Dermatologists Back Clobetasol Over Diets to Halt Lichen Sclerosus

Dr Dray

Unchecked chronic inflammation rather than dietary intake drives irreversible genital scarring and elevated cancer risk, leaving high-potency topical corticosteroids as the indispensable standard of care.

AI-assisted summary of Lichen Sclerosus: What You Need to Know in 2026 — original source. Check the original for full context.

Source published: 2026-09-04

Key ideas

Ultrapotent topical corticosteroids like clobetasol propionate remain the gold standard first-line treatment for lichen sclerosus, provided they are applied precisely with a mirror to avoid healthy tissue atrophy. (4:15)
Emerging therapies for refractory cases include systemic JAK inhibitors such as baricitinib and abrocitinib, alongside regenerative approaches like fractional CO2 laser, platelet-rich plasma (PRP), and autologous fat transfer. (6:02)
Vaginal estrogen treats menopausal dryness and tissue atrophy but does not address the underlying autoimmune inflammation of lichen sclerosus, meaning it cannot replace targeted anti-inflammatory medical therapy. (8:44)
Genital lichen sclerosus carries an increased risk of progressing to squamous cell carcinoma driven by chronic uncontrolled inflammation, making continuous medical therapy and dedicated follow-up essential. (12:43)

Detailed notes

## Background Published on YouTube on September 4, 2026, by board-certified dermatologist Dr Dray, this video delivers an updated guide to lichen sclerosus. According to the show notes, Dr Dray explains how the chronic inflammatory skin condition is diagnosed and managed, detailing first-line treatments like clobetasol, investigational options like JAK inhibitors and PRP, the elevated risk of squamous cell carcinoma, menopause-related considerations, and the reality behind popular dietary claims.

## TL;DR Lichen sclerosus is a chronic, scarring dermatosis targeting genital tissue that requires prompt medical intervention to prevent irreversible anatomical changes and mitigate squamous cell carcinoma risks. Ultrapotent topical corticosteroids like clobetasol remain the cornerstone first-line treatment, while calcineurin inhibitors serve as secondary alternatives and newer modalities like JAK inhibitors, lasers, and PRP offer hope for refractory disease. Although estrogen alleviates menopausal dryness, it does not halt the underlying inflammatory process, highlighting the need for targeted anti-inflammatory regimens alongside daily friction reduction. Sweeping dietary eliminations lack scientific evidence, reinforcing that consistent medical therapy and dedicated specialist follow-up remain the most effective path forward.

## Atmosphere & style The presentation is candid, empathetic, and clinically authoritative, offering a supportive space for patients dealing with an intimate and often isolating condition. Dr. Dray balances accessible scientific explanations with grounded humor and practical advice, directly addressing the anxiety caused by misdiagnoses and online health misinformation. Watching the video feels informative and reassuring, steering viewers away from extreme dietary fads and instilling realistic optimism through evidence-based medicine.

## Bulletin - [04:15](https://www.youtube.com/watch?v=u3yegvYrTDM&t=255s) Ultrapotent topical corticosteroids like clobetasol propionate remain the gold standard first-line treatment for lichen sclerosus, provided they are applied precisely with a mirror to avoid healthy tissue atrophy. - [06:02](https://www.youtube.com/watch?v=u3yegvYrTDM&t=362s) Emerging therapies for refractory cases include systemic JAK inhibitors such as baricitinib and abrocitinib, alongside regenerative approaches like fractional CO2 laser, platelet-rich plasma (PRP), and autologous fat transfer. - [08:44](https://www.youtube.com/watch?v=u3yegvYrTDM&t=524s) Vaginal estrogen treats menopausal dryness and tissue atrophy but does not address the underlying autoimmune inflammation of lichen sclerosus, meaning it cannot replace targeted anti-inflammatory medical therapy. - [12:43](https://www.youtube.com/watch?v=u3yegvYrTDM&t=763s) Genital lichen sclerosus carries an increased risk of progressing to squamous cell carcinoma driven by chronic uncontrolled inflammation, making continuous medical therapy and dedicated follow-up essential.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=u3yegvYrTDM&t=0s) Lichen sclerosus is a chronic inflammatory skin condition primarily targeting anogenital tissue in both sexes, exhibiting a bimodal incidence peak around puberty and postmenopause. - [00:48](https://www.youtube.com/watch?v=u3yegvYrTDM&t=48s) Affected skin characteristically turns white and thins out to a 'wet cigarette paper' texture, causing intense pruritus, painful fissures, introital stenosis, and structural architectural scarring. - [02:17](https://www.youtube.com/watch?v=u3yegvYrTDM&t=137s) The etiology involves complex genetic and autoimmune dysregulation, frequently co-occurring with conditions like autoimmune thyroiditis, vitiligo, and alopecia areata. - [02:17](https://www.youtube.com/watch?v=u3yegvYrTDM&t=137s) Securing a diagnosis is frequently delayed because the condition mimics contact dermatitis, psoriasis, vitiligo, or ordinary postmenopausal atrophy, often necessitating a vulvar biopsy. - [04:15](https://www.youtube.com/watch?v=u3yegvYrTDM&t=255s) Ultrapotent topical corticosteroids like clobetasol propionate are the first-line standard of care and should be applied sparingly directly to active lesions using a mirror. - [04:15](https://www.youtube.com/watch?v=u3yegvYrTDM&t=255s) Topical calcineurin inhibitors, including tacrolimus and pimecrolimus, serve as effective second-line steroid-sparing alternatives that avoid the risk of steroid-induced dermal thinning. - [06:02](https://www.youtube.com/watch?v=u3yegvYrTDM&t=362s) Investigational options for treatment-resistant disease include systemic JAK inhibitors (baricitinib, abrocitinib), fractional CO2 lasers, platelet-rich plasma injections, and autologous fat grafting. - [08:44](https://www.youtube.com/watch?v=u3yegvYrTDM&t=524s) Vaginal estrogen provides symptomatic relief for postmenopausal genitourinary atrophy and dryness, but it does not treat the autoimmune inflammation driving lichen sclerosus. - [09:58](https://www.youtube.com/watch?v=u3yegvYrTDM&t=598s) Minimizing friction and secondary irritation is critical: patients should avoid fragranced personal care products, wear loose cotton garments, and protect chafing-prone areas with barrier ointments. - [12:43](https://www.youtube.com/watch?v=u3yegvYrTDM&t=763s) Prompt medical evaluation is required for red-flag symptoms such as persistent lumps, thickened plaques, or non-healing sores due to the elevated risk of squamous cell carcinoma. - [13:26](https://www.youtube.com/watch?v=u3yegvYrTDM&t=806s) Restrictive elimination diets lack scientific evidence for curing lichen sclerosus and pose real nutritional risks, while commercial food IgG antibody panels are notoriously misleading. - [17:37](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1057s) Patients seeking dietary optimization should focus on overall nutrient density and whole foods or consult a registered dietitian rather than adopting extreme online dietary fads. - [18:20](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1100s) Because the disease is chronic and unpredictable, patients benefit from multidisciplinary care across dermatology, gynecology, and urology, and should seek specialized centers if treatments stall.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=u3yegvYrTDM&t=0s) Introduction and What Is Lichen Sclerosus?

