Lichen Sclerosis Diet and Natural Remedies for Lichen Sclerosis

Written by Ryah Nabielski, MS, RDN

Lichen sclerosis, interchangeable with lichen sclerosus, is an autoimmune skin disease affecting women, especially during times of hormone change. While diagnosis is common in menopause, many younger women also experience this condition.

The standard treatment for lichen sclerosis is steroid cream for life! But when searching for how to treat lichen sclerosus naturally with integrative approaches, there isn’t much information available about diet and lifestyle support.

My goal with this article is to connect with women who’ve received this diagnosis or are experiencing a flare, offering information, strategies, and support. I’ve seen women halt the progression of lichen sclerosis and go through long periods where they aren’t dependent upon the conventional treatment.

I’ve become a bit of a lichen sclerosis specialist through the lens of nutrition as nutrition work deeply supports root cause factors that contribute to inflammation and disease progression.

The suffering of those with lichen sclerosis is invisible to the outside world. It affects the quality of life and is often hard and uncomfortable to talk about, even with medical professionals.

If this topic pertains to you, please keep reading to learn more about:

·      What is lichen sclerosis

·      Lichen sclerosis causes and autoimmunity

·      The connection with female hormones

·      Lifestyle support and natural remedies for lichen sclerosis

·      The importance of a real food, personalized nutrition strategy

Let’s jump in!

What is Lichen Sclerosis?

Lichen sclerosis is a chronic, inflammatory skin disease that mainly affects the skin of the genitals. It primarily affects women, but lichen sclerosis in men and children also occurs. [1]

This article will focus on lichen sclerosis as it pertains to women’s health, as that is the community I serve in my practice.

It’s an autoimmune disease, meaning there is a dysregulation of the immune system where immune cells attack self-tissue and drive inflammation. In this case, the self-attack is on the delicate tissue of the vulva (female external genitals).

Symptoms of lichen sclerosis include:

·      Itching

·      Burning

·      Vulvar depigmentation – the skin can appear white or blueish

·      Thinning of the skin

·      Vulvar fissures or tearing

·      Pain with sex [1]

Over time, lichen sclerosis can cause changes, including the fusion of tissue and scarring. In extreme cases, vaginal scarring can disrupt the vaginal and urethral openings (vulvar dystrophy). It also increases risk of vulvar cancer.

Six to 20% of people with lichen sclerosis have the disease in other areas of the body. [1] Case reports include lichen sclerosus on the eyelids and breasts. [2, 3]

Lichen sclerosis is diagnosed with a biopsy. [1]

Is Lichen Sclerosis an Autoimmune Disease? Lichen Sclerosis Causes

Conventional medicine suggests that the cause of lichen sclerosis isn’t known. Still, we do know that it has a genetic component and is associated with changes in the immune system and autoimmunity. [1]

Those with one autoimmune disease are more likely to have a second. Lichen sclerosus is associated with:

·      Thyroid disease (Hashimoto’s thyroiditis, Graves’ disease)

·      Vitiligo

·      Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)

·      Alopecia areata

·      Rheumatoid arthritis

·      Pernicious anemia

·      Psoriasis [1]

Through the lens of functional medicine, which looks at the connections between body systems, autoimmune disease corresponds with changes in the gut microbiome. After all, much of the immune system resides in the gut, and the microbiome helps to shape and inform our immunity. [4]

In addition to a genetic predisposition for autoimmune disease, we often see dysbiosis, an imbalance in the gut microbiome. Clinically, this may look like low levels of beneficial bacteria, overgrowth of bacteria or yeast, the presence of pathogens (bacteria, yeast, parasites, viruses), or another pattern.

In addition, autoimmunity is associated with intestinal permeability, commonly called leaky gut. [5]

What is leaky gut? The cells that line the GI tract are the essential barrier in regulating what enters the body. When food is digested, its smallest components enter through the epithelial cells in the small intestine.

When this barrier is compromised in leaky gut, larger proteins or pathogens enter between epithelial cells into the bloodstream, where the immune system detects them and attacks. When the immune system is confused, it can attack your tissue instead (called molecular mimicry).

