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Lichen simplex chronicus (LSC)

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What is LSC?

Lichen (LY-kin) simplex chronicus (kro-ni-kus) is a skin condition caused by long term irritation of the vulva.

It may cause itching, burning, and/or thickened skin. You may have this for weeks or months. Many doctors call it an "itch-scratch cycle." This happens when the vulvar skin becomes sensitive and irritated.

What are the signs LSC?

Moisture, scratching, scrubbing, and the use of medicines may cause the skin to look different in each person.

Signs may be:

  • Mild to severe vulvar itching and/or burning
  • Pink to dusky red or purple looking skin
  • Swelling and/or thickened skin
  • Leathery texture to the skin
  • Tears in the skin caused by scratching
  • Raw and/or damp feeling
    • Women tend to think vaginal discharge is the cause of the dampness. The dampness may come from the outer vulvar skin though. Long term irritation to the outer vulvar skin can cause it to weep. This leads to a sticky white discharge in the inner labial folds called "smegma."

How is LSC diagnosed?

  • Your health care provider will look for common skin changes of the vulva.
  • Your discharge will be checked to rule out infection.
  • A biopsy or small skin sample might be needed to test.

What causes LSC?

It may be caused by many factors, such as contact irritants. When you have an irritation long enough that an "itch-scratch cycle" starts, lichen simplex may happen.

  1. Something rubs or irritates the skin.
  2. You start to scratch the itchy skin.
  3. Scratching, often during sleep, causes the skin to thicken.
  4. This causes more itching.

What are contact irritants?

They are products that irritate the skin. This is not always an allergic reaction.

The difference between an "allergen" and an "irritant" is:

Allergens are materials that cause 1 or more of the following:

  • Trouble breathing
  • A general skin reaction, such as a rash, hives, and blisters
  • Itching after contact of only 1 or 2 times

Irritants are materials that cause:

Burning or itching at the site where it is in contact with the skin

These items irritate vulvar skin:

  • Laundry detergents with enzymes, whiteners, brighteners, or fragrances
  • Fabric softeners and dryer sheets
  • Bath soaps, gels, and lotions
  • Bubble bath, oils, bath salts, or skin softeners
  • Feminine hygiene sprays, perfumes, or powders
  • Adult and baby wipes or towelettes
  • Deodorant tampons and pads
  • Douches or washes
  • Contraceptive creams, jellies, foams, and sponges
  • Condoms, prepackaged with lubricant or spermicide
  • Toilet paper that is colored, perfumed, or has Aloe
  • Synthetics, such as nylon underwear or panty hose

What is the treatment for LSC?

The goals are to lessen itching and break the "itch-scratch cycle."

  • Follow the Vulvar Skin Care Guidelines.
    • Keep the vulvar site clean and dry.
    • Even if the irritant is removed, if the "itch-scratch cycle" has started you may have LSC if you do not get treatment.
  • Use topical steroids.
    • Ointments are often better than creams.
    • Use a thin layer where you have discomfort.
    • This will help:
      • Redness
      • Swelling
      • Itching
      • Burning
    • Use only as ordered by your provider. Overuse may make it worse.
  • Do baking soda soaks.
  • Gold Bond® or Zeasorb® powder may be used on the vulva and groin if chronic dampness/moisture is a problem.
  • Medicines may be taken by mouth to help itching.
  • Think about losing weight if you are overweight.

Your symptoms should slowly get better with treatment. If they do not get better, a follow-up visit and other treatment may be needed.