Lichen sclerosus is a chronic inflammatory skin condition that primarily targets the genitalia and the perianal skin. Returning to the topic after a widely viewed 2023 video, Dr. Dray notes that the massive response proved just how many patients struggle in silence and search desperately for answers. This 2026 update addresses promising newer therapeutic modalities, common patient inquiries, and the frequently debated question of whether dietary triggers play a causal or therapeutic role.

While lichen sclerosus predominantly targets women—specifically the vulva and the skin surrounding the anus—it also affects the penis in men, and can occasionally manifest at extragenital locations such as the abdomen. The disease typically displays a bimodal age distribution, with distinct peaks around puberty and in postmenopausal individuals. Although far more prevalent in females, it is equally debilitating for male patients.

Clinically, the affected skin turns white, thins out, and becomes exceptionally fragile, often taking on the characteristic texture described in dermatology as "wet cigarette paper." This profound fragility means that trivial friction causes tearing, leading to painful fissures, bleeding, and ulceration. Alongside structural vulnerability, intense, intractable itching ranks among the most distressing symptoms. Over time, persistent inflammation promotes deep scarring that alters normal anatomy. In women, this can cause labial adhesions, narrowing of the introitus, dyspareunia (pain during sexual activity), and dysuria. In men, involvement of the foreskin and urethra can lead to severe phimosis. Because of these progressive architectural changes, rapid diagnosis and therapeutic intervention are essential.

- **Primary anatomical sites:** Vulva and perianal region (females); foreskin, glans, and urethra (males); rarely extragenital (e.g., abdomen). - **Classic clinical hallmark:** Thin, ivory-white skin resembling wrinkled or "wet cigarette paper." - **Bimodal incidence:** Two primary peaks occur at puberty and during the postmenopausal years. - **Functional consequences:** Fissuring, bleeding, introital stenosis, severe dyspareunia, urinary difficulties, and phimosis.

---

[02:17](https://www.youtube.com/watch?v=u3yegvYrTDM&t=137s) Potential Causes and Diagnostic Challenges

The precise etiology of lichen sclerosus remains elusive, presenting as a multifactorial dermatosis driven by a complex interplay of genetic predisposition and immune dysregulation. The condition frequently co-occurs with other autoimmune disorders, most notably autoimmune thyroid disease, vitiligo, and alopecia areata. Chronic mechanical trauma, persistent local irritation, and hormonal shifts also appear to act as triggers or contributing factors, though no single mechanism accounts for every presentation.

```mermaid flowchart TD accTitle: Lichen Sclerosus Clinical Course and Management accDescr: Flowchart illustrating etiology, clinical presentation, and treatment escalation pathways for lichen sclerosus.

subgraph Etiology["Underlying Drivers"] E1["Genetic Susceptibility"] E2["Autoimmune Dysregulation"] E3["Hormonal Shifts & Trauma"] end

subgraph Pathology["Tissue Presentation & Risks"] P1["Fragile, White Skin 'Wet cigarette paper'"] P2["Fissures, Severe Pruritus & Pain"] P3["Progressive Scarring & Adhesions"] end

subgraph Therapy["Management Escalation"] T1["First-Line: Ultra-Potent Topical Steroids (e.g., Clobetasol Propionate)"] T2["Alternative: Topical Calcineurin Inhibitors (Tacrolimus, Pimecrolimus)"] T3["Investigational/Refractory: JAK Inhibitors, Fractional CO2 Laser, PRP, Fat Transfer"] end

E1 & E2 & E3 --> P1 P1 --> P2 --> P3 P2 --> T1 T1 -->|Poor tolerance or failure| T2 T2 -->|Refractory disease| T3 ```

Navigating the healthcare system to secure an accurate diagnosis is notoriously exhausting. Patients frequently bounce between multiple gynecologists, urologists, primary care providers, and general dermatologists before obtaining answers. The condition is easily mistaken for vitiligo, allergic or irritant contact dermatitis, inverse psoriasis, lichen simplex chronicus, recurrent infections, or dismissed as ordinary postmenopausal atrophy.

A skin biopsy is often necessary when the visual presentation is ambiguous or when there is concern about premalignant alterations. However, a single biopsy may yield inconclusive results. When an inconclusive pathology report leaves symptoms unresolved, patients should seek out gynecologists or dermatologists who specialize in vulvovaginal disorders rather than settling for uncertain answers.

- **Autoimmune comorbidities:** High association with autoimmune thyroiditis, vitiligo, and alopecia areata. - **Common diagnostic mimics:** Lichen simplex chronicus, vitiligo, genital psoriasis, contact eczema, and genitourinary syndrome of menopause. - **Biopsy considerations:** Often required to rule out malignancy or clarify atypical lesions; repeat sampling is sometimes necessary.

---

[04:15](https://www.youtube.com/watch?v=u3yegvYrTDM&t=255s) First-Line Treatment: What Actually Works

The cornerstone of lichen sclerosus management relies on potent to ultrapotent topical corticosteroids, most frequently clobetasol propionate. Treatment typically begins with daily application during the active inflammatory phase until clinical remission is achieved, after which the patient transitions to an intermittent maintenance schedule to prevent relapses.

Technique matters immensely with ultrapotent steroids. Because clobetasol carries real risks of skin atrophy when misused on healthy tissue, patients should never blindly "get a glob on your finger and rub it down there." Dr. Dray strongly advises using a handheld mirror to visually inspect the exact spots needing treatment and applying only a pea-sized amount directly to the diseased plaques. Clinicians must actively demonstrate this application technique during office visits. When used correctly under medical supervision, high-potency topical steroids are exceptionally safe, minimize complications, and prevent irreversible tissue destruction.

For individuals who cannot tolerate topical clobetasol or fail to respond adequately, topical calcineurin inhibitors—such as tacrolimus and pimecrolimus—serve as proven secondary alternatives. These steroid-sparing agents selectively suppress T-lymphocyte activation and target the underlying inflammatory cascade without carrying the risk of corticosteroid-induced dermal thinning.

- **Gold standard treatment:** Ultrapotent topical corticosteroids (e.g., clobetasol propionate ointment). - **Application best practices:** Use a mirror for precise placement, apply only a minimal amount, and restrict application strictly to active lesions. - **Steroid-sparing options:** Topical calcineurin inhibitors (tacrolimus, pimecrolimus) provide targeted anti-inflammatory action without the risk of skin thinning.

---

[06:02](https://www.youtube.com/watch?v=u3yegvYrTDM&t=362s) Emerging and Regenerative Therapies for Difficult Cases

For refractory cases that do not respond to conventional topical steroids or calcineurin inhibitors, recent clinical research offers promising alternatives. Systemic Janus kinase (JAK) inhibitors—including baricitinib and abrocitinib—are being investigated for treatment-resistant disease. By disrupting intracellular cytokine signaling pathways central to autoimmunity, these oral agents have shown early success in turning off recalcitrant inflammation, though they remain outside formal first-line guidelines.

Procedural and regenerative options are also gaining traction for refractory disease. Fractional carbon dioxide (CO2) laser therapy has demonstrated efficacy in reducing stubborn pruritus and promoting tissue remodeling, especially when topical treatments fail to calm nerve irritation. Platelet-rich plasma (PRP)—popularized in aesthetic medicine by Kim Kardashian's "vampire facial"—involves centrifuging autologous whole blood to isolate concentrated platelets filled with growth factors, which are then reinjected into the vulvar tissue to stimulate healing.

Similarly, autologous fat grafting involves harvesting adipose tissue from areas like the abdomen or flanks and transferring it into scarred genital skin to exploit the regenerative properties of adipose-derived stem cells. Dr. Dray emphasizes that while these cutting-edge procedures are compelling for stubborn cases, they remain experimental adjuncts rather than standardized, first-line medical therapies.

- **JAK inhibitors under investigation:** Baricitinib and abrocitinib for severe, refractory disease. - **Fractional CO2 laser:** Explored as a procedural option to improve tissue remodeling and relieve intractable itching. - **Platelet-rich plasma (PRP):** Autologous growth factor concentrate injected locally to dampen inflammation and stimulate tissue repair. - **Autologous fat grafting:** Harvested adipose tissue transfers utilized for structural regeneration and healing in scarred tissue.

[08:44](https://www.youtube.com/watch?v=u3yegvYrTDM&t=524s) The Role of Estrogen Therapy and Menopause

Because lichen sclerosus is particularly common during and after menopause, questions frequently arise regarding the role of vaginal estrogen therapy. During menopause, declining hormone levels lead to tissue atrophy, vaginal dryness, urinary frequency, and pain with intercourse (dyspareunia). While vaginal estrogen can be immensely helpful in addressing these genitourinary symptoms by restoring moisture and reducing tissue fragility, it does not target the underlying autoimmune, inflammatory mechanism of lichen sclerosus itself.

Estrogen is not a first-line treatment for lichen sclerosus, and relying on it alone is entirely insufficient to prevent the severe anatomical and structural complications of untreated disease. While a post-menopausal woman dealing with both conditions may experience symptomatic relief of menopausal dryness from estrogen, the lichen sclerosus still demands targeted, active management. Ultra-potent topical corticosteroids like clobetasol propionate remain the gold standard and first-line medical therapy.

