Overcoming lichen sclerosis conditions Associated With Genital Cancers

This is a sensitive topic and is presented for medical educational purposes for the general public to be aware of the cancers that can affect different parts of the human body – even the sensitive ones. Understandably, some people may be uncomfortable for cultural reasons, but this is one of the reasons why cancer incidence rates exist in many parts of the world. Here, in this section, there will be images for educational purposes. If you don’t want to read more about this, that’s understandable.

Image from Viju Rathod’s lecture titled Path anat(tumours of female genital system ) Kurst State University

https://www.slideshare.net/slideshow/path-anattumours-of-female-genital-system/83646568

A skin condition that is characterised by ivory skin, itching, redness, and scarring.
This can be in the genital areas (agenital) and outside the genital areas.
It can affect the patient’s quality of life not only with the symptoms but can also cause negative emotions about how the vaginal or penis looks.
Treatment is difficult, and over time it can progress and cause more symptoms.

Factors That Affect The Treatment Of Lichen Sclerosus

Traditional Chinese Medicine

Studies show that Fructus cnidii and sweet wormwood help prevent itching (pruritus) and inflammatory diseases and autoimmune disorders, respectively.

Topical Corticosteroids

How do topical corticosteroids work?

Corticosteroids is a type of steroid hormone that is made in the adrehnal cortex. It has several anti-inflammatory effects and here it presents the role of eicosanoids which are produced by the polyunsaturated fatty acid arachidonic acid. This is present on the plasma membrane, more specifically the phospholipids (phosphate combined with lipids). The eicosanoids consists of cyclic endoperoxides, prostaglandins, thromboxanes and leukotrienes. The eicosanoids begins when a stimulus, hormones, neurotransmitter, paracrine or other types of agent binds its receptors and activates the enzyme phospholipase A2, in the plasma membrane. The enzyme divides the arachidonic acid from the phospholipids. Thr arachidnoic acid then divided into two pathways and undergo metabolism: 5-lipoxygenase and cyclooxygenase. The first pathway 5-lipoxygenase leads to the activation of 5-HPETE. This then leads to the formation of leukotrienes which causes the anti-inflammatory effect and increases the permeability of small blood vessels, cause contraction of smooth muscle and attract neutrophils to site of infection. The cyclo-oxygenase pathway leads to the formation of cyclic endoperoxidase, prostaglandings and thromboxanes. Similar to Prostaglandins, it increase the dilation of vessels and mediates inflammation. Thromboxane causes small fragments called platelets to aggregate. This helps to induce blood clots.

Mautz, T.T., Krapf, J.M. and Goldstein, A.T. (2022). Topical corticosteroids in the treatment of vulvar lichen sclerosus: A review of pharmacokinetics and recommended dosing frequencies. *Sexual Medicine Reviews*, 10(1), pp.42–52. doi:10.1016/j.sxmr.2021.03.006.

Lichen sclerosis can be treated with topical corticosteroids:

Clobetasol Propionate 0.05% is first-line.

Please click here for further information:
https://cks.nice.org.uk/topics/eczema-atopic/prescribing-information/topical-corticosteroids/

https://thewomenshealth.clinic/faq/what-is-the-best-steroid-cream-for-lichen-sclerosus/

Calcineurin inhibitors

This is applied for Resistant cases of lichen sclerosis and also other skin conditions and autoimmune skin disorders
Calcium dependent
Calcineurin inhibitors prevent T cell activation, influencing the T cell receptors and the cytokine signalling, where transcription of interleukin 2 is prevented.
Calcineurin Inhibitors are an alternative to topical steroids, lowering inflammation in the skin that is characterised by itchiness and soreness.

Significant decreases were found in papules, atrophic and erythematous patches, erosions, and ulcerations.

Types of Calcineurin Inhibitors
There are two main types:

Tacrolimus Ointment

0.003% strength for children (2 and above) and adults.
0.1% strength for adolescents 16 years and older.

Pimecrolimus cream

This is for mild inflammation and suitable for children as young as 3 months.

