Healing Lichen Sclerosus From the Inside Out: A Functional Medicine Approach

Lichen sclerosus, like most inflammatory skin conditions, is often misunderstood. Standard treatment focuses on trying to reduce inflammation on the surface, but ignores the root causes of inflammation and immune dysregulation within the body. 

To really heal from lichen sclerosus, we need to address these causes and focus on calming the system from the inside out. This is what I do with my functional medicine telehealth patients to restore balance and wellbeing, without the side effects of treatments like steroid creams.  

Here’s my guide to healing lichen sclerosus using a holistic, functional medicine approach. 

Lichen Sclerosus: The Basics

Lichen sclerosus is a chronic, inflammatory skin condition that affects the genital and anal regions. It often flies under the radar or is misdiagnosed. 

Though it can affect both men and women of any age, lichen sclerosus is about 10 times more common in women than in men, and occurs most often in prepubescent or postmenopausal women (suggesting a hormonal influence). 

Lichen sclerosus causes thin, patchy, discoloured skin that may be very itchy, feel like it’s burning, have white patches, and/or tear easily. In women it typically affects the vulva and/or the anal area, and in men it usually shows up on the head of the penis. It can also affect different parts of the body.

Like all chronic inflammatory conditions it exists on a spectrum: some people may experience just a bit of itching or soreness and mild discoloration, while others may have painful lesions, very intense itchiness, and even scarring. Lichen sclerosus may also lead to sexual discomfort and/or painful urination. 

The Problem With Conventional Lichen Sclerosus Treatment

Conventional medicine approaches lichen sclerosus by working to suppress the symptoms. Standard treatment involves potent topical steroids to reduce inflammation and itching on the surface. 

This often (though not always) at least delivers short-term relief, but the problem is that steroid ointments aren’t addressing what’s causing the inflammation in the first place. And over time, they can further thin the already delicate skin, as well as cause side effects, and become less effective especially when used chronically. (1, 2)

Here’s what’s really missing in conventional care: asking questions. Why is inflammation occurring? What is the immune system really reacting to? What’s going on with hormonal balance and gut health? 

We need to go deeper, beyond symptom management, to identify and treat the root causes that perpetuate inflammation and immune dysregulation in lichen sclerosus. That’s how we get to true healing. 

Root Causes of Lichen Sclerosus 

Like most chronic inflammatory conditions, lichen sclerosus is multifactorial. There are often several interconnected imbalances that may be contributing to the condition. I’m including these here because they’re directly related to how we’ll go about treating lichen sclerosus. 

Immune Dysregulation and Autoimmunity

A high percentage of people with lichen sclerosus have other autoimmune conditions. This seems to be especially true for women (the correlation isn’t as strong for men); however, most studies looking into this are specifically looking at diagnosed autoimmune conditions. (3) Autoimmunity exists on a spectrum, and many people may be experiencing the earlier stages of it without yet having a specific diagnosis. 

The most common diagnosed autoimmune conditions we see among those who develop lichen sclerosus are: 

• Autoimmune thyroid conditions (Hashimoto’s or Grave’s disease) 
• Vitiligo 
• Alopecia areata 

The general consensus is that lichen sclerosus itself is autoimmune in nature. (4) What this means is that the immune system is attacking the skin, creating the inflammation and discomfort we associate with the disease. 

Leaky Gut and Gut Imbalances

The gut, skin, and immune system are intricately connected. (5) I almost always see leaky gut (increased intestinal permeability) in my autoimmune patients. This occurs when the gut barrier becomes weakened, allowing undigested food particles and toxins to leak out into the bloodstream and activating the immune system. 

Gut dysbiosis (an imbalance of gut bacteria), chronic infections, parasites, and yeast overgrowths like candida can also be contributing factors to lichen sclerosus. 

Hormonal Imbalances 

In women, lichen sclerosus is most common both before menstrual age (prepubescence) and after menstruation ends (postmenopause). These are times when estrogen is lower, suggesting hormonal changes as a cause or contributing factor. (6) Low estrogen can thin and dry vaginal tissue, making it more fragile and reactive. 

Because of this hormonal connection, researchers have investigated the use of topical testosterone cream for lichen sclerosus. However, this treatment has been shown to be effective in only 20% of cases, and to cause complications in around 40% of participants, so hormone replacement therapy is not generally recommended. (7)

Genetics

Individuals with lichen sclerosus may have a genetic predisposition to autoimmunity, and/or a family history of autoimmune disease. Genetics alone are not likely to be responsible for the development of lichen sclerosus– it’s usually the interaction between genes and environmental factors (like gut imbalances). 

Trauma To the Area

Trauma to the affected area including chronic friction, tight clothing, sexual abuse, or under-lubricated sex can trigger or worsen lichen sclerosus. 

In many cases, we’re looking at a perfect storm of a combination of the risk factors I’ve mentioned: a genetic predisposition, combined with leaky gut or a hormonal imbalance, and often, a localized trauma or trigger. (8)

Holistic Strategies For Healing Lichen Sclerosus 

Now that we have a better understanding of what’s going on behind the scenes, here are my top holistic and functional medicine strategies for healing lichen sclerosus and restoring balance. 

