Lichen Sclerosus is an uncomfortable, itchy and sometimes painful womens health condition that impacts the skin and surrounding tissues of the vagina. Lichen sclerosus typically worsens around perimenopause and menopause as the vagina experiences adverse hormonal changes causing dry skin, and an overall decrease in hydration and elasticity.
WHAT NATURAL MEDICINE, HERBS, VITAMINS BEST HELP LICHEN SCLEROSUS?
With Functional Medicine, natural hormones, herbs, and Naturopathy we are working together to determine individuallized nutrition, macros, food triggers, environmental triggers, nutritional deficiencies, and hormone imbalance.
There is unfortunately not an easy quick fix for Lichen Sclerosus in my opinion as a women’s health doctor treating this condition for over seventeen years. My patients that are successful and reach remission or improvement with lack of progression generally go through a several month process with me. They also understand this will be a bit of a detective process.
Lichen Sclerosus is complicated and requires me to put on a lot of different specialty hats:
Dermatology + Women’s Health + Gynecology + Urology + Rheumatology
Thankfully, I have my eight years of experience in MD specialties to combine with seventeen years as a Women’s Health Naturopathic Doctor to address what I see as one of the most challenging Women’s Health and Dermatology conditions to quickly improve, somewhat like Psoriasis, that also requires a multifaceted approach.
While I can help improve Lichen Sclerosus I want my patients to have a realistic timeline for improvement. As much as I wish I could snap my fingers and instantly make it better we need to understand why the body is sending us this annoying message, what hormones are off, what the triggers are (different for all my Lichen patients), and what makes it better and worse.
DO I HAVE TO STOP MY LICHEN SCLEROSUS MEDICINE TO USE NATURAL MEDICINE?
No. I recommend that my Lichen patients continue to use their steroid cream, topical or clobetasol cream until they are improved with Natural Medicine and Herbs. While the cream is thinning the skin overtime and overall worsening the condition, the cream is generally needed at first to control symptoms. Not using the cream may result in long term irreversible scarring aka permanent damage to your vagina! When the vaginal tissues begin to change from pink to white this is a sign that permanent scarring has formed and is difficult to reverse which is why I recommend implementing my natural remedies for Lichen Sclerosus and balancing hormones along with using medication at first. To prevent long term damage.
Natural medicine takes several weeks to begin working as women then gradually work with me to taper their steroid cream down as they improve.
WHAT CAN I APPLY NATURALLY FOR LICHEN SCLEROSUS?
The majority of my patients that I have helped with Lichen over the past seventeen years working as a Women’s Health Naturopathic Doctor have reported applying Emu Oil as the most relieving topical. They use this frequently for hydration and then use the clobetasol when there is break through inflammation or Lichen flares.
Thirty years ago at the GNC health food store I worked at, women would often buy Emu oil for their Lichen Sclerosus which leads me to believe there are more undiagnosed cases out there than doctors are aware of and this may be more common than we think. I also learned from them that they would not have flares as long as they regularly used it.
Other natural remedies for Lichen Sclerosus that my patients find helpful are aloe vera gel, calendula oil or succus, gotu kola, olive oil, rosemary oil, turmeric cream for pain and inflammation, vitamin e for scarring, If using essential oils on the vagina be sure to dilute them in a carrier oil first, generally 1-5 drops per ounce of oil to start.
Diluting essential oils properly is especially important when applied vaginally. Test a small amount on your wrist or neck before applying to your vagina. I don’t need any women cursing my name. No natural treatment for Lichen Sclerosus I have successfully used on my patients should ever burn! Rosemary oil helps with pain, is anti-inflammatory and also is a powerful antifungal as most of my Lichen patients have yeast overgrowth either as an underlying trigger or directly caused by the daily dependence on steroid cream that shuts down the immune system to the place it is applied allowing yeast and other opportunistic infections to take over.
Probiotics topically and vaginally are also important to correct the likely flora imbalance going on with yeast overgrowth being a common trigger for Lichen Sclerosus. Thankfully these are now readily available over the counter unlike back in the 90’s when women had to make their own probiotic suppositories from my recipe handout.
HOW LONG DOES HOLISTIC LICHEN SCLEROSUS TREATMENT TAKE?
Most women clear up in several months. I would plan to work with me for a minimum of three months. Generally three to six months for a more progressed or complicated case. I have had some severe Dermatology patients that took 6-12 months to clear their skin with the diet, nutrition, herbal medicine and functional medicine techniques I prescribe.
IS NATURAL TREATMENT FOR LICHEN SCLEROSUS DANGEROUS?
