Lichen simplex is a severe form of eczema that affects the vulva. It can also affect other areas of the body such as the anus, the legs and the nape of the neck. The condition is intensely itchy.
Unlike general eczema, where the rash is present at onset, the rash with lichen simplex only develops because the person has been scratching excessively and has damaged the skin.
What Causes the Itch?
Doctors don’t know what causes it but think that the central and peripheral nerves and inflammatory cells are altered so they perceive an abnormal sensation of itch in otherwise healthy tissue.
The mind-body connection also comes into it as emotional tension can induce the itchy sensation in some people.
Environmental causes are also to blame for some cases of lichen simplex and are thought to be a contact dermatitis type of reaction. For instance, there was a small study looking at a chemical called P-phenylenediamine (an ingredient of hair dye) found that patients lichen simplex symptoms improved after they discontinued use of the hair dye.
The condition isn’t dangerous but it should be treated because it can be emotionally distressing and interrupt sleep and therefore affects mental functioning and motor skills.
If the lichen simplex is in the vulvar area, it can also make sexual intercourse painful and difficult and lead to diminished quality of life.
Treatment
Treatments include:
• Emollient creams (to sooth sore skin and cleanse the area -- they can be used instead of soap).
• Topical steroid cream (to suppress the lichen simplex). It should only be used in tiny amounts as it can make the skin thinner, which could in the long term make the situation worse. A 30 g tube should last three months.
• Anti-itch creams
• Antihistamine medicine (to ease the itch).
• Lidocaine anaesthetic cream can also dim the itch.
Self-Care Measures
If you suffer from any kind of genital eczema you should avoid using soaps, shampoo or bubble bath near the area. You should also use a non-biological washing powder for people with sensitive skin so that your clothes don’t end up irritating your skin. Wear loose-fitting, plain cotton underwear and dresses and skirts as this will allow the area to breathe more and will avoid chafing.
Improving your Sex Life
You might think that your sex life is over due to the condition, but it is possible to work around it. The topical steroid should ease the symptoms sufficiently for you to still have sex, however, you should apply it well beforehand and make sure the ointment is completely absorbed into your skin, otherwise your partner may also absorb some of the steroid.
Alternatively, he could use a condom. Sperm can be an irritant, especially to sore and sensitive skin, so it may be better for you if he does use one. Choose a hypoallergenic brand. You should also have a second method of contraception, as steroid creams can permeate condoms.
Using a sexual lubricant can make sex more comfortable.
The Vulvar Pain Society has numerous tips about vulvar pain and they suggest the use of lidocaine to help with painful intercourse. If you are in a lot of pain, you could dab a tiny amount of lidocaine ointment on the affected areas a few minutes prior to intercourse.
However, don’t go overboard with it. If you apply too much in lots of areas, it will numb the pleasure as well as the pain! The key is moderation.
Just using a pea-sized amount on the areas that most hurt should not interrupt your enjoyment. Your partner may want to use a condom in this instance too, as some men find it numbs them.
Source:
Lichen Simplex, British Society for the Study of Vulval Disease. Web. 27th February 2012. http://bssvd.org/index.php?option=com_content&view=article&id=40:lichen-simplex&catid=8:vulval-conditions&Itemid=8
Lichen Simplex Chronicus, Medscape Reference. Web. 27th February 2012. http://emedicine.medscape.com/article/1123423-overview#a0104
Genital Eczema in Women, The National Eczema Society. Web. 27th February 2012.
http://www.eczema.org/Factsheet_Genital_Eczema_in_Women.pdf
General good advice. Vulvar Pain Society. Web. 27th February 2012.
http://www.vulvalpainsociety.org/vps/index.php/advice-and-self-help/general-advice
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.
Reviewed February 27, 2012
by MIchele Blacksberg RN
Edited by Jody Smith