• Wellington Hospital patient information sheet.

Lichen sclerosus is an autoimmune condition (inflammation occurring when it shouldn't) that is common, especially after menopause. It is not known why lichen sclerosus occurs. Lichen sclerosus causes itchiness and irritation and often thickened white areas around the vulva and anus. Longstanding lichen sclerosus often leads to changes or flattening of the folds of skin around the clitoris and the labia minora (the inner skin folds of the vulva).

Sometimes specific triggers can be identified; these can include vulval hygiene products (creams, moisturisers, etc.), soaps or detergents, toilet papers, food triggers, stress, weather and others. Unfortunately many people are not able to identify any triggers.

Treatment involves identifying and avoiding any triggers, and steroid creams.

The strongest steroid cream available in Aotearoa is Dermol. There are lots of different instructions on how to use Dermol, and no evidence that any one regime is better than any others. We recommend using the following for a flare up:

• Twice daily for four weeks

• Daily for four weeks

• Twice weekly for four weeks

The cream, should be applied all over the vulva, and if the anus is also affected (itchy) then also around the anus - with particular focus any problematic areas. If the symptoms are not improving with the above regime you should see a doctor quickly.

Moisturiser creams can also be used to relieve itching and other symptoms. A very basic moisturiser that does not contain any fragrances should be used - we recommend Non-Ionic Cream (cetomacrogol).

Lichen sclerosus can lead to changes in the skin secondary to chronic inflammation. These changes can cause a condition called VIN (vulval intraepithelial neoplasia) which can in turn lead to skin cancer (SCC - squamous cell carcinoma). For this reason it is extremely important to see a doctor if you develop:

• Any areas that are not responding to Dermol treatment

• Any ulcerated areas, or other new changes