No. Unless some weird alternative medicine Tiktok Doc is selling you something I am unaware of, however the things I use with my patients are generally safe, time tested, organic and good for them. The worst case I see is a patient that does not want to change their nutrition to reduce the inflammation to their vagina. When patients do not want to change their nutrition to what their skin requires, or cannot work with me in baby steps to eat what they are supposed to eat to clear their symptoms, then I will see the patient fail to improve. Failure to achieve normal healthy vaginal tissues from noncompliance is generally the worst case scenario using natural medicine for Lichen Sclerosus. These women are better off working with their MD and using drugs as I unfortunately cannot help them.
DOES HORMONE IMBALANCE CAUSE LICHEN SCLEROSUS?
Yes and No. If hormone imbalance was the ultimate cause of Lichen Sclerosus then all of my menopausal patients would eventually suffer from this painful Dermatology condition. However, this is one of the most complex conditions I treat as a Women’s Health doctor and it requires a multifactorial approach between all the specialties I assisted in Dermatology, Gynecology, Urology, and Rheumatology. There is currently not one theory as to what causes Lichen Sclerosus but multiple theories, as well as multiple triggers, and no true curative medication or treatment. Principles I learned from all of the different specialties help me achieve successful outcomes.
WHAT DOES LICHEN SCLEROSUS MEAN?
“Lichen Sclerosus” root word Lichen means moss and sclerosus means scarring or hardening, such as in multiple sclerosis. In similar scar tissue forming Dermatology condition, Scleroderma the root word sclero is also referring to the permanent hardening of the skin. Therefore scarring generally means permanent damage and is not a good diagnosis to receive and means we need to act quickly and aggressively. Scarred vaginal tissues begin to experience a white moss pattern that is hallmark to this condition and most OBgyn’s can just diagnose it based on visual inspection after seeing it enough times.
IS LICHEN SCLEROSUS AN AUTOIMMUNE DISEASE?
Lichen Sclerosus is not a true autoimmune disease that has a definitive blood test such as the positive RF test used to confirm a diagnosis of Rheumatoid Arthritis. However, with that being said, many doctors that specialize in Lichen Sclerosus do consider it to be an autoimmune disease and treat it as such with steroids or natural steroid like treatments such as what I implement as a Naturopathic Doctor.
Personally, I treat this highly inflammatory condition as an autoimmune disease and see that it does respond to my anti-inflammatory methods similar to autoimmune disease as well as follow a pattern of waxing and waning with flares similar to what women with other autoimmune disease's experience.
Many doctors and Dermatologists refer to Lichen Sclerosus as “Psoriasis of the Vagina." I would agree that my natural treatments for my Psoriasis patients in my Holistic Dermatology practice are very similar to my Lichen treatments but each patient’s triggers are of course individualized which makes it difficult for me to post a Lichen Sclerosis blog with a cookie cutter treatment plan for this inflammatory condition. Instead the best I can do is provide a description of the process I take women through to understand the “Root Cause" as I discuss more in my blog Natural Rheumatology: My Autoimmune Journey.
Women with preexisting Autoimmune Disease such as Hashimoto’s, Rheumatoid Arthritis, Lupus, Scleroderma, and so forth are more likely to experience Lichen Sclerosus symptoms. As we say in Rheumatology “Birds of a feather flock together” so most patients with an autoimmune condition are likely to have a second or unfortunate third. Sadly, I do have patients in my women's health practice with multiple autoimmune conditions.
Thyroid conditions, cause dry skin, and absolutely worsen Lichen Sclerosus, especially Hashimoto’s Thyroiditis, and thus are highly correlated with Lichen Sclerosis.
WHAT TRIGGERS A LICHEN SCLEROSUS FLARE?
#1 on my list of most common Lichen Triggers is hormone imbalance, as it absolutely will worsen Lichen Sclerosus and certainly does not improve a pre-existing battle with Lichen. When women experience Lichen Sclerosus symptoms prior to perimenopause or menopause that generally indicates other factors causing the dermatology issue than just hormones. Inflammation, food triggers, stress, anxiety, insomnia, lack of exercise and underlying chronic infections can also be to blame. Although I have seen women in their twenties with Lichen experiencing early menopause or “Premature Ovarian Insufficiency.” Therefore it is important to get hormones checked and not assume they are fine just because a woman is twenty or thirty with this condition.
After twenty five years working in women’s health I can confirm without a doubt that becoming menopausal and losing female hormones absolutely makes most chronic vaginal conditions I treat MUCH worse such as chronic herpes, chronic yeast infections, bladder urgency, bladder burning, frequent urination, and pelvic pain.
Most women with Lichen Sclerosus I see are already super frustrated, often in tears, embarrassed, and sadly ashamed from their painful cracking and bleeding vaginas. Many women with Lichen Sclerosus also feel hopeless because they have already been to multiple doctors, OBgyn’s, Urologists, and Women’s Health Doctors before they head to me and think to use Naturopathic Medicine. So I would not write this blog sending frustrated Lichen patients on a "Fool's Errand" recommending a holistic approach, unless I saw that it was actually helpful. Most of my Lichen patients tell me they wish I was the first doctor they saw for their Lichen and not the last! So there you have it ladies…addressing the “Root cause” is the best #1 Naturopathic way!