So, we have a genetic predisposition, a leaky gut situation, and an environmental trigger (or several) for the perfect storm of autoimmune disease. The environment plays a more significant role than genetics. [6]

Triggers for lichen sclerosis and other autoimmune diseases may include:

·      Food sensitivities – gluten and dairy are common, but individual sensitivities vary [6]

·      Exposure to environmental toxins – heavy metals, endocrine disruptors, plastics, pesticides, etc. [6]

·      Infections – gut infections, viral infections (like Epstein Barr virus) [7]

·      Stress and trauma – Stress often proceeds the onset of autoimmunity or flares [8]

Estrogen and Lichen Sclerosis

Women are more likely than men to have an autoimmune disease, and 85% of people with multiple autoimmune disorders (polyautoimmunity) are female. Hormonal changes, including changes in estrogen, help to explain the disparity. [9]

The most common onset of lichen sclerosis is post-menopause when estrogen levels are much lower than during the reproductive years. For younger women, diagnosis may occur during the postpartum period, when estrogen levels are also low. In addition, some women report changes in lichen sclerosis symptoms as hormones fluctuate throughout the menstrual cycle.

For younger women, there may be some fear around pregnancy and giving birth with lichen sclerosus. However, estrogen levels are high during pregnancy, and the immune system is naturally suppressed, so symptoms may be better during pregnancy.

Estrogen levels impact immune function and play an important role in skin health. A decline in estrogen is associated with signs of aging, such as fine lines, wrinkles, and dryness. As estrogen declines in perimenopause and menopause, it may cause vaginal dryness and associated symptoms like frequent urination, UTIs, and thinning skin. [10, 11]

Some research suggests an association between low testosterone and lichen sclerosis. Testosterone and other androgens help to keep the skin thick and support healthy muscle tone. [1]

Lifestyle and Integrative Approaches for Lichen Sclerosis

It’s important to have a Lichen sclerosus gynecologist or dermatologist on your healthcare team to help with treatment and monitoring.

The standard treatment for lichen sclerosis is clobetasol propionate, a steroid cream. [12] In studies, when steroid cream was initiated early and used consistently, it reduced scarring by 36% and cancer risk by almost 5%. [1]

While steroid treatment may be the only tool your provider discusses with you, many natural and integrative options can address contributing environmental factors, reduce inflammation, and prevent flares. These include:

·      Balance the microbiome. We can use functional stool testing to look at microbiome balance, gut function, and permeability. My favorite test is the GI MAP.

With test results and a thorough intake process, we can address each person’s unique microbiome with diet change (more on diet below), targeted supplements, probiotics, and lifestyle habits.

·      Remove autoimmune triggers. If we can identify possible triggers such as stress, toxin exposures, food sensitivities, or others, we can work to reduce or remove them to help calm down the immune system. Again, this is highly personal and working with a practitioner is helpful in identifying the most important changes to make.

·      Choose common sense hygiene. Wear loose fitting clothing, cotton underwear, and generally prioritize comfort. Wash the affected area with water and avoid abrasive, scented, and irritating products. Of note, many skincare products contain chemical ingredients that can disrupt hormones and the microbiome.

·      Find comfort in movement. When it comes to lichen sclerosis and exercise, you may have to adjust (like not riding a bike when in a flare), but generally, exercise is supportive for autoimmune disease, helps manage stress, and has many other benefits. Find movement that brings you joy!

·      Try topical creams for lichen sclerosus. While clobetasol is the standard of care, you may find other options to be soothing and supportive too. Some options to consider include:

• Emu oil or emu oil-based creams

• Natural vaginal moisturizers/lubricants (without fragrance or preservatives)

• Coconut oil (This may be the best lubricant for lichen sclerosus, but if you use condoms, be sure to choose a water-based option instead)

• Estrogen cream – this requires a prescription; please work with your doctor

• DHEA – DHEA is available over the counter but is a hormone, so please work with your doctor for safety and guidance

·      Consider PRP. PRP, or platelet-rich plasma, is a medical procedure where the patient’s plasma is taken from their blood and then injected into a specific area to help regenerate tissue. It can be injected into the active areas of lichen sclerosis to help reduce inflammation and break up scar tissue. Preliminary research shows promise, and PRP is becoming more widely available to patients. Of course, please discuss with your doctor. [13]

Lichen Sclerosus Diet and Supplements for Lichen Sclerosus

Nutrition is a powerful healing tool. Making specific changes in the diet can help to:

·      Reduce inflammation

·      Support the immune system

·      Improve skin health

·      Balance the microbiome

·      Modulate estrogen levels

·      Nourish the brain and adrenals (involved in the stress response)

·      And more!

Adopting an anti-inflammatory diet helps to reduce inflammation throughout the body and helps address many of the factors that contribute to lichen sclerosis.

