Lichen sclerosus & dermatitis

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by Guest Posts on Fri Sep 11, 2020 12:12 pm

Lichen sclerosus & dermatitis

I was initially diagnosed with vulval lichen sclerosis, 6 months ago, now I’m being told it looks unlikely, more like dermatitis/eczema. With no concrete diagnosis should I treat it as LS to be cautious due to the risk of it developing to cancer, I.e frequent steroid use even without symptoms. Or, should I treat as eczema and apply as and when. I’m concerned I could risk it developing into something dangerous if not treated correctly. I’ve been referred for patch testing but it’s a long wait.

Sarah
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Julie Van Onselen
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by Julie Van Onselen on Mon Sep 14, 2020 9:51 pm

Re: Lichen sclerosus & dermatitis

Dear Sarah
How frustrating for your to be between two diagnosis, when you see a dermatologist for patch testing, your diagnosis should be clear. The treatment for both conditions is similar, although for LS topical steroids are prescribed continuously, where as for eczema topical steroids are used in for short treatment bursts.I advise that you use a bland emollient for washing and moisturising, and try to avoid cosmetic vaginal products and soap.
The National Eczema Society has an excellent factsheet on female genital eczema, lots of the practical tips will help you be more comfortable, please see https://eczema.org/information-and-advi ... al-eczema/
There is also a booklet on patch testing, so you know what to expect when referred.
If you are diagnoses with lichen sclerous for definite, the support group who can help you is:
http://lichensclerosus.org
I hope this helps for now and you soon have a definite diagnosis.
Julie Van Onselen
Independent Dermatology Nurse
http://www.talkhealthpartnership.com/on ... nselen.php

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Dr Nevianna Bordet
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by Dr Nevianna Bordet on Wed Sep 16, 2020 11:03 pm

Re: Lichen sclerosus & dermatitis

Dear Sarah,
I am a dermatologist in vulval clinics as well as patch testing clinics and therefore have experience of both. Unfortunately, vulval eczemas is common and it is only sometimes that an allergen is responsible as the cause (contact allergic vulval eczema). More often, patients have a background of atopy (eczema in childhood that we call atopic dermatitis, asthma and/or hay fever) and happen to have vulval eczema in later life. Sometimes a contact allergen can make this worse but it is rarely the cause. So please do not hang all your hopes on patch testing. It is a useful test, but will not necessarily give you a diagnosis. While waiting for it, I would recommend you avoid the common allergens we see such as fragrance (including fragranced shower gels/ toilet paper/ sanitary pads), wet wipes, gel nails etc
Lichen sclerosis only has the characteristic scarring changes once it has been there for a while, so if you are presenting with early LS then it may well look like eczema. Although in a specialised Vulval clinic an expert will usually be able to determine the difference. And of course, rarely eczema and LS co-exist. Personally, I feel you should treat your symptoms. If you do not have any scarring changes of LS at the moment and you examine yourself on a regular basis and you see no change in the way the vulva looks, you are fine to use the steroid creams just on an intermittent basis rather then continuously. I hope this helps.
Dr Nevianna Bordet
Consultant Dermatologist

http://www.talkhealthpartnership.com/on ... bordet.php

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