```mermaid flowchart TD accTitle: Estrogen Therapy vs Topical Steroids in Post-Menopausal Lichen Sclerosus accDescr: Visual flowchart outlining how vaginal estrogen manages menopausal tissue atrophy while topical clobetasol treats the inflammatory process of lichen sclerosus.

subgraph Hormonal ["Menopause-Related Changes"] A["Hormonal Decline"] --> B["Genitourinary Symptoms (Dryness, Atrophy, Pain)"] B --> C["Vaginal Estrogen Therapy"] C --> D["Symptom Relief (Tissue Hydration)"] end

subgraph Inflammatory ["Lichen Sclerosus Pathology"] E["Chronic Autoimmune Inflammation"] --> F["Structural Damage & Scarring"] F --> G["First-Line Clobetasol Propionate"] G --> H["Disease Control & Prevention"] end

C -.->|"Does NOT treat"| E ```

[09:58](https://www.youtube.com/watch?v=u3yegvYrTDM&t=598s) Daily Skin Care and Minimizing Friction

Managing lichen sclerosus on a daily basis requires eliminating anything that causes irritation or friction, as secondary irritation directly exacerbates underlying inflammation. Dr. Dray emphasizes the need to be "peacemakers" rather than "stirring the pot" or "egging on the inflammation" with unnecessary irritants. Scented personal care items—including bubble baths, body washes, douches, and fragranced panty liners—must be strictly avoided, and switching to fragrance-free laundry detergents is strongly advised.

Clothing choices are equally critical. Patients should steer clear of tight, restrictive garments like skimpy, lacy thongs in favor of loose, breathable fabrics. Friction and moisture entrapment from athletic wear and leggings pose significant issues for both men and women:

- **Underwear Selection:** Men and women alike should opt for loose-fitting cotton underwear over tight, synthetic fabrics to minimize friction and heat buildup. - **Barrier Ointments for Chafing:** High-friction activities like running require barrier protection to prevent skin-on-skin rubbing. Effective options include plain petroleum jelly, zinc oxide diaper rash creams, or dimethicone-based anti-chafing protectants (such as Monistat Chafing Relief Powder-Gel, which Dr. Dray notes is equally effective for men since chafing mechanics are identical across sexes). - **Managing Incontinence:** Contact with urine or stool—even a single drop—causes severe, rapid irritation. Incontinence from postpartum recovery or normal aging requires immediate clothing changes, gentle cleansing with dilute soapy water, thorough rinsing, and patting completely dry.

[12:43](https://www.youtube.com/watch?v=u3yegvYrTDM&t=763s) Lichen Sclerosus and Squamous Cell Carcinoma Risk

Genital lichen sclerosus carries an established elevated risk of progressing to squamous cell carcinoma (SCC). Dr. Dray clarifies that a diagnosis does not guarantee cancer—the vast majority of patients with properly controlled disease never develop malignancy. However, chronic, persistent, uncontrolled inflammation is the primary driver of this increased risk.

Long-term management depends on consistent topical therapy and dedicated clinical follow-up. Patients must monitor their genital anatomy and seek immediate evaluation for any red-flag signs rather than assuming symptoms are simply an atypical flare: - A new, persistent lump or nodule - Unexplained thickened plaques or rough patches - Non-healing sores, fissures, or erosions - Distinct areas of abnormal-looking skin

[13:26](https://www.youtube.com/watch?v=u3yegvYrTDM&t=806s) The Truth About Diet, Elimination Trends, and Food Allergies

Dietary adjustments cannot cure lichen sclerosus, but poor metabolic health and diets high in refined sugars promote systemic inflammation that can worsen inflammatory skin disorders. Dr. Dray humorously points out that a diet consisting solely of "McDonald's, for example, or only eating Taco Bell, Doritos, Mountain Dew, Fritos" will certainly not help the body manage chronic disease, whereas cooking affordable whole foods at home supports overall immune health.

However, Dr. Dray firmly cautions against sweeping elimination diets (such as strictly gluten-free, dairy-free, carnivore, or plant-free diets) popularized online. These diets lack solid evidence for lichen sclerosus and carry significant risks of severe nutritional deficiencies. She highlights a notable case report of an individual patient (an "N of 1") whose symptoms completely cleared after eliminating tomatoes and nightshades, only to flare immediately upon eating salsa. While cutting out nightshades or tomatoes might be a harmless temporary trial for someone who notices an exact personal correlation, it is by no means a universal trigger or an established standard of care:

- **Risks of Broad Elimination:** Eliminating major food groups without medical supervision poses real nutritional hazards and should not be undertaken based on social media claims. - **The Pitfalls of Allergy Testing:** Commercial food IgG/allergy panels are notoriously misleading. Because humans naturally develop circulating antibodies to foods they have eaten across their lives, broad testing often makes individuals believe they are allergic to everything. An antibody titer alone is not diagnostic without clear, reproducible, acute clinical reactions. - **General Dietary Guidance:** When patients ask what to eat, clinicians often mention the Mediterranean diet—a broad dietary pattern rich in fruits, vegetables, olive oil, nuts, seeds, and seafood with limited red meat and moderate red wine—which supports general vascular and inflammatory health without imposing dangerous dietary restrictions.

[17:37](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1057s) Navigating Diet Rabbit Holes and Working with a Dietitian

When it comes to nutrition and lichen sclerosus, adopting a sensible dietary pattern makes far more sense than falling prey to online extremes. The goal is to lean heavily toward whole foods while cutting back on inflammatory culprits like processed meats and "refined garbage." Because appointments can be rushed, a physician might simply toss out a quick recommendation like, "Oh, yeah, Mediterranean diet," without providing practical guidance on how to implement it safely. Rather than navigating that alone, consulting a registered dietitian is the best way to structure meals without resorting to severe restrictions.