Herbal Therapies

There are several herbal therapies that can be included in a holistic lichen sclerosus treatment plan. Some of these herbs can be used topically as more gentle, natural alternatives to strong prescription creams (or used in combination, depending on what you decide with your healthcare provider). 

There are also a number of herbs that can help to support overall reduction of inflammation and irritation, as well as encourage wound healing and reduce stress. Here are a few of the best herbal treatment options: 

• Calendula cream or salve has powerful anti-inflammatory, antifungal, and antibacterial properties, and can help reduce irritation, inflammation, and swelling (and fight off infections in the affected area). (9, 10)
• Chickweed is another herb that can be added to a vitamin E cream or coconut oil to help soothe and reduce itching, pain, and inflammation. (11)
• Gotu kola may help to promote wound healing, improve lesions, and minimize scarring. (12)
• Curcumin (taken as an oral supplement) is one of the most powerful natural anti-inflammatory and antioxidant options around, and has been shown to help improve inflammatory skin disease. (13)
• Sea buckthorn oil (also taken orally) has been shown to help reduce inflammation, itching, and pain, and support mucosal integrity in the vaginal area. (14, 15)
• Ashwagandha and other adaptogenic herbs don’t necessarily have a direct impact on lichen sclerosus, but they can help to manage your stress response and promote sleep, which can both be out of whack especially in the earlier stages of your healing process. 

Dietary Strategies

Food is foundational when it comes to healing from any chronic illness. We’ll start with the simplest strategy: an anti-inflammatory diet. If they’re currently a part of your eating plan, eliminate processed foods, refined sugars, and alcohol, all of which can contribute significantly to inflammation and immune system activation. 

From there, you can try an elimination diet, with the goal of identifying and then eliminating (sometimes for the short term, sometimes over the long term) individual dietary triggers. 

Dietary triggers can be wide ranging, but there are a few that come up a lot for those with lichen sclerosus. One of the most common sensitivities in these cases seems to be oxalates, which are found in high quantities in foods including spinach, beets, and potatoes. (16) Other common culprits may include dairy, gluten, and high histamine foods. (17, 18)

Some people with LS also find success with specific dietary protocols including the Autoimmune Protocol (AIP) or a ketogenic diet. Some experimentation is usually required to find what works for you (but trust me, it’s worth it). 

Also, while it’s important to identify what should be eliminated, don’t forget to think about supportive foods too. Eating a wide variety of fruits, vegetables, herbs, spices, and omega-3 fatty acid-containing foods can help to support hormonal balance and gut health, and reduce inflammation. 

Healing the Gut 

Balancing the gut microbiome and healing the gut lining are essential for regulating systemic inflammation and supporting immune system function in lichen sclerosus. (19)

Here are the most effective gut healing strategies you can incorporate into your plan: 

• Take a probiotic supplement to help support the gut, skin, and vaginal microbiomes. Specific probiotic strains including Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1 have been studied for their beneficial effects on vaginal health , but any high quality probiotic can help reduce inflammation, support gut health, and balance bacteria. (20) 
• Improve gut lining integrity with the help of supplements including L-glutamine, aloe, and slippery elm. Improving leaky gut is essential when it comes to improving immune dysregulation and inflammation. 

Other Functional Medicine Strategies

An individualized anti-inflammatory diet, targeted herbal support, and a gut health healing plan are the core components of holistic lichen sclerosus treatment. But there are several other things you can incorporate into your plan. 

• Specialized testing: I’ll often recommend functional medicine testing for my lichen sclerosus patients, to get a better understanding of factors that may be underlying immune dysregulation and inflammation. These may include gut microbiome stool testing, food sensitivity testing, and/or hormone testing. 
• Avoid irritation and friction: Whatever you can do to avoid disrupting the sensitive and delicate areas affected by lichen sclerosus is helpful. Try to wear loose clothing and organic cotton underwear as much as possible to allow your skin to breathe. Avoid using any scented products when washing your genital area, and opt for natural lubricant options for sexual intercourse. These habits are helpful for maintenance treatment as you heal.
• Consider PRP: In some cases, platelet-rich plasma (PRP) treatments injected into the affected area can help to support collagen synthesis, repair scar tissue, and reduce inflammation. (21)
• Reduce stress: Stress and emotional trauma are among the biggest contributing factors to chronic inflammation and autoimmune disease. (22) Make sure to prioritize the time and space you need to heal from any emotional trauma and practice stress management techniques such as mindfulness meditation. 

It’s also important to check in with your doctor regularly if you have lichen sclerosus, as it is connected to an increased risk of skin cancer including squamous cell carcinoma. (23)

A Deeper Approach To Healing

Lichen sclerosus can be painful, deeply uncomfortable, emotionally distressing, and isolating. But with the right support, it’s possible to reverse symptoms of lichen sclerosus and feel comfortable in your body again. 

If your doctor has told you there’s nothing to be done beyond topical corticosteroids, it may be time for a second opinion and a deeper approach. 

My functional medicine telehealth team and I would be happy to provide you with holistic care and personalized support. You can reach out to us anytime to get started. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

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