Lichen sclerosus cannot be cured, but it can be controlled. Early, consistent treatment prevents scarring and reduces the risk of long-term complications.

• Topical corticosteroids are the first-line treatment. A potent corticosteroid ointment such as clobetasol propionate, applied according to a specialist-guided protocol, reduces inflammation, relieves itching, and slows scarring. Most patients see improvement within 3 months of starting treatment.
• Topical calcineurin inhibitors such as tacrolimus or pimecrolimus are used in patients who do not respond to corticosteroids or who need a steroid-sparing option for long-term maintenance.
• Topical oestrogen improves tissue quality and elasticity in post-menopausal women and is used alongside corticosteroid treatment rather than as a replacement for it.
• Emollients and barrier creams protect and soothe the affected skin. Regular use of fragrance-free emollient reduces friction and prevents further irritation. This becomes part of the daily routine rather than a temporary measure.
• Platelet-Rich Plasma (PRP) therapy is an option for patients whose condition does not respond adequately to topical treatments. Growth factors from the patient's own blood are injected into the affected tissue to stimulate healing and improve skin quality.
• Surgery is performed where scarring has already caused structural changes such as a narrowed vaginal opening, fused labia, or an adherent clitoral hood. Surgery addresses the structural problem but not the underlying condition. Medical treatment continues after surgery.
• Annual surveillance is recommended for all patients regardless of how well controlled the condition appears. Each review involves assessment of disease activity, treatment response, and examination of the skin for any early changes that may need biopsy.

Lichen sclerosus is diagnosed through clinical examination and, where the picture is unclear, a skin biopsy.

Clinical examination: A gynaecologist examines the affected skin for characteristic white, fragile patches, scarring, and any structural changes sufficient for diagnosis in most cases.

Vulvoscopy: Uses a colposcope to examine the skin in more detail, particularly when the appearance is atypical.

Skin biopsy: A small tissue sample taken under local anaesthetic, used to confirm the diagnosis and rule out vulvar intraepithelial neoplasia (VIN) or vulvar cancer where there is any doubt.

Thyroid function tests and thyroid antibody screening: Recommended at diagnosis, given the association between lichen sclerosus and autoimmune thyroid disease.

Before treatment begins, stop using all fragranced soaps, body washes, bubble baths, and synthetic sanitary products, as these should not be reintroduced after treatment starts either. Avoid scratching the affected area in the days before consultation, as this alters the clinical appearance. If a biopsy is planned, avoid sexual intercourse and topical applications to the area for 48 hours beforehand. Bring a record of any topical preparations you have already applied to the area, including the product name, strength, and how long you used it.

Provide a full medical history at the consultation, including any autoimmune conditions, skin conditions, allergies, and current medications.

Lichen sclerosus requires ongoing management. Apply the prescribed corticosteroid or topical medication exactly as directed and do not reduce or stop without consulting your specialist, even when symptoms have improved. Symptoms that disappear do not mean the condition has resolved; it means treatment is working.

Wash the genital area with plain warm water only and pat dry gently. Apply fragrance-free emollient at least once daily. Wear loose cotton underwear and avoid tight trousers, synthetic fabrics, and sanitary pads with plastic backing.

Attend follow-up appointments every 6 to 12 months. At each visit the specialist checks treatment response, monitors for scarring, and examines the skin for any changes that need biopsy. If you notice a new lump, ulcer, or an area that bleeds without reason between appointments, seek review promptly rather than waiting for the next scheduled visit.

Symptoms typically improve within 3 to 6 months of starting treatment. The goal is control, not cure. Lichen sclerosus is managed over the long term rather than resolved with a single course of treatment.

For ongoing comfort, continue the daily emollient routine, avoid all irritants, and use vaginal moisturisers or lubricants if intercourse remains uncomfortable despite treatment. Over-the-counter antihistamines help with nighttime itching. Cool compresses provide short-term relief from burning.

If intercourse remains painful despite medical treatment, discuss surgical correction of structural changes with your specialist. Many women find that pain and discomfort reduce substantially once treatment is established, though this takes several months.

Lichen sclerosus affects confidence and intimacy for many women. Counselling or patient support groups help with the psychological side of managing a chronic condition. Annual surveillance appointments should not be missed even when the condition feels well controlled.