Online spaces are filled with hazardous dietary extremes. People will readily fall into rigid traps—whether believing they must survive exclusively on potatoes or going entirely carnivore on nothing but ribeye steak. These restrictive rabbit holes are not only scientifically unfounded for managing lichen sclerosus, but they can also be genuinely dangerous to overall health.

- **Focus on dietary quality:** Emphasize whole, nutrient-dense foods while minimizing ultra-processed meats and refined items that stoke systemic inflammation. - **Consult nutritional professionals:** Work directly with a dietitian to build sustainable eating habits rather than attempting unmonitored elimination protocols. - **Avoid extreme dietary dogma:** Steer clear of fads promoting single-food survival (such as all-potato or all-ribeye regimens).

---

[18:20](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1100s) The Critical Need for Ongoing Follow-Up and Specialists

Consistent medical follow-up is vital because lichen sclerosus is unpredictable: symptoms can flare, and previously effective treatments can suddenly stop working. Leaving inflammation unchecked leads to progressive tissue changes and needless suffering. Managing the condition properly often demands a coordinated multidisciplinary care team comprising dermatologists, gynecologists, and urologists who can address different aspects of the disease.

Even though clinicians may occasionally seem pressed for time or in a hurry, they are there to help. However, patients should never feel trapped in care that isn't producing results. If a provider is not meeting your needs or symptoms remain uncontrolled, it is completely appropriate to seek a second opinion. Specialized academic and regional centers exist—both across the country and internationally—that focus specifically on vulvar dermatoses and inflammatory urogenital conditions, offering access to true experts in the field.

```mermaid flowchart TD accTitle: Multidisciplinary Care Pathway for Lichen Sclerosus accDescr: Recommended clinical team and escalation pathway for patients with lichen sclerosus.

subgraph CoreTeam["Core Care Team"] Derm["Dermatology"] Gyn["Gynecology"] Uro["Urology"] end

subgraph Evaluation["Ongoing Monitoring"] Assess["Assess Symptom Control & Tissue Architecture"] Stable{"Responding to Treatment?"} end

subgraph Escalation["Next Steps"] Maint["Maintain Consistent Long-Term Follow-Up"] Referral["Seek Second Opinion at Specialized Vulvar/Urogenital Centers"] end

CoreTeam --> Assess Assess --> Stable Stable -- Yes --> Maint Stable -- No --> Referral ```

---

[19:01](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1141s) The Bottom Line: Progress, New Therapies, and Realistic Hope

Reflecting on the landscape since her 2023 update, Dr. Dray emphasizes that while three years have passed, medicine has made notable strides even if fundamental questions remain unanswered. There is still no definitive cure, science has yet to pinpoint the exact root trigger for why an individual develops the condition, and there is no specialized "lichen sclerosus diet" that will reverse it. Nevertheless, the expanding therapeutic horizon offers genuine grounds for optimism.

For patients dealing with recalcitrant disease that fails standard topical corticosteroids, newer modalities are actively being investigated and utilized. JAK inhibitors represent an emerging medical option, while procedural interventions such as platelet-rich plasma (PRP), laser therapy, and regenerative medicine techniques continue to move through the pipeline. While more rigorous clinical research is still required for several of these newer treatments, they signal meaningful progress. The key takeaway is to stay consistent with prescribed therapies, maintain close contact with your medical team, and persevere through the journey. Dr. Dray concludes with her trademark farewell: "give it a thumbs up, share it with your friends, and as always, don't forget sunscreen and subscribe."

- **No universal cure yet:** The exact etiology remains elusive, and dietary interventions cannot replace targeted medical therapy. - **Emerging therapeutic options:** JAK inhibitors, PRP therapy, fractionated lasers, and regenerative medicine approaches offer potential alternatives for stubborn cases. - **Consistency is key:** Long-term control relies on sticking with proven medical management and maintaining active communication with healthcare providers.

## Notable quotes > [00:00](https://www.youtube.com/watch?v=u3yegvYrTDM&t=0s) wet cigarette paper — Dr. Dray

> [04:15](https://www.youtube.com/watch?v=u3yegvYrTDM&t=255s) get a glob on your finger and rub it down there — Dr. Dray

> [06:02](https://www.youtube.com/watch?v=u3yegvYrTDM&t=362s) vampire facial — Dr. Dray

> [09:58](https://www.youtube.com/watch?v=u3yegvYrTDM&t=598s) peacemakers — Dr. Dray

> [09:58](https://www.youtube.com/watch?v=u3yegvYrTDM&t=598s) stirring the pot — Dr. Dray

> [09:58](https://www.youtube.com/watch?v=u3yegvYrTDM&t=598s) egging on the inflammation — Dr. Dray

> [13:26](https://www.youtube.com/watch?v=u3yegvYrTDM&t=806s) McDonald's, for example, or only eating Taco Bell, Doritos, Mountain Dew, Fritos — Dr. Dray

> [13:26](https://www.youtube.com/watch?v=u3yegvYrTDM&t=806s) N of 1 — Dr. Dray

> [17:37](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1057s) Oh, yeah, Mediterranean diet — Dr. Dray

> [17:37](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1057s) refined garbage — Dr. Dray

> [19:01](https://www.youtube.com/watch?v=u3yegvYrTDM&t=1141s) give it a thumbs up, share it with your friends, and as always, don't forget sunscreen and subscribe. — Dr. Dray

## Mentioned Dr. Dray, Kim Kardashian, Clobetasol propionate, Tacrolimus, Pimecrolimus, Baricitinib, Abrocitinib, Monistat Chafing Relief Powder-Gel, McDonald's, Taco Bell, Doritos, Mountain Dew, Fritos, YouTube

## Video description Lichen sclerosus is a chronic inflammatory skin condition that can cause intense itching, irritation, pain, white or fragile skin, fissures, scarring, and changes in genital anatomy. In this video, dermatologist Dr. Dray explains how lichen sclerosus is diagnosed, the most effective treatments, newer therapies being investigated, the connection with menopause, and whether diet can actually help.

Dr. Dray discusses why high-potency topical corticosteroids such as clobetasol remain the cornerstone of treatment, how topical calcineurin inhibitors may be used, and what is currently known about newer approaches including JAK inhibitors, laser therapy, PRP, and regenerative treatments. Current guidelines continue to recommend potent or ultrapotent topical corticosteroids as standard treatment for genital lichen sclerosus, with long-term follow-up because the condition can be chronic and recurrent.

The video also addresses an important concern for people with lichen sclerosus: the increased risk of vulvar or genital squamous cell carcinoma and the skin changes that should be evaluated by a healthcare professional. Early diagnosis and appropriate treatment can help reduce complications.

Dr. Dray also takes a closer look at diet and lichen sclerosus, including claims about gluten-free diets, dairy-free diets, anti-inflammatory diets, and eliminating nightshades. She explains what the evidence actually shows and why restrictive elimination diets should not be started without careful consideration.

In this video:

0:00 Introduction 0:48 What Is Lichen Sclerosus? 2:17 Why Does Lichen Sclerosus Happen? 3:02 How Is It Diagnosed? 4:15 Treatment: What Works? 6:02 Newer Treatments for Difficult Cases 8:35 Can Lichen Sclerosus Cause Cancer? 9:38 Menopause and Estrogen 9:58 Daily Skin Care 13:24 What About Diet? 18:20 The Importance of Follow-Up 19:01 The Bottom Line