Please do first always visit your MD OBgyn or Dermatologist to first establish a diagnosis for Lichen Sclerosus and do not self diagnosis this. Specialty offices will have testing needed to rule out other similar conditions. I also always prefer to know what we are working with and some doctors may need to perform additional testing in cases that do not appear in a classic Lichen pattern.
So I post this random blog, to provide hope for women in frustration with these symptoms to consider natural medicine, especially for this condition that can also painfully cause marital problems due to the inability to have intercourse.
Painful intercourse, tearing, scarring and a sudden appearance of white spots indicates Lichen Sclerosus which should be diagnosed and confirmed first by your MD OBgyn or Dermatologist prior to seeking my help. I have had a few patients self diagnose their Lichen Sclerosus and fail to improve on my expected Holistic Dermatology timeline because we were not treating actual Lichen Sclerosus but severe yeast overgrowth, or another vaginal infection. The diagnosis should have already been ruled out via testing at a Dermatology office. They have special equipment that can look and determine if it is a yeast overgrowth or may need to study a tissue sample under a microscope to watch for typical inflammatory patterns associated with Lichen Sclerosus such as scarring and hyperkeratosis.
WHAT LICHEN SCLEROSUS PATIENTS RESPOND BEST TO NATUROPATHY?
Motivated women always do the best in my Naturopathic Women’s Health practice. The women I can help the best with their Lichen Sclerosus are highly motivated to make nutrition changes and work together to find the root cause because they are sick of using their clobetasol cream. They have noticed it is getting worse over the years, they are often scared, and in severe states of itching, burning, discomfort and pain.
They have noticed it is thinning their skin and vaginal tissues and understand it is because chronic use of cortisone creates a cortisol stress reaction that shuts down our normal body functions like healing and repairing in order to stop inflammation. As in my blogs “Adrenals: Running From the Bear” and "Adrenal Stress: Are You in Fight, Flight, or Fright?"
Women with Lichen Sclerosus that are compliant and highly motivated are my most successful patients. This level of motivation helps me get through the detective process of analyzing if it is nutrition, hormones, environmental, autoimmune, etc. Then we implement an individualized nutrition and supplement plan after performing the needed testing. Women that understand this is a detective process and are not busy googling a bunch of natural remedies to apply to their vagina and muddying the waters while I am trying to do my work.
WHAT WOMEN DO NOT DO ACHIEVE SUCCESS WITH NATURAL TREATMENTS OR LICHEN SCERLOSUS?
While most of my patients are able to reach remission or slow progression, I occasionally have a certain patient type that will never improve their Lichen Sclerosus. This type of patient generally fails out of my practice no matter what women’s heath condition they have because they are so busy googling things and trying random treatments they found on their Facebook Chat Group that I am unable to study what nutritional and hormone changes I am implementing at the “Root Cause” are helping.
Oftentimes random internet treatments can also flare Lichen and cause me to throw away my perfectly effective natural treatment plans. Therefore if you are a patient that needs to be your own doctor at all times, cannot stop googling, and cannot follow my directions I do not expect a successful outcome.
WHY ARE STEROIDS BAD FOR LICHEN SCLEROSUS?
Steroids are fine to treat occasional flares from time to time. Otherwise I would not prescribe clobetasol to my own patients with Lichen at all if I thought it was a terrible cure. It is just a terrible long term cure. The real reason steroids fail Lichen patients is that we are putting the vaginal tissues in constant “stress emergency” mode and never “heal, hydrate, and repair” mode.
As I discuss further in my blog “Adrenals: Fight, Flight, or Fright?” both synthetic and natural cortisol tell our bodies to go into emergency mode to reduce inflammation. The hormone cortisol sounds the emergency alarm like a FOUR ALARM FIRE AT THE FIRE STATION….
The body goes into emergency fire fighting mode....and wisely shuts down all extra functions except what it needs to do to put out the fire, or run from a bear while in crisis emergency mode. While our body thinks we are running from this bear it is not resting/digesting/repairing/caring about anything else because it wisely believes we are in emergency mode and all of our blood is then shunted to our lungs, heart and muscles so we can run as fast as possible.
Women that have stomach problems, chronic stress, anxiety, and autoimmune disease are the best fit for a holistic Naturopathic approach. As these other symptoms are likely inner related to the Dermatology condition, although no MD Dermatologist will ever agree with me on that. Lets talk a bit more about why long term steroid cream is not good for the vagina in Lichen Sclerosus and triggers yeast infections which cause itching which worsens cracking and bleeding.
