St. Augustine Woman's Journal - Educational Resource to the Women of St. Johns County Since 2009

Lichen Sclerosis


September 1, 2018 | View PDF

Mary J, a healthy 72 year old, came to our office with a problem. She reported intense itching of the vulvar tissues, and was getting worse each month. She had tried Monistat cream from the drugstore, changed her laundry detergent to one with no perfumes, she even tried changing to all cotton underwear. Nothing was helping and it had gotten so bad that the patient noticed it often during the

day. Sex with her husband had become painful and she was sure there was an infection in the tissue.

When I examined her, she had the classic signs of a common skin condition called lichen sclerosis. The skin around the vagina and anus had become whitened, with a thickened look. There was evidence of scratching in the area, a finding called excoriation.

In every medical specialty there are conditions that are tough to manage. Lichen sclerosis is one of these. The cause is unknown, though an autoimmune response is considered likely, there is no known cure. And the best we can do at this stage is help manage the symptoms.

Lichen sclerosis, so named because the skin changes resemble a plant growth called lichen, is really a condition of thin skin. Thinning of the vulvar skin allows the nerve endings in the deeper tissue to be irritated; an itch is simply a variant of pain. The diagnosis is usually made with a skin biopsy to rule out the other cause, though it is easy to recognize visually.

It is usually seen in postmenopausal patients but it can be seen at any age, and symptoms are progressive, getting worse with time. Progression is variable. Treatment is usually topical, with steroid creams as the mainstay of therapy. Hormone creams, particularly

testosterone in petroleum jelly, have been used with variable success.

Recently, the Mona Lisa laser has been used in our practice to treat this condition; we are very encouraged with the results. The laser promotes thickening of the skin, thus reducing itching and irritation. 100% of patients treated thus far report significant improvement.

Susan Yarian, MD

Dr. Yarian is a University of Florida graduate, with a B.S. in Industrial Engineering. She worked as an engineer for a number of years before pursuing her medical degree at the University of South Carolina where she also went on to complete her residency. As the

founding partner of ObGyn Associates of St Augustine, she has been gratified to watch the practice grow from a one doctor, one midwife office in 2001 to our current practice. She is particularly interested in high-risk obstetrics, but enjoys all aspects of gynecologic care. Even after 20 years of private practice, she feels it is a privilege to be part of women’s lives in such an important way. Academic Background:

• B.S., Industrial Engineering, University of Florida

• M.D., University of South Carolina School of Medicine

• Residency, Obstetrics & Gynecology, University of South Carolina


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