What is lichen sclerosus and why is it often underdiagnosed in women of color?
Lichen sclerosus is a chronic inflammatory skin condition that most often affects the vulva. Here at Alloy, we describe it as something that causes thin white patches, itching that can feel intense or worse at night, and sometimes cracking or bleeding of the vulvar or perianal skin. Over time, the skin can change shape or texture because of ongoing inflammation.
Dr. Sameena Rahman explains it clearly in one of our webinars. She shares that lichen sclerosus is likely autoimmune and can cause thickened skin, pigment changes, shrinking of the labia minora, or even a clitoris that becomes hidden under thicker skin. If you want to hear her describe why it is missed so often, you can watch the chapter where she walks through it in more detail: Lichen sclerosus and underdiagnosis in women of color.
Why it’s underdiagnosed in women of color has a few layers. One issue is that most medical images used in training show the condition only on lighter skin, which means the classic “white patches” or architectural changes look different on darker skin and may be overlooked. Dr. Rahman also points out that pigment changes can be mistaken for other conditions like vitiligo, and that many healthcare providers don’t receive enough education about vulvar disorders in the first place. Add to that the lack of research involving women of color, and you end up with a condition that gets missed far too often.
Here at Alloy, we talk about lichen sclerosus on our site because it can look a lot like menopausal dryness or itching, but it needs its own specific treatment and careful follow up. If your symptoms align with what you’re reading about and you’re unsure whether it’s hormonal or something like lichen sclerosus, the safest step is to see someone who can examine the skin directly and, if needed, perform a small biopsy.
If you’d like to read more about other causes of vulvar itching, including lichen sclerosus, you can take a look at our page on vaginal itching:Vaginal itching and menopause.
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