Synthetic cortisone and natural cortisol in high amounts stop digestion, skin repair, skin regrowth, modulation of the rate of skin growth, hair growth, mental health neurotransmitter production, production of white blood cells for immunity, and female hormone production needed for menopausal and perimenopausal vaginal hydration.
Female hormones are important in Lichen Sclerosus, let me explain why as the #1 reason my Lichen patients fail is refusing to use natural hormones from yams because they are scared of hormones based on research conducted over twenty years ago on synthetic hormones.
Estrogen is mandatory for Lichen Sclerosus as it stimulates vaginal mucus production, while progesterone keeps the vagina plump and properly oxygenated. Testosterone is also mandatory to help hydrate both the inside and outside of the vaginal tissues. Men have high testosterone and generally have skin so oily they can wash it with a bar of Dial soap and not use moisturizer so we have to use at least a teensy bit of testosterone until dry skin and tissues improve from white to pink.
The only time I do not use natural hormones for my Lichen Sclerosus patients is when they have a history of breast cancer. But even then, some oncologists will allow me to lightly prescribe certain hormones after a certain number of years have passed and there is less concern and danger to the breast. Although my hormone receptor positive patients with breast cancer will not likely ever be candidates unless they have had a total hysterectomy and masectomy.
Applying local hormones to the vagina for my patients with a personal or strong family history of breast cancer in lower doses is generally just as effective for this annoying Dermatology condition, and for some severe cases that do not have a history of cancer, I do prescribe topical and systemic natural hormones in order to clear up symptoms the fastest.
Without all three hormones consistently, my Lichen Sclerosus patients tell me things have suddenly worsened. Many have tried to go out of their hormone cream “out of curiosity” only to flare severely back up and have to start over from where we first began.
Therefore, I do not find it realistic to successfully treat this severe of a women’s health condition without the use of female hormones, as I feel like it is cruel for me as a Naturopathic Doctor to let women with this condition suffer in silence thinking herbs alone will be enough.
DOES VAGINAL pH AFFECT LICHEN SCLEROSUS?
Yes pH that is too alkaline can harbor yeast and make itching and scratching worse that then worsens cracking and bleeding. To get your vaginal pH tested you can buy teststrips on Amazon. The easy fix if your pH is abnormal is then to work with a seasoned women’s health doctor that is experienced in balancing hormones, vaginal pH, and nutrition for this condition.
Otherwise I see this condition quickly progress when women do not immediately hit it with “The Works, “ address it with my multifactorial approach while working to get to the “Root Cause.”
Fortunately there are no women more motivated to follow my nutrition and hormone tips than my Lichen Sclerosus patients!
The burning, pain, scarring, physical discomfort, sexual dysfunction, marital issues, and fear that things will look worse keeps them highly motivated to do everything possible.
WHEN SHOULD I SEE A DOCTOR FOR MY LICHEN SCLEROSUS?
ASAP. The earlier the better. The sooner I can understand what the underlying causes are triggering my patients with Lichen Sclerosus the faster I can prevent and/or reverse progression. Once vaginal tissues have become cracked, scarred and are bleeding this becomes much more difficult to achieve. The best I can do at this point is stop the bleeding and stop the progression but once a significant amount of scar tissue has built up from Lichen Sclerosus it is generally irreversible.
So… the minute your OBgyn or Dermatologist has told you that you have Lichen Sclerosus that is when I recommend booking a visit with me to understand why so that you are not constantly relying on steroid cream that ultimately makes the skin thinner, triggers itchy yeast infections, and ironically is simply worsening this women’s health condition in vicious cycle of demise in the grand scheme of things.
Need my help with your Lichen Sclerosus? I would be happy to help! Simply visit my SCHEDULE page to treat yourself to a Naturopathic visit!
CAN YOU HELP ME VIA TELEMEDICINE IF I DO NOT LIVE IN ARIZONA?
Women out of state often ask me since this is one of my specialties if I can help them out of state. The options are to fly into Arizona and come see me at my Scottsdale Clinic. Or set up the phone consultation and be prepared to provide me with an OBgyn or Family Doctor that already has been made aware I am most likely going to need to prescribe some hormones for you with their assistance after looking at your labs. Many doctors are happy to do this because they have little to offer but the clobetasol cream. Please do not be embarrassed to ask your doctor for help. We have seen this condition before and just want you to feel comfortable in your skin again. Think of women's health doctors as auto mechanics for your vagina. We just want to fix your issues, provide relief, and make things work properly again! We want you to feel comfortable in your skin and not be itchy or in pain! So stop googling for natural remedies for Lichen Sclerosus and instead, lets get to work on it via my Holistic Women's Health Dermatology process!
Simply visit my schedule page to set up your Naturopathic session with me and let's get working on your Lichen Sclerosus ASAP.
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum Depression, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions.
In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones.
Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
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