If you have persistent vulvar itching, pain, fissures, white patches, skin changes, or changes in the architecture of the genital skin, it is important to get evaluated rather than assuming the symptoms are simply a yeast infection, irritation, or menopause.

Disclaimer: This video is for educational purposes only and is not a substitute for personalized medical advice, diagnosis, or treatment from your healthcare provider.

#LichenSclerosus #LichenSclerosusTreatment #Dermatologist #VulvarHealth #Clobetasol #VulvarDermatology #SkinHealth #WomensHealth

FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=u3yegvYrTDM)

中文简报

皮肤科医生主张使用氯倍他索而非饮食疗法遏制硬化性苔藓导致不可逆生殖器瘢痕形成和癌症风险升高的主要原因是未受控制的慢性炎症而非日常饮食，这使得强效外用皮质类固醇成为不可或缺的治疗标准。硬化性苔藓是一种累及生殖器组织的慢性瘢痕性皮肤病，需要及时进行医疗干预，以预防不可逆的解剖结构改变并降低鳞状细胞癌风险。超强效外用皮质类固醇（如氯倍他索）仍是一线治疗的基石，钙调神经磷酸酶抑制剂可作为次选替代方案，而 JAK 抑制剂、激光以及 PRP 等新型疗法为难治性病例带来了希望。尽管雌激素能够缓解绝经期干燥，但它无法阻断潜在的炎症病程，这凸显了在日常减少摩擦的同时采取针对性抗炎方案的必要性。大范围的饮食排除疗法缺乏科学证据，这进一步证实持续规范的药物治疗与专科随访才是最有效的应对途径。丙酸氯倍他索等超强效外用皮质类固醇仍是硬化性苔藓一线治疗的金标准，但建议借助镜子精准涂抹，以避免正常组织萎缩。 (4:15) 针对难治性病例的新兴疗法包括巴瑞替尼和阿布昔替尼等系统性 JAK 抑制剂，以及点阵 CO2 激光、富血小板血浆（PRP）和自体脂肪移植等再生疗法。 (6:02) 阴道雌激素可治疗绝经期干燥和组织萎缩，但无法解决硬化性苔藓潜在的自身免疫性炎症，因此不能替代针对性的抗炎药物治疗。 (8:44) 生殖器硬化性苔藓在慢性不受控炎症的驱动下进展为鳞状细胞癌的风险增加，因此持续的药物治疗和针对性的专科随访至关重要。 (12:43)

Reading summary

In this 2026 clinical overview, dermatologist Dr. Dray outlines the management of lichen sclerosus, emphasizing that while early diagnosis and consistent anti-inflammatory therapy prevent permanent anatomical scarring and elevated cancer risks, unproven dietary trends cannot replace targeted medical treatment. Clinical Characteristics and Diagnostic Complexity (0:00) Lichen sclerosus is a chronic inflammatory dermatosis primarily targeting the anogenital region in women and men, occasionally presenting at extragenital sites such as the abdomen. It follows a bimodal age distribution peaking around puberty and during postmenopausal years. Clinically, affected skin turns ivory-white, thins to a fragile texture described as "wet cigarette paper," and tears under minimal friction, producing painful fissures, bleeding, and severe pruritus. Over time, persistent inflammation promotes scarring that causes labial resorption, introital narrowing, dyspareunia, and phimosis in men. Securing an accurate diagnosis is notoriously difficult, with patients frequently enduring long delays across multiple specialties. The condition is easily mistaken for vitiligo, contact dermatitis, inverse psoriasis, or postmenopausal atrophy. While a punch biopsy is often required to rule out premalignant changes or clarify atypical lesions, single biopsies can yield inconclusive results, warranting repeat sampling or evaluation by dedicated vulvovaginal specialists. First-Line Medical Therapy and Estrogen's Role (4:15) The standard of care for halting disease progression relies on ultrapotent topical corticosteroids, most commonly clobetasol propionate ointment. Dr. Dray emphasizes that precise application technique is critical to avoid steroid-induced skin thinning on healthy tissue: patients should inspect the area with a handheld mirror and apply only a pea-sized amount strictly to active plaques. Once inflammation subsides, treatment transitions to intermittent maintenance. For patients unable to tolerate corticosteroids, topical calcineurin inhibitors such as tacrolimus and pimecrolimus offer steroid-sparing alternatives that suppress T-cell activation without risking dermal atrophy. Dr. Dray clarifies that while vaginal estrogen therapy effectively relieves postmenopausal tissue dryness, atrophy, and dyspareunia, it does not target the underlying autoimmune inflammatory process of lichen sclerosus. Relying on estrogen alone is entirely insufficient to prevent progressive structural scarring and architectural changes. Emerging Systemic and Regenerative Therapies (6:02) For patients with refractory disease unresponsive to standard topical regimens, several newer therapies are under clinical evaluation. Oral Janus kinase (JAK) inhibitors, such as baricitinib and abrocitinib, are being investigated to disrupt cytokine signaling cascades central to treatment-resistant inflammation, though they remain outside formal first-line treatment guidelines. Procedural and regenerative options are also gaining traction for refractory presentations. Fractional carbon dioxide (CO2) laser therapy has demonstrated efficacy in promoting tissue remodeling and relieving intractable pruritus. Platelet-rich plasma (PRP) injections utilize concentrated autologous growth factors to stimulate healing, while autologous fat grafting transfers adipose-derived stem cells into scarred tissue to encourage structural regeneration. Dr. Dray cautions that while these cutting-edge modalities show promise, they remain experimental adjuncts requiring further research rather than standardized first-line therapies. Friction Control, Hygiene, and Cancer Monitoring (9:58) Daily management requires minimizing friction and secondary irritation, which directly exacerbate baseline inflammation. Dr. Dray advises eliminating fragranced cleansers, bubble baths, and scented panty liners, recommending loose-fitting cotton underwear over restrictive synthetic garments. High-friction activities such as running require barrier protection, including plain petroleum jelly, zinc oxide paste, or dimethicone anti-chafing gels. Additionally, because urine and stool cause rapid, severe irritation, urinary or fecal incontinence requires immediate, gentle cleansing with dilute soapy water. Uncontrolled genital lichen sclerosus carries an established elevated risk of progressing to squamous cell carcinoma (SCC). Although Dr. Dray notes that the vast majority of patients with properly controlled disease never develop malignancy, chronic inflammation drives this vulnerability. Long-term medical management requires vigilant clinical follow-up and prompt evaluation of any non-healing fissures, persistent nodules, or newly thickened plaques. Nutritional Realities and Elimination Diet Risks (13:26) Addressing widespread patient inquiries, Dr. Dray emphasizes that diet does not cause lichen sclerosus, nor can it cure it. While diets dominated by ultra-processed foods and refined sugars promote systemic inflammation, sweeping elimination protocols—such as strict gluten-free, dairy-free, or carnivore diets—lack scientific evidence and carry severe risks of nutritional deficiencies. Although one published case report documented remission after eliminating tomatoes and nightshades, Dr. Dray stresses this represents an isolated outlier rather than a generalized clinical standard. Dr. Dray also advises against commercial food IgG allergy panels, which measure normal antibody exposure rather than genuine clinical allergies. Instead of restrictive diets, clinicians favor balanced, anti-inflammatory dietary patterns like the Mediterranean diet, ideally structured with a registered dietitian to support overall metabolic and immune health. Dr. Dray concludes that while lichen sclerosus remains incurable and its exact causes are not fully understood, expanding therapeutic options provide realistic optimism. Long-term stability relies on consistent adherence to medical therapy, regular specialist follow-ups, and seeking second opinions at specialized vulvovaginal centers when treatment fails to control symptoms.

Source quotes

[0:00] Dr. Dray: wet cigarette paper [4:15] Dr. Dray: get a glob on your finger and rub it down there [6:02] Dr. Dray: vampire facial [9:58] Dr. Dray: peacemakers [9:58] Dr. Dray: stirring the pot [9:58] Dr. Dray: egging on the inflammation [13:26] Dr. Dray: McDonald's, for example, or only eating Taco Bell, Doritos, Mountain Dew, Fritos [13:26] Dr. Dray: N of 1 [17:37] Dr. Dray: Oh, yeah, Mediterranean diet [17:37] Dr. Dray: refined garbage [19:01] Dr. Dray: give it a thumbs up, share it with your friends, and as always, don't forget sunscreen and subscribe.

