What’s causing this annoying itch?

Q:

I’ve had awful vulval itching for more than a week. The over-thecounter feminine itch cream I’ve been using helps, but now there’s a shiny white patch next to my clitoris. What’s going on?

A:

The itching and white spot you describe are classic symptoms of lichen sclerosus, a condition that can impact skin at any age. It occurs in both men and women, producing white patches anywhere on the body, but the genital form is most common. And while its causes aren’t well understood, the fact that it’s diagnosed 10 times more in women—and most frequently after menopause—suggests a female hormonal link.

Though lichen sclerosus elsewhere on the body may resolve on its own, the vulval type requires treatment, so I recommend making an appointment to see your health-care provider. In the meantime, continue using your over-the-counter cream since scratching the area can damage the skin and increase infection risk. It’s also a good idea to avoid using harsh soaps or scented products since they often contain chemicals that can irritate this delicate skin. Finally, to limit friction, instead of rubbing your skin with a towel to dry off after showering, try gently patting your skin dry or using a blow-dryer on the cool setting to dry off.

Lichen sclerosus can sometimes be diagnosed on a physical examination, but your doctor may order tests to confirm the diagnosis. The condition is typically treated with prescriptionstrength steroid creams, which are generally applied daily for several weeks, then tapered to two or three times weekly for as long as needed.

Your doctor may also suggest taking supplements such as vitamins C and E and increasing your intake of foods that contain them (including citrus fruits, berries, leafy greens, nuts and sunflower seeds). Research suggests that the vitamins’ antioxidant action fights the cell-damaging oxidative stress that has been linked to lichen sclerosus. Plus, they’ve been shown to combat scarring and speed skin healing.