Pimecrolimus has a similar role to tacrolimus, where it binds to macrolide binding protein 12 (FKBP-12) and inhibits the calcium-dependent phosphatase, calcineurin. This blocks T cells and the transcription of early cytokines. Amongst the examples of cytokines are Interleukin-2, interleukin-4, interleukin-10 (Th2- type), and interferon gamma (Th1-type).

For Further Information, please visit:

https://www.bad.org.uk/pils/topical-calcineurin-inhibitors

Calcineurin Inhibitors | immunosuppressant | Cyclosporin & Tacrolimus mechanism of action By Animated biology With Arpan

Other Medications For Lichen Sclerosis

Emollient creams and moisturizing creams – prevent dryness and irritation
Antihistamines – itching
Surgery – relieves severe scarring.
Regular monitoring due to the link with vulvar squamous cell carcinoma.

Did you know carbon dioxide laser vaporisation helps overcome lichen conditions?

Guo et al. compared carbon dioxide (CO2) laser therapy and photodynamic therapy (PDT) using 5% 5-aminolevulinic acid (5-ALA) as a photosensitizer.

What were their findings?

Carbon dioxide treatment: It helped improve conditions of patients with symptoms of itching, improve the elasticity of the skin and healthy colour (less red sore), lesion size and total clinical scores.

5-ALA PDT: It also showed improvements on itching, skin colour and total clinical scores.

Generally, CO2 laser was often effective in comparison to other laser types and high-potency topical corticosteroids, serving as an adjunct in the genital LS treatment armamentarium (medical supplies).

Importantly, higher laser doses did not prove to be more effective than lower doses.

Alternative to excision
It is applied in cases of multifocal lesions.
Post-examination under anaesthesia needed.
No cancer detected – definitive laser procedure needed.

CO2 Laser Resurfacing in Cincinnati | Amy Brenner, MD & Associates

References

British Association of Dermatologists (2025) Topical Calcineurin inhibitors. Available at: https://www.bad.org.uk/pils/topical-calcineurin-inhibitors (Accessed: 5th November 2026)

Conte, S., Daraj Mohamed, S., Shergill, M., Yacovelli, A., Johnston, L., Starkey, S., Cohen, Y., Law, A., Litvinov, I.V. and Mukovozov, I. (2024). Treatment modalities for genital lichen sclerosus: A systematic review. Dermato, [online] 4(4), pp.136–172. doi:10.3390/dermato4040014.

Drug Bank (n.d.) Pimecrolimus. Available at: https://go.drugbank.com/drugs/DB00337 (Accessed: 7^th November 2026)

Guo, J.-Q., Chen, S.-Y., Chen, X.-M., Lu, J.-Q., Song, Y., Liu, H.-Y., Hu, L.-N. and Zhu, Z.-Y. (2022). Clinical study on multi-focused laser in the treatment of vulvar lichen sclerosus. Frontiers in Surgery, 9. doi:10.3389/fsurg.2022.919135.

Mautz, T.T., Krapf, J.M. and Goldstein, A.T. (2022). Topical corticosteroids in the treatment of vulvar lichen sclerosus: A review of pharmacokinetics and recommended dosing frequencies. Sexual Medicine Reviews, 10(1), pp.42–52. doi:10.1016/j.sxmr.2021.03.006.

National Institute For Health and Care Excellence (2026) Topical Corticosteroid. Available at: https://cks.nice.org.uk/topics/eczema-atopic/prescribing-information/topical-corticosteroids/ (Accessed: 7^th November 2026)

Rathod, V. (n.d.) Path anat (tumours of female genital system. Available at: https://www.slideshare.net/slideshow/path-anattumours-of-female-genital-system/83646568 (Accessed: 7^th November 2026)

Women’s Health Clinic (n.d.) What is the best steroid cream for lichen sclerosus?. Available at: https://thewomenshealth.clinic/faq/what-is-the-best-steroid-cream-for-lichen-sclerosus/ (Accessed: 7^th November 2026)