Original transcript

[0:00] Well, hey guys. Welcome back. If you're [0:01] new here, I'm Dr. Dre. I'm a [0:03] boardcertified dermatologist. And today [0:05] we are talking about lychens sclerosis, [0:08] a chronic inflammatory skin condition [0:10] that affects the genitalia and the skin [0:12] around the anus. My last video on lychan [0:14] sclerosis was back in 2023, and it is [0:17] one of the more popular videos on my [0:19] channel, which tells me what I already [0:21] know that this is a condition a lot of [0:23] people are struggling with and are [0:25] looking for answers. Today, I'm going to [0:27] provide some updates with regards to the [0:29] treatment options that clinicians are [0:31] exploring that are showing a lot of [0:32] promise. I'm also going to talk about [0:34] something that I often get questions [0:36] about with regards to any skin [0:37] condition, and that is, is there [0:39] anything in my diet that could be [0:40] causing this? Are there any foods that I [0:42] should try and eat or foods that I [0:44] should try and avoid? So, we're going to [0:46] touch on that today as well. Like [0:48] sclerosis is a chronic inflammatory skin [0:50] condition that in women most commonly [0:52] affects the vulva and the skin around [0:54] the anus. It can also affect the penis [0:57] in men and in some people it even [0:59] affects skin at sites outside of the [1:01] genitalia like on the stomach for [1:03] example. While it can occur at any age, [1:06] it most commonly occurs in two peaks. [1:08] One at puberty and the other in [1:10] post-menopausal women. Overall, it's a [1:12] lot more common in women, but men [1:14] certainly are affected and it is equally [1:17] debilitating for them as well. The skin [1:19] of the affected areas becomes white, [1:21] thin, fragile, and prone to tearing. [1:24] It's often described as having this [1:25] characteristic wet cigarette paper [1:27] appearance. Because the skin becomes so [1:29] fragile, even minor friction results in [1:32] tearing. This can cause fissures, [1:34] bleeding, and ulcers. And one of the [1:35] most debilitating aspects of this [1:37] condition is the itch because it can be [1:39] very intense. Over time, the [1:41] inflammation and fragility can lead to [1:43] scarring that can result in [1:44] architectural changes that start to [1:47] severely impact overall function in the [1:49] area. In women this can cause for [1:51] example adhesions and narrowing of the [1:53] vaginal opening. This can lead to pain [1:54] with sexual activity and it can also [1:56] lead to problems with urination. In men [1:58] like sclerosis can affect the foreskin [2:00] and the urethra and sometimes lead to a [2:03] condition known as fimosis. So it's [2:05] really important because of the scarring [2:07] and disfiguring nature of this condition [2:09] that it receive prompt diagnosis and [2:12] appropriate medical therapy to slow and [2:14] prevent these alterations from happening [2:17] from scarring. Why exactly do you get [2:19] stuck with this debilitating condition? [2:21] Unfortunately, we don't have an good [2:23] answer as to why people get it, but like [2:26] many things in dermatology, it appears [2:28] to be multiffactorial. There's a [2:30] combination of a genetic susceptibility [2:32] combined with an underlying immune [2:34] dysfunction. It's commonly commonly [2:36] associated with other autoimmune [2:37] conditions, particularly autoimmune [2:39] thyroid disease. It's also associated [2:41] with other dermatologic autoimmune [2:43] conditions like vitiligo and alipcia [2:45] ariata. There's likely an underlying [2:47] contributing factor coming from some [2:49] sort of source of chronic irritation or [2:51] a prior trauma to the area. And it's [2:54] clear, especially given the peaks of [2:56] onset, that there's likely a hormonal [2:58] contribution as well. But again, we [3:00] don't have a single cause that explains [3:02] every case. One of the most challenging [3:04] aspects of lychen sclerosis is getting [3:06] it diagnosed. You might see one, two, [3:10] three gynecologists, urologists, primary [3:13] care providers, several dermatologists [3:15] before you ever get the correct [3:17] diagnosis. And going through that is [3:20] very, very emotionally taxing. It can [3:22] sometimes easily be confused with either [3:23] vitiligo, a contact eczema, psoriasis, [3:27] another condition that even sounds like [3:28] it like in simplex chronicus, certain [3:31] infections, and it can even be well [3:33] chocked up to hormones and menopause. a [3:36] biopsy might be necessary, especially if [3:38] the diagnosis is not clear or if there's [3:40] any concern at all that there might be [3:42] some precancerous changes occurring. [3:44] Unfortunately, many times one biopsy is [3:47] not enough. And while it's really [3:48] frustrating to hear that you might need [3:50] to have another biopsy, I want you guys [3:52] to know that because if you've been told [3:54] that, well, we already had a biopsy and [3:57] it showed this and that's all there is [3:58] to it, then I would suggest that you [4:01] seek out the opinions of dermatologists [4:03] and gynecologists with an established [4:05] track record of extensive experience [4:08] specifically with vulvar diseases. [4:10] Getting the diagnosis right matters so [4:12] that you can pursue the right treatment [4:14] and prevent complications. So, let's [4:16] talk about treatment. what actually [4:17] works. Fortunately, we do have effective [4:19] firstline treatments. First line [4:21] treatment is potent topical steroid. [4:23] Most commonly, that's going to be [4:24] clubbed. It's generally used daily [4:26] during the initial treatment period. And [4:28] then once the disease is controlled, the [4:30] frequency of use is reduced to a [4:32] maintenance schedule. If you are using [4:33] topical clatazol, here's something [4:35] really important to know. It's very very [4:37] important that you apply the topical [4:39] clatazol to the right area. You don't [4:41] need to coat the entire genital area [4:43] because cladazol is very strong and can [4:45] have unwanted side effects especially [4:47] when used to otherwise healthy skin. I [4:49] always suggest getting a handheld mirror [4:52] to look and see where exactly you are [4:54] applying. Don't just get a glob on your [4:56] finger and rub it down there and use a [4:58] very very small amount. Make sure that [5:00] the prescribing physician takes the time [5:03] actually to demonstrate the proper [5:05] application. That's their job and [5:07] there's valid reason to be concerned [5:08] about adverse effects. That's why I'm [5:10] emphasizing here how important it is to [5:12] apply it correctly in the right area. [5:14] But I also want you guys to feel [5:16] comfortable that when used as directed, [5:18] these are not only very, very safe and [5:20] low risk of side effects when used [5:22] correctly. They are incredibly effective [5:25] and their first line treatments here, [5:26] they work. Keeping the disease [5:28] controlled is key, not only to reduce [5:31] symptoms, but to reduce the risk of [5:32] complications. But for people who either [5:34] don't tolerate topical clbatazol or it's [5:37] not working for whatever reason, there [5:39] are alternatives that can be likewise [5:41] effective such as the topical [5:43] medications pimprolamus or tacrolymus. [5:46] These are medications known as [5:48] calcinurine inhibitors. They work a [5:50] little bit more precisely to halt the [5:52] inflammatory uh reaction that is