Corticosteroid creams or ointments are the preferred treatment of lichen sclerosus. These offer relief from itching and scarring. Additionally, they improve the skin’s appearance. It could take months for normalcy to resume after initializing treatment.
Initially, topical corticosteroids should be applied to the areas affected twice daily. Subsequently, an application a few times a week will prevent a recurrence. Long-term treatment with corticosteroids may lead to thin skin as a result of atrophy. Additionally, they may cause yeast infections in the genitals.
Therefore, it is essential to have your treatment monitored if you are on long-term corticosteroid therapy. This can be done by scheduling regular appointments with your doctor. Immunomodulatory agents such as pimecrolimus and immunosuppressant ointments like tacrolimus are used when corticosteroid therapy fails. Tacrolimus and pimecrolimus are preferred to corticosteroids in long-term treatment.
Oral or topical retinoids, methotrexate, oral cyclosporin, and hydroxyurea are used to treat genital lichen sclerosus that is resistant to the treatments mentioned earlier. Phototherapy is a treatment involving the use of ultraviolet light. It can be used to treat lichen sclerosus on other body parts except for the genitals.
Surgery has been proven to be ineffective for advanced genital lichen sclerosus in women as the patches recur. However, surgery is useful when vaginal scarring is severe, but only if the lichen sclerosus is well controlled.
Surgery is effective in men with advanced genital lichen sclerosus who have not responded to other forms of treatment. In men, surgery involves Circumcision, which is excision of the foreskin. This offers a permanent solution as it prevents the recurrence of the condition.
Vaginal dilators, numbing creams, and water-based lubricants can be prescribed to women experiencing painful sex.
It is essential for medical professionals to conduct patient education in addition to giving treatment. Patients should be educated on the chronic nature of the condition and the importance of adhering to treatment to prevent a recurrence. The condition can cause abnormal developments. Therefore, you need to conduct frequent self-examinations. This is because lichen sclerosus is associated with an increased risk of cancer.
Patients should be encouraged to visit a gynecologist or dermatologist for annual cancer screening. Patients with genital lichen sclerosis should also be educated on the need for screening for urinary and sexual dysfunction at each doctor’s visit.