The first step is to shift to a diet composed mainly of whole, unprocessed food. This change alone can have a significant impact on inflammation, help to improve nutrient status, and reduce exposure to environmental toxins.

The best diet for lichen sclerosus is a personalized diet. Within a real food diet, there is a lot of room for personalization to address each woman’s root causes while fitting with her lifestyle and preferences.

While there isn’t a specific list of foods to avoid with lichen sclerosus, limiting or eliminating processed food greatly helps. You’ll be avoiding processed oils, excess added sugar, chemical preservatives, and more. In addition, identifying and removing food sensitivities further helps reduce inflammation.

Working with a functional nutritionist is incredibly supportive for dialing in the diet that works for you. However, be aware that a lot of autoimmune nutrition information you’ll come across advocates for very restrictive protocols. And while some may be warranted (as in the case of discovering food sensitives), too much restriction over time can impede healing, cause stress, and negatively impact one’s relationship with food or mental health.

Your nutritionist can also help you determine the supplements for lichen scleroisis that may support you the most. And help to answer questions like: does vitamin D help with lichen sclerosus? Or what’s up with vitamin B12 and lichen sclerosus?

As you can see, there are many ways to support the body in healing. What’s most important is finding what diet and lifestyle change works for you. If you’re curious to learn more about how I can help you on your journey with lichen sclerosis, please reach out!

The contents of post and website are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.

References

1.     Kirtschig G. (2016). Lichen Sclerosus-Presentation, Diagnosis and Management. Deutsches Arzteblatt international, 113(19), 337–343.

2.     García-Arpa, M., Franco-Muñoz, M., Ramos-Rodríguez, C., & Sánchez-Caminero, M. P. (2021). Lichen Sclerosus on the Eyelids. Liquen escleroso en los párpados. Actas dermo-sifiliograficas, 112(2), 179.

3.     Ryan, M. P., Monjazeb, S., Ross, L. S., & Kroger, K. T. (2019). Bullous hemorrhagic lichen sclerosus of the breast: a report of two cases and review of the literature. Dermatology online journal, 25(12), 13030/qt2w48m85h.

4.     Xu, H., Liu, M., Cao, J., Li, X., Fan, D., Xia, Y., Lu, X., Li, J., Ju, D., & Zhao, H. (2019). The Dynamic Interplay between the Gut Microbiota and Autoimmune Diseases. Journal of immunology research, 2019, 7546047.

5.     Kinashi, Y., & Hase, K. (2021). Partners in Leaky Gut Syndrome: Intestinal Dysbiosis and Autoimmunity. Frontiers in immunology, 12, 673708.

6.     Vojdani, A., & Vojdani, E. (2021). The Role of Exposomes in the Pathophysiology of Autoimmune Diseases I: Toxic Chemicals and Food. Pathophysiology : the official journal of the International Society for Pathophysiology, 28(4), 513–543.

7.     Vojdani, A., Vojdani, E., Rosenberg, A. Z., & Shoenfeld, Y. (2022). The Role of Exposomes in the Pathophysiology of Autoimmune Diseases II: Pathogens. Pathophysiology : the official journal of the International Society for Pathophysiology, 29(2), 243–280.

8.     Ilchmann-Diounou, H., & Menard, S. (2020). Psychological Stress, Intestinal Barrier Dysfunctions, and Autoimmune Disorders: An Overview. Frontiers in immunology, 11, 1823.

9.     Desai, M. K., & Brinton, R. D. (2019). Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Frontiers in endocrinology, 10, 265.

10.  Stevenson, S., & Thornton, J. (2007). Effect of estrogens on skin aging and the potential role of SERMs. Clinical interventions in aging, 2(3), 283–297.

11.  Nappi, R. E., Martini, E., Cucinella, L., Martella, S., Tiranini, L., Inzoli, A., Brambilla, E., Bosoni, D., Cassani, C., & Gardella, B. (2019). Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Frontiers in endocrinology, 10, 561.

12.  Pérez-López, F. R., & Vieira-Baptista, P. (2017). Lichen sclerosus in women: a review. Climacteric : the journal of the International Menopause Society, 20(4), 339–347.

13.  White, C., Brahs, A., Dorton, D., & Witfill, K. (2021). Platelet-Rich Plasma: A Comprehensive Review of Emerging Applications in Medical and Aesthetic Dermatology. The Journal of clinical and aesthetic dermatology, 14(11), 44–57.