causing [5:55] the disease. But they don't come with [5:56] the same battery of potential adverse [5:59] side effects and they may be a better [6:01] option for you. But what about people [6:03] who don't respond to these at all? What [6:05] else is there? And this is where things [6:07] get a little spicy in comparison to my [6:09] last video and that we have some [6:10] interesting promising updates for the [6:12] treatment of refractory lykan sclerosis, [6:15] meaning disease that remains difficult [6:17] to control with standard therapy. And [6:19] one area of interest that honestly has [6:21] huge interest from a variety of [6:23] different disease angles is the class of [6:25] medications known as jack inhibitors. If [6:27] you're in the United States, there's a [6:28] good chance you've seen a commercial for [6:29] a jack inhibitor at this point. They are [6:32] everywhere. Don't just know the brand [6:33] names. Always know the actual drug name. [6:35] Albeit they can be a bit of a mouthful. [6:37] So the drug names specifically we're [6:39] talking about here are baracitib and [6:41] abroitib. I will write those out on the [6:44] screen there. These have been studied in [6:45] patients with lyans sclerosis that [6:47] hasn't responded to conventional [6:49] therapies and the early results are [6:50] looking really promising. However, [6:52] they're still not firstline treatments [6:54] for this condition. These medications [6:56] work by targeting specific aspects of [6:58] the immune system and they've been [7:00] proving to be very useful for shutting [7:02] down and quieting a variety of [7:03] autoimmune conditions. Then another area [7:05] that's received a lot of attention [7:07] actually is laser treatment, [7:08] particularly fractional CO2 laser [7:10] treatment. Some studies suggest that [7:12] laser treatment might actually improve [7:14] some of the symptoms, which hey, even if [7:15] it can't get rid of the disease, getting [7:17] rid of the itch, I think most people [7:19] would be like, "Yeah, sign me up." [7:20] Especially if the itch has not responded [7:22] to topical corticosteroids. Again, still [7:24] not a first-line treatment by any means, [7:26] but I wouldn't be surprised if perhaps [7:27] your dermatologist might consider [7:29] offering that to you if they have that [7:30] laser and are comfortable using it in [7:32] this area. There's also growing interest [7:33] in something known as plateletri plasma, [7:35] otherwise known as PRP. You may have [7:37] heard of this when Kim Kardashian went [7:39] viral for the vampire facial. PRP is [7:42] essentially something that is derived [7:44] from your own blood. They take out a [7:46] sample of your blood, spin it down, and [7:47] isolate this plateletri fraction that is [7:50] enriched in uh these granules that have [7:53] growth factors and all sorts of [7:54] anti-inflammatory this that and the [7:56] other. And then they inject it back in [7:58] to where they want to treat. In this [8:00] case, it would be the genital area [8:01] perhaps can help calm things down quite [8:03] a bit. It it's showing promise. There's [8:05] also regenerative approaches that [8:07] utilize autogus fat transfer and fat [8:10] grafting. basically harvesting fat from, [8:12] I don't know, like a love handle and uh [8:14] injecting it back in elsewhere. And [8:17] because those cell populations have a [8:18] variety of regenerative properties to [8:20] them, they may help with the healing [8:22] process. But it's important to know [8:23] these are experimental and emerging [8:25] therapies. In other words, they're not [8:27] like on the guidelines, this first line [8:29] by any means. It's still still going to [8:30] be clubbed, but I know a lot of you guys [8:32] have done the clatazol thing and either [8:34] you didn't get results or you know, [8:36] you're like, we need to we need to [8:37] consider other things. All right. Given [8:39] that this is so common to arise with [8:41] menopause, however, I want to talk about [8:43] something that often gets brought up and [8:44] that is what is the role here for [8:46] estrogen therapy because lychans [8:48] sclerosis again it's common in [8:50] menopause. With menopause, you also [8:53] frequently you know vaginal estrogen can [8:55] be helpful and is often brought up in [8:57] the conversation when it comes to [8:58] addressing genital urinary symptoms that [9:01] women start experiencing a lot with [9:03] menopause like vaginal dryness, urinary [9:05] frequency, pain with intercourse. This [9:07] is related to the hormonal changes of [9:09] menopause leading to well atrophy of [9:12] these tissues and dryness and just an [9:15] overall greater tendency to irritation [9:16] and discomfort. And while patients who [9:19] have lyen sclerosis who are [9:20] post-menopausal may also be experiencing [9:22] these symptoms and derive benefit [9:24] symptomatically with a estrogenbased [9:27] therapy. The estrogen unfortunately does [9:29] not target the inflammatory aspect of [9:32] the lychen sclerosis. It's not [9:34] considered like a firstline treatment. [9:35] it alone would not be sufficient for [9:37] example to prevent the um you know the [9:40] serious adverse complications of [9:42] untreated disease. So while a [9:44] post-menopausal woman could definitely [9:46] have menopause related dryness urinary [9:49] problems the estrogen is not necessarily [9:51] going to directly treat the LS that [9:54] still needs active ongoing treatment and [9:56] again topical cladazol is the first [9:58] line. You want to make sure if you have [10:00] this that you are really, really careful [10:03] to avoid scented products in that area. [10:06] And that doesn't just include bubble [10:08] baths, shower washes, bubble baths, [10:10] douches. Avoid all of that stuff. But [10:12] you also want to be careful with scented [10:15] panty liners, they put fragrance in [10:17] those. Your laundry detergents, you [10:19] might all, you know, it might behoove [10:20] you to switch to fragrance-free [10:22] fragrance. It can be really irritating [10:24] for stuff like this for reasons that are [10:26] not always clear. Also, the clothing [10:28] that you wear can make a difference [10:30] here. You want to avoid tight, [10:31] restrictive clothing. You want to stick [10:32] to loose, breathable fabrics. The [10:35] skimpy, lacy, tight thongs, cute or [10:37] whatever, but not [clears throat] so not [10:39] so good here. Remember, any kind of [10:40] friction is going to cause irritation in [10:42] that area. Anything that brings in [10:44] irritation, worsens the inflammatory [10:46] underlying process. So, that's what [10:48] we're trying to avoid. We're trying to [10:50] avoid stirring the pot, okay? We want to [10:52] be peacemakers when it comes to that. We [10:54] don't want to be egging on the [10:56] inflammation with a bunch of sold [10:58] dejaunu, you know. So, there you have [11:01] it. Um, and then for the men out there, [11:03] you know, you want to do things as well [11:04] to reduce friction in that area. Wear [11:07] loose- fitting cotton underwear rather [11:09] than more restrictive uh synthetic [11:11] fabric. Also, your athletic wear for [11:13] both men and women. You know, the the [11:15] leggings and things can lead to a lot of [11:17] friction, trapping of moisture. Moisture [11:19] leads to a lot of irritation. And then [11:21] if you're doing things like running [11:23] where you have a lot of repeat motion [11:25] and skin-on-kin rubbing, use a barrier [11:27] cream, you know, to cut down on shafing [11:29] for sure. Plain petroleum jelly is [11:32] great. Diaper rash cream is great in [11:34] these areas. Also, a dimethylone based [11:36] skin protectant like