Patient Information: Vulvar - Vaginal Disease

Lichen Simplex

What is Lichen simplex?
Lichen simplex is a skin condition resulting from a chronic irritation of the vulva. Lichen simplex may cause itching, burning, and/or thickened skin.

Symptoms occur when the vulvar skin becomes sensitive and irritated and may exist for several weeks or months. As a result of constant vulvar scratching, the skin thickens, itches more, then is scratched again. Many doctors refer to this as an itch-scratch cycle.

What are the signs and symptoms of Lichen simplex?
Moisture, scratching, scrubbing, and the use of medications may cause the skin to look different in each person.
Signs and symptoms may include:

• Chronic vulvar itching and/or burning on the vulva. This may be mild to severe.
• Pink to dusky red or purple-looking skin.
• Swelling and/or thickened areas of skin.
• Skin tears caused by scratching.
• Raw and/or damp feeling.

Women tend to think the dampness is caused by a vaginal discharge. Many believe it to be the cause of their symptoms. In reality, the dampness may come from the outer vulvar skin surface. Chronic irritation to the outer vulvar skin can cause it to weep.

How is Lichen simplex diagnosed?
Your doctor or health care provider will look for common skin changes of the vulva. A sample of your discharge may be checked to rule out infection.

What is the cause of Lichen simplex?
When the irritation exists long enough so that an itch-scratch cycle develops, Lichen Simplex may occur. It may be caused by many different factors, such as contact irritants.

What are contact irritants?
Contact irritants are products that cause irritation of the vulvar skin. This is not always an allergic reaction. Following is the difference between an allergen and an irritant.

• Allergens: Materials that cause difficulty in breathing or a general skin reaction (hives, rash, blisters) and itching after contact of only one or more times.
• Irritants: Materials that cause burning or itching at the site where the irritant was in contact with the skin after a number of uses.

The following items may irritate vulvar skin:

• Laundry detergents containing enzymes
• Fabric softeners and dryer sheets
• Bath soaps, gels, lotions
• Bubble bath, oils, bath salts, skin softeners
• Feminine hygiene sprays, perfumes or powders
• Adult and baby wipes or towelettes
• Deodorant tampons and pads
• Douches
• Contraceptive creams, jellies, foams and sponges
• Condoms, prepackaged with lubricant or spermicides
• Colored, perfumed toilet paper
• Synthetics such as nylon underwear or panty hose

What is the treatment for Lichen simplex?
The goals of treatment are to relieve itching and break the itch-scratch cycle.

• Follow the Guidelines for Vulvar Skin Care.
  The vulvar area should be kept as clean and as dry as possible. Although the initial irritant may be removed, if the itch-scratch cycle has already developed, the Lichen Simplex process may continue without additional treatment.
• Apply topical steroids
  • How it is used: A thin layer is applied to the areas of discomfort.
  • How it Works: Decreases redness, swelling, itching, and burning.
  • Caution: Use only as prescribed by your doctor. Overuse may result in making your problem worse rather than helping it.
• Baking Soda Soaks Soak in luke warm bath water with 4-5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 2-3 times a day for 10-15 minutes. If you are using a sitz bath, use 1-2 teaspoons of baking soda.
• Gold Bond or Zeasorb powder may be applied to the vulvar and groin areas if chronic dampness/moisture is a problem.

Symptoms should resolve with treatment. If symptoms persist, further follow-up and treatment may be needed.

Peer Review Status: Internally
Peer Review Date: 2004