Lichen simplex chronicus is the result of itching and scratching. The chronic scratching and rubbing leads to lichenification. Can result from atopic dermatitis/eczema.
Treatment: soak in water twice a day, steroids.
Lichen sclerosus is thinning of the epithelium. It does not involve the vagina. There's a 3 to 8% lifetime risk of cancer. Vulvar pruritus, burning, dyspareunia, loss of vulvar architecture; loss of labia minora, can involve the perianal area. Doesn't usually involve the vagina. Can cause fissures.
Treatment is ultrapotent topical steroids (clobetasol propionate 0.05% for 3 months). A 30-gram tube should last for 3 months. After 3 months, use an ultrapotent steroid ointment 3 times a week or nightly mid-dose topical steroid ointment. Monitor 3 and 6 months after initial therapy.
Lichen planus is a chronic inflammatory and autoimmune disease that affects the skin, nails, hair, and mucous membranes. It is characterized by polygonal, flat-topped, violaceous papules and plaques with overlying, reticulated, fine white scale (Wickham's striae), commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. There is no cure, but many different medications and procedures have been used in efforts to control the symptoms. Get punch biopsy to diagnose. Order histopathology and direct immunofluorescence to differentiate from bullous diseases.
Lichen planus can be confused with lichen sclerosus. You can see fusion of the prepuce over the clitoris and loss of labia minora; vaginal stenosis; whitish, scarred vulva; erosions that bleed on contact, lichenification. LP involves the entire vulva, perineum, and perianal area. If pt has buccal involvement, 25% of these people also have vulvovaginal disease. It's reticulated (lacelike) and can be erosive.
Treatment: clobetasol propionate 0.05%; methotrexate, cyclosporine; oral steroids if local therapy fails
