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Mr Parijat Bhattacharjee, Private Consultant Gynaecologist, Harrow, Brentford, Northwood, London, UK / Media / Videos » Lichen Planus - Vulval Skin Disorders

Lichen Planus - Vulval Skin Disorders

Lichen Planus - Vulval Skin Disorders
Posted on: 03-Jul-2026

This video, titled "Lichen Planus - Vulval Skin Disorders" by Gynae Consultant, outlines the clinical presentation, classification, diagnosis, and treatment of lichen planus affecting the vulval area.

What is Lichen Planus?

  • Definition: Lichen planus is a relatively rare, chronic inflammatory condition. It is thought to be an autoimmune, T-cell-mediated disorder that can affect the skin, nails, oral mucosa, and genital mucosa.
  • Target Demographic: While vulval symptoms can stem from estrogen deficiency or contact dermatitis, lichen planus specifically targets the mucous membranes. It is most commonly diagnosed in postmenopausal women, with an average age of onset around 57 years.
  • Key Clinical Difference: Unlike lichen sclerosus (which predominantly limits itself to outer skin surfaces), lichen planus frequently involves the internal vaginal mucosa.

The Three Main Types

1. Erosive Lichen Planus

  • Characteristics: This is the most common form. It typically begins at the introitus (vaginal opening) as well-defined, red erosions bordered by a raised, whitish edge. This variety often spreads further up into the vagina.
  • Symptoms: Patients frequently report significant pain, superficial dyspareunia (painful intercourse), and postcoital bleeding.
  • Complications: Early recognition is critical because vaginal involvement can cause extensive internal scarring, structural fusing, and an architectural loss of the anatomy if left untreated.

2. Classical Lichen Planus

  • Characteristics: Typically presents as raised papules on the anogenital keratinized (outer) skin. This variant often resolves spontaneously over time.

3. Hypertrophic Lichen Planus

  • Characteristics: This is a very rare type that usually surfaces in the perianal skin, appearing as raised, thickened plaques.

Diagnosis and Malignancy Risks

  • Clinical Mainstay: Diagnosis is primarily established through a visual physical examination by a specialist.
  • Biopsy: A skin biopsy is required if there is diagnostic ambiguity, if alternative conditions need ruling out, or if there is any suspicion of malignancy.
  • Cancer Risk: Transformation of the affected tissue into squamous cell carcinoma is rare, but certain medical studies suggest it can happen in up to 3% of cases. Consequently, an annual medical follow-up is considered essential.

Treatment and Management Protocols

General Skin Care

  • Patients are advised to strictly avoid harsh chemical irritants.
  • Standard soaps should be replaced with gentle emollient soap substitutes to preserve the skin barrier.

Topical Therapies

  • First-Line Approach: The primary treatment relies on an ultra-potent topical corticosteroid, specifically Clobetasol Propionate (0.05% ointment), applied twice weekly over a three-month course.
  • Efficacy: While limited to a few randomized control trials, clinical evidence demonstrates that this initial regimen improves symptoms in up to 75% of patients and drives complete clinical remission of acute symptoms in 55% of cases.
  • Maintenance: Long-term management often shifts to a weaker topical steroid applied twice a week, or short, intermittent bursts of potent steroids to keep flare-ups controlled.

Advanced Management

  • In rare, severe scenarios where significant architectural scarring has already bound tissues together, surgery may be introduced to restore function.