Lichen Sclerosus

Living with a vulval skin condition such as lichen sclerosus can affect you in a variety of ways. Symptoms such as itching, soreness, pain and discomfort can be extremely distressing.  So how can these symptoms be managed?

As with any skin condition treatment usually involves putting on creams and ointments first. These usually consist of an emollient, which moisturises and protects your skin and a treatment cream or ointment to treat your lichen sclerosus.

You may often be faced with a variety creams and ointments, which at times can be confusing. Which one should you use and when, how often and how much?

Washing, cleansing and skin care

Many products generally used for washing, bathing and showering will irritate and dry your skin. It is better not to use soaps, bubble baths, talc and anything with a strong perfume. Emollients  form the basis of your skin care routine they cannot be overused and can be used as often as necessary.

There are many so it is important to get to know what is available. (Box 1 shows a limited selection) Your doctor or nurse will be able to discuss this with you. Emollients come in various forms, there are bath oils, shower preparations, creams / ointments which can be used as soaps and general moisturisers. So which one do we advise? Emollient choice is a very personal thing, and will depend on your age and lifestyle. What suits one person will not suit another. The key however is to keep things simple, generally we prefer the use of ointments as they moisturise the skin, last longer and protect sensitive areas from urine which may irritate your skin but  creams will often be used as a soap i.e aqueous cream .

After using  a soap substitute for washing it is important to dry the area well, patting rather than rubbing, and then putting the cream or ointment, on again which will act as a barrier protecting the sensitive skin. The emollient can be put on regularly throughout the day if the area becomes sore or itchy but  should not be used at the same time as other treatment cream/ointments.  There should be a 1/2 - 1 hour gap between using your emollient and treatment cream / ointment as you may dilute treatment and make it less effective.

 

Useful Tips

• Emollients will make the bath /shower slippery so use a mat.
• Keep lids on pots of cream and remove the contents with a spoon.
• Carry small amounts of emollient in a small pot / container for work / school, the pot can be washed and dried for reuse the next day.
• Don't share creams / ointment they should be for one person only.
• Cotton underwear is best.
• Panty liners may protect underwear from creams/ointments, which may stain clothing.
• Moist toilet tissues / baby wipes may irritate the skin.
• If using nappies / continence pads certain creams/ ointments may affect  how they work. Discuss this further with your nurse / health visitor.
• Avoid soaps, bubble bath, shower gels which may irritate the skin.
• Avoid anything with a strong perfume.
• Contraception - do not use ointments at the same time as using a condom.
• Follow your doctor's instructions and use products only prescribed for you.
• Don't buy creams over the counter at your chemist or supermarket, they may irritate and make things worse.
• Keep things simple.

Steroids put on the skin (topical steroids)

Topical steroids are used to treat your lichen sclerosus. They come in cream or ointment form and we generally prefer you to use ointments as they are greasier and contain fewer ingredients you could become allergic to. There are different strengths of steroid from mild to moderate, strong to very strong. With lichen sclerosus we usually need stronger ointments but you may find you will need different strengths at different times. After the lichen sclerosus improves you may be asked to put your steroid cream / ointment less often, for example regularly twice a week, to stop the problem coming back. Your doctor and nurse will discuss this with you. When using your steroid it is important you only use it specifically on the areas of lichen sclerosus including the skin around the back passage (anus) and not on normal skin. Side effects will only occur if you use large amounts of strong steroids on sensitive skin such as the face, in skin creases such as the groin. Ideally apply your treatment using a mirror so that you can apply the treatments directly onto the areas involved, use only enough to make the skin shiny. Using more will not make any difference. It is important to know how much steroid you are using so do keep a record of how much you use, what size tube and how long it lasts. It helps us to keep an eye your treatment.  If applying treatments is difficult discuss this with your nurse /doctor. It may be easier for the community nurse or practice nurse to help you with you steroid treatments.

Sandra Lawton RGN,OND, ENB 393,
Dermatology Liaison Sister,
Queen's Medical Centre
Nottingham UK