Written by Dr. Patricia Gutiérrez Ontalvilla, MD, PhD. Plastic surgeon and specialist in vulvar lichen sclerosus.
It is one of the questions I hear most often in my practice: “Doctor, if it no longer itches or bothers me, is the lichen still doing damage in there?”. The question makes perfect sense, and the honest answer is that feeling well and being well on the inside do not always coincide.
Yes, lichen sclerosus can remain active without symptoms. What damages the tissue is not “your cells,” but the chronic inflammation of VLS, which can continue to affect the skin of the vulva even if the itching, stinging, or discomfort have disappeared. The absence of symptoms does not equate to the absence of disease.
Why does lichen sclerosus continue to damage the skin even if I don’t notice it?
Vulvar lichen sclerosus is a chronic inflammatory condition of the vulvar skin. “Chronic” means that it does not disappear completely, although it can be very well controlled. The symptoms (itching, burning, fissures) are the visible part. The underlying inflammation is the part you do not notice.
When that inflammation subsides, the discomfort calms down before the process is completely halted. Therein lies the trap: there is a distance between “I feel fine” and “the tissue is calm.” The skin can continue to change silently, thinning, losing elasticity, or forming white patches, without warning you with pain.
Noticing improvement is a good sign, but it is not proof that the disease is inactive. The person who confirms if VLS is truly controlled is your doctor, not your symptoms.
What happens to the vulvar tissue when inflammation continues silently
In VLS, sustained inflammation alters the structure of the skin. The tissue loses thickness and flexibility and, over time, anatomical sequelae may appear: narrowing of the vaginal opening, fusion of the labia, or phimosis of the clitoris. Many of these changes take hold gradually, without a clear moment of pain to serve as an alarm.
That is why the goal of treatment is not just “so it doesn’t itch.” It is to extinguish the underlying inflammation to protect the tissue in the long term. When the regimen is abandoned at the first sign of relief, a clear path is left for that slow damage.
VLS is a chronic condition: it is controlled, not eliminated (ISSVD 2022 consensus).
of women with VLS do not feel itching (the most common symptom)
Risk of malignant progression (cancer) associated with poorly controlled VLS in the long term.
So, how do I know if my lichen sclerosus is truly controlled?
The short answer is: in the clinic, not from doubt at home. The amount of treatment, the frequency, and how long to maintain it are adjusted according to how your skin responds, not according to how you feel in a good week.
Clinical assessment combines the examination of the vulva (color, texture, elasticity, anatomical changes) with your history of symptoms. When there are doubts about activity or suspicious areas, a biopsy may be indicated. Asking why each thing is indicated is not a lack of trust in your doctor: it is taking better care of yourself.
Controlling inflammation and caring for the tissue: two different levels
Topical corticosteroids are the gold standard treatment for controlling VLS inflammation, and their use must always follow medical instructions. In my practice, I frequently see that the fear of using them leads to stopping them prematurely; if this is your case, you might be interested in this article on corticophobia in lichen sclerosus and this other one on why it is not advisable to abandon treatment.
There is, furthermore, a step at another level. The Liquenia regenerative protocol does not control inflammation as corticosteroids do, but rather works on the vulvar tissue itself with stromal vascular fraction (SVF), regenerative cells obtained from your own fat. It does not replace your medical regimen: it is a different path, and whether it fits your case is assessed individually. You can find more information on how tissue regenerates in lichen sclerosus and on the credentials and publications of Dr. Gutiérrez Ontalvilla.
As daily cosmetic support, and never as a treatment, some women complement the care of dry or fragile vulvar skin with specific cosmetics for the area. It is an external care that accompanies, not a therapy for the disease.
References
- Gutiérrez-Ontalvilla P, et al. Randomized clinical trial on SVF and autologous nanofat in vulvar lichen sclerosus. Aesthetic Surgery Journal, 2025. DOI: 10.1093/asj/sjaf148 (NCT03961126, N=18).
- Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, Brackenbury F, Mohd Mustapa MF, Exton LS. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. British Journal of Dermatology. 2018;178(4):839-853. doi:10.1111/bjd.16241
- Lee A, Bradford J, Fischer G. Long-term Management of Adult Vulvar Lichen Sclerosus: A Prospective Cohort Study of 507 Women. JAMA Dermatology. 2015;151(10):1061-1067. doi:10.1001/jamadermatol.2015.0643
- Bleeker MCG, Visser PJ, Overbeek LIH, van Beurden M, Berkhof J. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiology, Biomarkers & Prevention. 2016;25(8):1224-1230. doi:10.1158/1055-9965.EPI-16-0019
Frequently asked questions
If it no longer itches, are the lichen sclerosus cells still being damaged?
Damage can still occur. In vulvar lichen sclerosus, what injures the tissue is chronic inflammation, and this can persist even if symptoms have disappeared. Therefore, improvement is not enough to ensure the disease is inactive. Maintaining or reducing treatment is decided in the clinic, based on how your skin evolves.
How do I know if lichen sclerosus is still active if I have no symptoms?
It can only be known through a medical assessment. The specialist examines the color, texture, and elasticity of the vulva and looks for anatomical changes that you do not perceive. The absence of itching or discomfort is not enough to confirm that the disease is inactive. This is why regular follow-up is so important.
Is it dangerous if VLS remains active without showing symptoms?
It can be if it is not controlled. Sustained inflammation damages the tissue progressively and can lead to long-term anatomical sequelae. Well-monitored and treated lichen sclerosus reduces that risk. In the event of any visible change, pain, fissures, or bleeding, it is advisable to consult your gynecologist or dermatologist.
Does the Liquenia protocol replace corticosteroids?
No. Corticosteroids control inflammation and the Liquenia regenerative protocol works on the vulvar tissue itself with the stromal vascular fraction. They are different and complementary approaches. If you want to know if regenerative treatment fits your case, it is assessed individually in a consultation.
Do you doubt if your lichen sclerosus is truly controlled?
A specialized assessment can confirm if the inflammation has been halted or if it remains active in silence.
This content is for informational and educational purposes. It does not replace diagnosis or individualized medical advice. If you have persistent symptoms, consult your specialist.
