vulvar lichen sclerosus

Does anyone have experience/success treating this? I know “treat the pattern” but I have done a thorough intake she doesn’t really present with much constitutional imbalance (and is not overly forthcoming about dialoguing with me….she’s a nurse and everything is normal and fine). I have no experience with this to give her any assurance that TCM treatment will help - it is considered a chronic, autoimmune disorder.

Here is the western description of the symptoms….
•Itching is the most common symptom and some people experience soreness and burning.
•The skin becomes pale and white in appearance and look like a whilte 'film'. This may be patchy or involve all of the vulva extending down to the anus. The skin may split causing stinging and pain.
•Small purplish/red areas may be seen on the white background. These are due to tiny areas of bleeding into the skin, often because of scratching.
•There may be scarring that causes loss of vulvar tissue (eg. clitoris) or shrinkage of the vulvar areas, which can cause pain and interfere with sexual intercourse and even cause problems with urination.
•It does not involve the vagina.

From a TCM perspective, it seems like a damp heat presentation. The white film seems like a damp thing but there is no discharge typical with the syndrome (and she doesn’t have any) so then I’m left questioning damp….

Thanks for your thoughts,
Steph

I haven't ever treated this myself, but I am familiar with the Chinese discussions of this condition. The white skin is a local lack of blood. You have to determine whether this local lack of blood is part of a systemic blood vacuity or whether there is some evil qi blocking the blood from getting to this area. This second option is the more common one according to the Chinese literature. The types of evil qi which may be preventing the blood form nourishing the local area include, wind, cold, damp heat, qi stagnation, and/or blood stasis. In this case, there is, at the very least, wind due to blood not mothering the qi. Hiowever, there may also be externally contracted wind evils as well. Also, from your description, I would say there is blood stasis, either as part of the original pathomechanisms or as a result of the scratching causing bleeding causing stasis.

Hope some of these ideas help in parsing out your patient's presenting patterns. Also, besides any systemic internal treatment, you will also need some local treatment as well. For these, look under local treatments for scleroderma. "Different diseases, same treatment."

Good luck.

dabtcm

This is a situation and condition I have seen and treated in clinic numerous times, and generally present in women who are peri-menopausal or even post-menopausal, although it can also randomly occur in younger women as well.
Lichen Scleosis is a localized thinning of the tissues in the external genitalia that may even extend to the perineum. Western medicine usually offers one or two managements for this condition, the topical administration of topical cortico-steroid based creams or the topical administation of hormone-based gels/topicals as well. Neither of which is a favourable choice as cortico-steroid based creams may well further thin an already thinned (sclerotic) area, and hormone-based topicals may well initiate unfavorable cellular change in the area leading to a potentially more serious condition than what the patient already has.
From a TCM view point this condition is characterized as a form of 'senile vaginitis'. It is usually related to s Deficiency of Liver-Kidney Yin and Blood unable to adequately nourish the area Leading to atrophy and sclerosis. Loss of adequate Yin and Blood is witnessed both by the pale thinning tissue as well as localized Blood Stasis as seen by the areas of purple and subcutaneous hemorrhaging (petechiae). Deficiency of Yin and Blood causes Dryness and may well lead to Wind formation locally as witnessed by the itch. With this in mind it is important to use this as a basis for local treatment (washes) or internal treatment that address Yin/ Deficiency of Blood and enrich fluids as well as dispel local Wind related to Deficincy.
With this in mind it is important to enrich Yin and Fluids as well as invigorate flow to dispel the localized Blood Stasis which can interfere with normal nourishment of the tissue(s) locally. In employing either topical washes or internal treatment it is important to use 'clean' and not 'cloying' Yin/Blood enriching medicinals, as this can/may lead to the formation if Damp-Heat, which would be a more uncomfotable and difficult condition for the patient to manage as well as for you as a practitioner to treat.
Lichen sclerosis is one of atrophy and the concept of supplementation as mentioned is important as well as treating any other accompanying pattern(s) that the patient is presenting with in clinic. Also. consider that you must elicit her cooperation to be more forthcoming with information in order to gather as much information to treat her completely. This condition, although similar in some regards to scleroderma (an auto-immune condition) is not related. If you wish, I would be more than willing to post both topical as well as internal treatment(s) if you are able to provide more information as well as any other accompanying signs and symptoms as well as other pattern(s) as well if you are able to elicit this from the patient.....it helps us help you to help her !
Wishing the best of success in your care and management of this patient.

I was reading this subject with interest as I have a client with a very longstanding condition, similar symptoms to Stephanie's patient.

She's 84 now, but has experienced periodic but ongoing itching since her 50s! She's quite healthy for her age in other respects, except for this one nagging condition...which tends to come on at night. It's gotten so bad that she just has to look at the bed and starts to feel the itch!

I feel that for her now, esp at this age, blood stasis is implicated, as well as yin and fluid deficiency. There is a damp/heat component as well, because she often feels hot and sweaty "down there", and of course wind as it comes and goes, seemingly without a connection.

Stephanie, I'd love to hear what happened with your patient and any results, protocols? And the last poster offered to post suggested internal treatment...and a wash...the latter most appreciated, as I've finally convinced my patient to obtain a sitz bath with which to use a TCM external wash.

Thanks!