soaps, and detergents
• Drinking lots of water or fluids

How can Lichen Planus of Vulva be Prevented?

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

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

• Lichen Planus of Vulva may be asymptomatic in some individuals. Such individuals do not require any treatment; providing reassurance (if there are emotional issues) and maintaining periodic observance by the healthcare provider may be sufficient treatment
• There is no established cure for Lichen Planus. However, many individuals have mild symptoms, and the condition may spontaneously get better without any treatment. The lesions may completely disappear over time. The prognosis of the condition is excellent in such cases
• In some individuals, the symptoms may appear, subside, and then recur with time. Besides, ulcerative lesions are difficult to treat. In such cases, symptomatic treatment may be provided to improve the quality of life
• Individuals with milder signs and symptoms have a better prognosis than those with severe signs and symptoms
• Regular follow up visits with the healthcare providers are important

Additional and Relevant Useful Information for Lichen Planus of Vulva:

• It has not been observed that dietary factors, such as oily foods and chocolate-based products, contribute to its development
• 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 Lichen Planus of Planus. However, it helps to be clean and hygienic, which will help the condition from getting worse