I would be grateful if you would provide some information on alternative forms of treatment on vulval lichen sclerosis. Long term treatment for this condition, which seems to involve the use of powerful steroids, seems to be aggressive and unsatisfactory. LC, Parma........

The cause of this uncommon skin disorder is still unknown. Like psoriasis, lichen sclerosis (LS) is thought to be an autoimmune disease. It is more common in women than in men, but can affect both. While it can occur anywhere on the body, it is most commonly seen on the genitals. On the body it produces white spots, which have a curious tissue paper like wrinkled surface with a waxy, thickened feel to them. When it occurs on a woman's genitals, it causes the vulva to become white and thickened.

The usual treatment is initially to apply a super potent topical steroid cream in a very precise manner. After a few weeks of this, the patient is switched to a milder form of steroid cream. Other studies have shown that treatment with etretinate a form of oral vitamin A often used to treat psoriasis can be helpful. However, like steroids, this treatment brings with it numerous side effects, including dryness and cracking of the lips, conjunctivitis, reversible hair thinning and loss, photosensitivity, mood changes, anaemia and decreased night vision. If you take etretinate you should not get pregnant within two years of stopping treatment and should not give blood for a year.

As an alternative, you might want to consult a nutritionist who will undoubtedly put you on an immune enhancing supplement regime, which will include vitamin A (7500iu daily) in the form of beta carotene (the chemical precursor to vitamin A). Numerous studies have shown that vitamin A stimulates and enhances numerous immune system processes including killer cell activity and antibody response (JAMA 1981; 245: 53-8; Fed Proc, 1973; 32: 947; Arch Surg, 1984; 119: 161-5; Br J Cancer, 1984; 49: 343-8).

Studies into alternative treatments are thin on the ground. Often candida and thrush are present at the same time as LS. Though the link between the two has not been positively established, it would not hurt to go on an anti candida diet, avoiding sugars, yeast, alcohol and high allergy foods (for more tips about candida see WDDTY vol 9 no 9). If you are taking the Pill you might want to consider a different form of contraception since a change in your hormonal balance may also be a contributing factor to LS.

One recent study suggests that there may also be an allergic component in the development of vulval LS (Mod Pathol, 1998; 11: 844-54), so it might be worth getting yourself tested for allergies.

Other studies have shown that individuals with LS have lower levels of the Hyaluronic acid (HA). HA is a major component of connective tissue. It is involved in tissue hydration and tissue repair. One study demonstrated that individuals with LS had as much as 50 per cent less HA in their skin than healthy adults (Arch Dermatol, 1978; 263: 59-66). A tendency to produce less HA may run in families (Arch Dermatol 1990; 126: 1043-5). Strangely, although topical HA preparations are used to treat a number of other skin disorders and are used in skin repair after surgery, there appear to be no studies into its use in the treatment of LS. You may wish to discuss this with your dermatologist.