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Lichen sclerosus flare up - how can I treat the pain?

I have recently been diagnosed with lichen sclerosus affecting the skin of the vulva. I have Dermovate ointment to use sparingly once a day as needed. I am away at the moment and having an awful flare up, really painful when I urinate. I have been using the cream for a week. Taking baths (Epsom salt only in water) but it isn't getting any better. Not sure what to do, I don't see the point of going to a doctor .... can I use the Dermovate twice a day? is there anything else I can do? (I have tried Vaseline which only irritates it more).

31 July 2020

This answer was last reviewed on 31 July 2020 by registered nurse, Pedro Santos and a pharmacist in our Health at Hand team.

Thank you for contacting Health at Hand.

It must be very uncomfortable for you to have this condition and you may know that there isn’t a cure.

However if you look after the skin that is affected you can reduce or prevent any flare ups. Dermovate cream can certainly help with flare ups and can be used once or twice daily, so you can increase it to twice a day. Prolonged and repeated use of Epsom salts can damage the surrounding skin so this may be aggravating it. We suggest you stop using this and instead use a moisturising shower gel or a bath emollient. We do think that you should see a doctor to check you do not have any complications of this condition.

We have included more detailed information below to help you.

What is lichen sclerosus?

Lichen sclerosus is a long-term skin condition that affects the genital areas which include the vulva, penis and anus. Changes in the skin in these areas become inflamed, itchy and sore, which can then lead to problems with passing urine and having sex. Women are mostly affected although it can occur in men and children.

What causes lichen sclerosus?

What actually causes it is unclear. Experts think that changes in the immune system or hormones are likely to be responsible because many people who have lichen sclerosus also have other auto immune conditions, such as thyroid disease, pernicious anaemia or vitiligo.

Can you pass lichen sclerosus on?

Lichen sclerosus is not catching, you cannot give someone lichen sclerosus, including when having sex.

What can aggravate lichen sclerosus?

  • Irritants such as soap, detergents, shower gels and bubble baths can aggravate lichen sclerosus, so using these irritants should be avoided.
  • Friction or damage to the skin can make it worse so overzealous washing and drying of the vaginal or anal area should be avoided.
  • Irritation from urine leakage can also make the problem worse. It's a good idea to dry yourself thoroughly after going to the toilet, using a good soft toilet tissue. Avoid using toilet wipes.

Inflamed areas of skin have a tendency to flare up from time to time and often settle down by themselves. The severity and duration of flare-ups varies from person to person and from time to time in the same person.

However if you follow a strict hygiene regime you can greatly reduce the occurrence and severity of a flare up.

How can you treat or manage lichen sclerosus?

Use a moisturising wash such as shower gel or bath emollient such as:

  • Oilatum shower gel
  • Doublebase shower gel
  • Hydromol shower gel
  • Oilatum bath additive
  • Cetraben bath additive
  • Doublebase bath additive
  • Hydromol bathadditive
  • E45 wash

... or any other moisturising cleaning agent prescribed by your doctor.

Emollient bath additives are added to your bath water. Soaking for 10-20 minutes in this water will greatly help to hydrate the delicate skin of the vagina, vulva, and anus.

It is very important to dry your skin thoroughly after your bath or shower including the ano genital area, not only with a dry towel but a cool setting on the hair dryer.

Once the area is dry you can apply a moisturising cream or ointment such as:

  • Diprobase
  • Doublebase
  • Oilatum
  • Cetraben
  • Zerobase

... or any other moisturising agent prescribed by your doctor.

Generally ointments are stickier than creams, but they stay on longer so help maintain moisture in the skin for longer.

Steroid creams and ointments

During flare ups, applying steroid creams helps to reduce the inflammation. Clobetsol propionate, also known as Dermovate, has been found to be very effective in treating lichen sclerosus flare ups.

Dermovate cream can be used once or twice a day.

Betamethasone dipropionate 0.05% is also used in the management of lichen sclerosus.

For some people who cannot use these steroid creams or have found that they are not managing their symptoms, it's worth having a discussion with your doctor as other therapies may be available, such as laser or photodynamic therapy.  

Other Treatments

For some people Retinoid creams may be required. Some people may need photochemotherapy or photodynamic therapy. Surgical treatments are only used in those with severe scarring or those who have cancer.

For details of these treatments or any other questions please feel free to contact us at Health at Hand on 0800 003 004 or submit your quesry online via our Ask the Expert service.

Complications of lichen sclerosus

We're sure you are aware, but it is important to keep an eye out for any unusual changes of the genital skin and the surrounding area, such as thickening of the skin, bleeding or blistering of the skin of the vaginal areas because cancer of the vulva can be linked to lichen sclerosus.

Checking once a month for any changes is recommended. Any changes need to be reported straight away because if it is cancer, the earlier you detect it the greater your chances of effective treatment.

Further information

Further information can be found on the websites below:

Lichen sclerosus - NHS factsheet

Lichen sclerosus - British Association of Dermatologists

Answered by the Health at Hand team.

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