What is Peri-Vaginal Hypopigmentation and can it be treated?

Any change to the color of the skin, especially around the area of the vagina, is a concern for some women. In most cases the changes are very subtle, and may not be immediately noticeable even to your gynecologist. Peri-vaginal hypopigmentation may be a sign of vulvar lichen sclerosus (LS).

What is vulvar lichen sclerosus?
Lichen sclerosus is a benign skin condition in the dermatosus group. It is non-contagious, non-infectious, non-inflammatory and not a connective tissue disease. Women who develop the condition, get it simply because they have a genetic predisposition to do so.  Other conditions in this group that are more common include eczema, psoriasis, and dandruff. Like these condition, once they manifest, they tend to be chronic conditions that require consistent ongoing treatment to help suppress the associated symptoms. The onset of LS can occur at any age from infantancy to the elderly.

What are the symptoms of Lichen sclerosus?

Early skin changes of LS include the labia minora (small lips) and inner aspects of the labia majora (large lips) becoming wrinkly, shiny and sticky. Vulvar hypopigmentation can also occur as the initial sign or later in the course of the condition. Hypopigmentation is where the tissues turn white. This can occur in symmetric areas surrounding the opening of the vagina or in a splotchy configuration.  Later changes of the skin include the labia fusing together and/or fusion at the “v” or base of the vagina. This can result in progressive involution or disappearance of the labia minora (small inner lips) and/or shrinkage of the caliber of the vaginal opening resulting in tearing during tampon use or during intercourse. The skin tends to get thin due to thinning of the dermis making it easier to crack and stain from even less traumatic things including wearing tight pants or friction with clothing during exercise. Very advanced LS can manifest with plaques or thickening of the skin. The presence of this is the only time biopsy of the skin is necessary to exclude the presence of pre-cancer or cancerous transformation of the skin.

In early stages of LS there are typically no symptoms but as the condition progresses it causes a dry, chafed sensation with the predominant symptom being itching. LS only causes burning if areas of fusion break open causing linear fissures similar to paper-cuts.

Can it be treated?
Yes, effective treatment is available to treat LS. Treatments have evolved from using topical progesterone (which is still used for infants), to testosterone ointment, and currently to topical corticosteroids, which works most effectively to return the skin to its normal appearance. Following the initial medium to high potency  tapered treatment if needed, a maintenance regimen consisting of low potency corticosteroids is recommended by the experts in vaginal care at Fowler Gyn International (FGI). To often general gynecologists prescribe only supra-potent corticosteriods on an episodic basis, each time the symptoms reoccur. FGI dose not endorse this approach because it allows the condition to slowly progress between treatments. Hypopigmentation is particularly slow to respond, often requiring one or more years with proper treatment to significantly fade or resolve. The best case scenario for the areas that have fused is that the fusion will stop but the degree of resolution of the labia minora will not return to “normal.”

For expert treatment contact Fowler Gyn International, located in Phoenix, AZ, for an accurate diagnosis. Call FGI today at (480) 420-4001 for a free registration “talk to Doc” with board certified gynecologist, Dr. R. Stuart Fowler. To become a client, this is done online at fowlergyninternational.com, click “Start Here.”

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