What is Lichen Planus?
Lichen planus is a chronic inflammatory condition that can affect skin, mucous membranes, hair, and nails. In the context of gynecology, it primarily impacts the vulva and vagina. It is an autoimmune disorder, where the body's immune system attacks its own tissues. The exact cause remains unknown, but it is believed to be related to a combination of genetic and environmental factors.
How does Lichen Planus present in Gynecology?
Lichen planus in the genital area can present with a variety of symptoms. The most common include intense
itching, burning sensations, and pain during intercourse (
dyspareunia). Patients may also notice white, lacy patches on the vulva, or erosive lesions that can cause significant discomfort. In severe cases, scarring and narrowing of the vaginal opening can occur, leading to complications like
sexual dysfunction and difficulties in performing gynecological examinations.
Erosive Lichen Planus: Characterized by painful erosions and ulcers on the vulva and vagina, leading to significant discomfort.
Hypertrophic Lichen Planus: Presents with thickened, raised plaques that can be itchy and uncomfortable.
Reticular Lichen Planus: Identified by white, lacy patterns on the vulvar mucosa, often asymptomatic but can sometimes cause mild discomfort.
How is Lichen Planus Diagnosed?
Diagnosis typically involves a combination of clinical examination and
biopsy. During the examination, the gynecologist looks for characteristic lesions and patterns. A biopsy is often performed to confirm the diagnosis by examining the tissue under a microscope. Additional tests may be conducted to rule out other conditions with similar presentations, such as
lichen sclerosus, vulvar intraepithelial neoplasia, and infections.
Topical Steroids: High-potency corticosteroids are often the first line of treatment to reduce inflammation and control symptoms.
Systemic Medications: For severe cases, oral corticosteroids or immunosuppressive agents, such as
methotrexate or
cyclosporine, may be prescribed.
Topical Calcineurin Inhibitors: These medications, such as
tacrolimus and pimecrolimus, can be used especially when steroids are contraindicated or ineffective.
Phototherapy: Ultraviolet light therapy can be beneficial for some patients, although its use in the genital area is limited due to sensitivity.
Supportive Care: Measures like using emollients, avoiding irritants, and wearing loose-fitting clothing can help manage symptoms.
What is the Prognosis for Patients with Lichen Planus?
Lichen planus is a chronic condition with periods of remission and flare-ups. While it can be managed effectively with treatment, long-term follow-up is often necessary. Some patients may experience persistent symptoms that require ongoing treatment. Early diagnosis and appropriate management are crucial to prevent complications such as scarring and
vaginal stenosis.
Can Lichen Planus Affect Pregnancy?
Lichen planus can pose challenges during pregnancy due to the need for careful management of medications. Some treatments may not be safe for use during pregnancy, requiring adjustments and close monitoring. Additionally, erosive lesions can cause discomfort and complications during delivery. It is essential for pregnant women with lichen planus to work closely with their gynecologists to ensure both maternal and fetal health.
