Overview

• Chronic inflammatory condition that usually affects the genitalia and is more common in elderly females.
  • Leads to atrophy of the epidermis with white plaques forming.
• Thought to be an autoimmune condition. Associated with autoimmune diseases such as T1DM, alopcia, hypothyroid and vitiligo.

Making Diagnosis

Clinical Features

• Vulval itching + skin changes in vulva.
  • Skin Changes → ‘porcelain-white’ in colour. Shiny, tight, thin, slightly raised.
  • ‘White atrophic patches’ = lichen sclerosis.
• Soreness and pain possibly worse at night.
• Skin tightness.
• Painful sex.
• Erosions + fissures.

Investigations

• Biopsy may be performed if atypical features are present.

Management Plan

• FIRST-LINE: Potent Topical Steroids → clobetasol propionate 0.05% (dermovate).
  • Emollients.
• No Response to Steroids → tacrolimus (topical calcineurin inhibitor - immunosuppressant that reduces inflammation by controlling T-cell proliferation).