Lichen Planus of the Vulva: Symptoms, Causes, and Treatment in the UK

Lichen planus is a chronic inflammatory condition that can affect the skin, hair, nails, and mucous membranes. When it affects the vulva (the external part of the female genitals), it is referred to as vulval lichen planus. Unlike many other genital conditions, it is not a sexually transmitted infection (STI) and cannot be passed to a partner.

According to NHS guidance, lichen planus is thought to be an autoimmune condition where the body’s immune system mistakenly attacks the cells of the skin or mucous membranes. It can occur at any age, though it is most commonly diagnosed in women over the age of 40. There are several types of vulval lichen planus, including the 'erosive' type, which causes painful, raw areas that are particularly sensitive to touch.

Recognising vulval lichen planus can be challenging because its symptoms often overlap with other conditions like thrush or lichen sclerosus. However, British patients should look for these specific indicators:

• Soreness and Burning: A persistent raw feeling that makes wearing tight clothing or sitting uncomfortable.
• White Patches: A lacy, white pattern on the skin (known as Wickham striae) or solid white plaques.
• Erosions: Bright red, raw areas that may bleed slightly or ooze, often found around the vaginal opening.
• Painful Intercourse: Pain during or after sex (dyspareunia) is a very common complaint due to skin fragility.
• Itching: While less intense than in lichen sclerosus, itching (pruritus) can still occur.
• Scarring: Over time, if left untreated, the labia may shrink or the vaginal opening may narrow.

The exact cause of lichen planus remains unclear, but NICE (National Institute for Health and Care Excellence) evidence suggests a strong link to the immune system. It is not caused by poor hygiene, and it is not a form of cancer, although chronic inflammation does require long-term monitoring.

Some patients find that certain factors can trigger a 'flare-up' of symptoms. these may include high levels of stress, local trauma to the skin, or secondary infections like thrush. It is also common for women with vulval lichen planus to have the condition in other areas, such as the mouth (oral lichen planus) or on the wrists and ankles.

In the UK, the primary goal of treatment is to control the inflammation and alleviate pain. This usually involves a combination of medical treatments and lifestyle adjustments:

Topical Steroids

The first line of treatment is typically a very potent steroid ointment, such as clobetasol propionate. This is used to dampen the immune response and allow the skin to heal. Your GP will provide a specific tapering schedule, usually starting with daily application and reducing to twice weekly for maintenance.

Soap Substitutes

Standard soaps and shower gels are often too harsh for inflamed vulval skin. Patients are advised to use a plain emollient (such as aqueous cream or Zeroderm) as a soap substitute to cleanse the area without stripping natural oils.

Barrier Preparations

Using a thick emollient or a barrier ointment can help protect the skin from the irritating effects of urine and friction from clothing.

If you are experiencing persistent vulval soreness, itching, or have noticed unusual white patches, you should speak to a GP online or in person. Many women feel hesitant to discuss genital health, but early intervention is key to preventing permanent scarring and narrowing of the vaginal canal.

An online doctor in the UK can provide a confidential environment to discuss your symptoms. During a video consultation, a doctor can review your clinical history, discuss the appearance of the lesions, and advise on the best course of action. If the diagnosis is unclear, they may recommend a physical examination or a referral to a specialist vulval clinic or dermatologist for a skin biopsy.

It is easy to confuse these two conditions. While both cause white patches and discomfort, they have distinct characteristics. Lichen sclerosus typically causes intense itching and a 'parchment-like' thinning of the skin, often in a figure-of-eight pattern around the vulva and anus. Lichen planus is more likely to involve the mucous membranes inside the vagina and mouth, often presenting with the characteristic 'lacy' white lines and raw red erosions. A professional medical assessment is required to distinguish between them accurately.