Erosive lichen planus may be in vulva and vagina. (High Risk Of Vaginal Scarring).

HOUSTON -- If a patient has erosive lichen planus of the vulva, chances are she's got it in the vagina as well, and it's essential to treat it there to prevent scarring that could dose the vagina completely according to Dr. Elizabeth Edwards.

Most of her patients start on 25-mg hydrocortisone acetate suppositories, inserting one nightly or every other night for 1 month, Dr. Edwards said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

The suppositories are labeled for rectal use, but she assures patients that they also are acceptable for vaginal use. In especially severe cases she will prescribe topical dobetasol instead of hydrocortisone. Dr. Edwards said she believes that Temovate produces better results than generic dobetasol. Patients apply the Temovate nightly for the first month and once or twice a week thereafter to minimize the risk of systemic side effects.

Some antibiotics, most notably tetracychines, sulfa drugs, clindamycin, and erythromycin, have anti-inflammatory properties independent of their bacteriocidal effects, so Dr. Edwards usually prescribes them along with the steroid. She prefers the oral form of most of these medications, so patients aren't putting too many topical agents on inflamed, eroded skin. But she does prescribe topical clindamycin.

A compounding pharmacy can make clindamycin suppositories for vaginal use. Anecdotal reports suggest that this approach produces good results, although clinical trial data are lacking.

Healing the superficial lesions is important, but vaginal secretions should also be checked for white blood cells or immature epithelial cells, which are signs that the inflammation has not completely resolved, said Dr. Edwards of the department of dermatology at Wake Forest University, Winston-Salem, N.C.

Lichen planus usually subsides more slowly than lichen sclerosus, a condition for which it is sometimes mistaken.