Disclaimer:  The information below was gathered from medical research, case histories, and personal contact with sufferers.  However, this information is not a substitute for proper medical advice. You should seek prompt medical care for any specific health issues and consult your physician regarding medical questions or advice. The individuals involved with this site are not responsible for your use of this information.

• Prescription medication
• Clinical treatments
• Alternative remedies

Clobetasol propionate (an ultrapotent steroid) is the most common treatment for LS.  Some women also use estrogen and/or testosterone.   All three medicines are used topically in the form of creams or lotions.

The links in the table below provide information specific to each type of medicine.

^aEstradiol, estriol, and conjugated estrogens (in cream form, not orally) are the estrogens most commonly prescribed to treat the effects of LS.  The differences between these three types of estrogen are outlined here.
^bNote:  Although still prescribed, testosterone doesn't seem to be particularly effective in treating LS.  Both medical research and our own case histories bear out this fact.  However, if testosterone works for you, then by all means keep using it!

Where can I get more information on the use of topical corticosteroids and topical estrogen?

A nice lecture on topical corticosteroids can be found at the New Zealand Dermatological Society.  A discussion of the topical use of estrogen can be found at the Vulvar Pain Foundation.

What are these medications supposed to do, exactly?

Ultrapotent steroids reduce inflammation and help the immune response of the affected skin.  Research has shown that 75% of women on ultrapotent steroids experience the following:  white patches typically shrink or disappear, and the atrophy and itching improve.  Some women have also found that the steroids help to unfuse fused skin.

Although there has not been similar research on LS and estrogen, women using estrogen treatment have reported that it can revive and toughen the affected skin.  In particular, women have reported that estrogen has been helpful with atrophy and unfusing.

It is important to note that these medications can be used in combination.  For instance, a prescription of both clobetasol and estrogen is not uncommon.

How much medicine should I use?  And how often?

In most studies, the amount of ultrapotent steroid cream applied is a "pea-sized" (or smaller) dab.  Women who use estrogen typically use comparable amounts (pea-sized).

Because treatment is individualized according to each person's symptoms and needs, the frequency of application for ultrapotent steroids varies from person to person.  Typically, steroids are applied once or twice a day for an initial period (which might last anywhere from two weeks to two months), and then tapered in frequency.  Ultimately, a person's dosage might be tapered to once every two days, once a week, or "as needed".

Athough the use of estrogen for LS has not been researched, women typically apply dabs of estrogen between 2 to 4 times a week (at first), and then taper its use to once or twice a week.  Some believe that it may take as long as 6 months to see results from topical estrogen treatment.

It is not the case that more of these medications are necessarily better.  In fact, increasing the dosage of steroids or estrogen increases the chances of side effects; when used in small doses, however, these side effects are unusual.

Finally, note that these creams are to be applied on the vulvar skin only -- not inside the vagina.  One possible exception:  if you are postmenopausal, your physician might recommend internal application of estrogen.

Is there anything else I should know about these medications?

When applying medications like those listed above, some women find that certain brands produce adverse reactions such as excessive burning or stinging.  If this occurs, one possibility is that the reaction is due to the inactive base with which the active ingredients are mixed.   Propylene glycol, for example --  an ingredient found in many steroid and estrogen creams -- seems to be a common irritant.

In these cases, to avoid future irritation, you might switch bases by either a) switching brands,  or b) ordering a custom-made mixture with a more natural base.  Your physician may be able to order custom mixtures through a "compounding pharmacy".

Are any other medications used to treat lichen sclerosus?

Although the above medications are the most frequently prescribed (by far), sufferers have had some success with other medications:

• Tacrolimus (Protopic)
• Pimecrolimus (Elidel)
  
• Hydroxychloroquine (Plaquenil)
• Crotamiton (Eurax)
• Calcipotriene (Dovonex)
• Tretinoin (Retin-A)

Although prescription medication is the most common treatment for LS, other treatments include:

• Laser vaporization
• Injections of mid-range potency steroids
• Photochemotherapy

People have tried a number of non-prescription remedies, with varying degrees of success.  These alternative remedies include:

• Lienchiaopaitu Pien (Chinese antibiotic containing herbs)
• Aloe vera (gel/pills)
• Flax seed oil
• Beta Glucan (creams/pills)
• Omega vitamins
• Acupuncture
• Gluten- and dairy-free diet
• Low oxalate diet
• Calendula
• Jaffe-Mellor Technique (JMT)

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