the Monostat [11:38] Chafing Relief Powder Powder Gel. Yeah, [11:40] men could use that. Okay. There's [11:42] nothing about Monostat Chafing Relief [11:43] Powder Gel that is specific to the [11:45] issues of female chafing. Skin rubbing [11:48] together is skin on skin contact, [11:50] rubbing together, chafing, the same lub [11:52] lubricating barriers [clears throat] [11:54] work well for men and women is what I'm [11:55] getting at here. Now, if you struggle [11:57] with urinary incontinence, stool [11:59] incontinence, um that's actually a [12:02] common thing, you know, like sometimes [12:03] as you get up there in years, you laugh [12:05] and a little bit of urine comes out or [12:06] you it just happens, right? like it's [12:08] just part of the aging process for a lot [12:10] of people or just part of you know a lot [12:12] of women deal with these things after [12:14] they've had a baby shortly shortly after [12:16] they've had a baby for a bit and so be [12:18] real vigilant in those cases if that's [12:20] something you struggle with to change [12:22] out of your underwear right away and and [12:23] clean the area with just a little dilute [12:25] soapy water and rinse thoroughly and [12:28] make sure it's good and dry and and [12:29] change out your underwear. It's a it's a [12:31] pain, but uh that's that's a real [12:33] problem that can lead to a lot of [12:34] irritation is stool and urine in contact [12:37] with the skin. Even the tiniest little [12:39] drop of urine, I mean, it can really be [12:41] very irritating. Can lyen sclerosis [12:43] cause cancer? Genital lychan sclerosis [12:45] is associated with an increased risk of [12:47] squamous cell carcinoma. Now, that [12:49] doesn't mean that if you have lychen [12:50] sclerosis, you're going to get cancer. [12:52] Most people who have properly managed [12:54] lykan sclerosis don't go on to form [12:56] squaml carcinomaomas. Chronic [12:58] uncontrolled inflammation definitely [13:01] increases the risk. Okay, that's why not [13:03] only getting the right diagnosis is [13:05] huge. Staying consistent with your [13:07] treatments and following up with your [13:08] doctors. Okay, that that's also really [13:11] important. And if you notice any changes [13:13] down there, a new persistent lump, patch [13:15] of like abnormal appearing skin, a sore, [13:18] a thickened area, bring those to the [13:20] attention of your doctor ASAP. Don't [13:22] simply assume it's just another flare [13:24] that is acting a little off. All right. [13:26] What about your diet? Okay. Is there is [13:28] there anything that you can tweak in [13:29] your diet to get this under control? In [13:32] general, um while there's not a single [13:34] diet or a single food that's going to [13:36] calm this down, cure it, or anything of [13:39] that sort, when it comes to inflammatory [13:41] things, inflammatory conditions, they [13:43] are certainly not helped by only eating [13:46] McDonald's, for example, or only eating [13:49] uh Taco Bell, Doritos, Mountain Dew, [13:51] Fritos. But I would not recommend that. [13:53] you know these um highly refined sugars, [13:56] they are associated with just a lot more [13:58] inflammation. The way your body [13:59] metabolizes those refined sugars is much [14:02] different than in your whole foods in in [14:04] the foods that you could cook at home [14:06] for a fraction of the price. I might add [14:08] the body does not handle those um as [14:11] well. It's not to say that no one can [14:12] ever eat those, but I'm sure it's not [14:15] going to hurt you to change that up and [14:17] you might notice an improvement. Okay, I [14:19] don't want to overstate the role of [14:21] dietary changes, but um I would [14:22] encourage you to make that kind of [14:23] choice anyway. It's not going to hurt [14:25] the disease to make healthier food [14:27] choices. It can only it can only benefit [14:29] you in the long run, okay? It can only [14:31] benefit you to start making better diet [14:32] choices. But you're going to see people [14:34] online who sing the praises of [14:36] eliminating a particular food as the [14:38] cure. And you've got to be careful with [14:40] that. Okay? There's no diet like [14:42] glutenree, dairy free, animal free, [14:45] vegetable free. I mean, all of these [14:48] elimination diets, the anecdotes that [14:50] they are giving, there may be some truth [14:52] to them, but they're not enough to go [14:55] recommending this to a general audience, [14:56] and they can be really dangerous. [14:58] Elimination diets can result in [15:00] nutritional deficiencies. Not only is it [15:02] not evidence-based for lyan sclerosis, [15:04] but it's really not evidence-based for [15:06] anything other than if you have an [15:07] underlying food allergy. But I do want [15:09] to bring your attention to an [15:10] interesting case report I came across [15:11] cuz this is something that a lot of [15:13] people ask about and honestly I never [15:15] would have thought about this group or [15:17] even considered it a group until I think [15:19] it was a football player that was all [15:21] like oh yeah nope not eating that and [15:22] I'm like what and that is uh this one [15:25] case report I mean one person you guys [15:28] okay so one person does not make for the [15:30] treatment algorithm but this one case [15:32] report of a woman who noted that every [15:34] time she ate I think it was tomatoes she [15:37] had a flare up eliminating of zero [15:39] tomato and no night shades. Okay, the [15:42] disease for her cleared up. This is an N [15:44] of one. It cleared up, but then she ate [15:47] some salsa and it did come back. So, [15:49] that is for her compelling enough to be [15:52] like, you know what, you're not going to [15:53] die from not eating tomatoes and night [15:56] shades. There's enough other foods out [15:57] there that you're not going to become [15:58] nutritionally deficient. This definitely [16:00] seems to be some kind of trigger for [16:02] you, but it's not a universal trigger [16:05] for everyone. So, in other words, if you [16:07] think that this sounds like you and that [16:09] every time you eat tomatoes, things get [16:11] worse for you, it might be worth taking [16:13] a break from them for a while and seeing [16:14] if it helps. But I would caution against [16:17] big elimination diets, like eliminating [16:20] huge groups of food all at once, [16:22] especially without medical supervision. [16:24] And I also would discourage testing for [16:27] food allergy. Food allergy testing is a [16:30] slippery slope because tons of stuff. I [16:33] promise you if you go and get tested for [16:34] food allergies, you're going to come up [16:36] allergic to everything, right? That's [16:38] what you're going to be led to think. [16:39] I'm allergic to all of this stuff. No, [16:41] you have antibodies to all this stuff. [16:43] Why? Well, cuz you've been exposed to [16:45] all these foods throughout your whole [16:46] life. Okay? The antibbody presence alone [16:49] does not equal allergy. It has to be [16:51] clinically relevant. Meaning every time [16:53] you eat just that food, you get allergic [16:55] reactions and specific types of [16:57] reactions. So in other words, this is [16:59] not a fruitful line for you to go [17:01] pursuing or it's all food allergy [17:03] testing. Nor do I recommend just doing [17:05] an elimination diet. Elimination diets [17:08] can do a lot of harm nutritionally. [17:10] Okay? So I don't recommend that. In [17:11] other words, no, there's not a lyan [17:13] sclerosis diet out there. If you go and [17:15] ask your doctor, "What food should I be [17:16] eating?" You know, they may just say, [17:17] "Oh, Mediterranean diet." Cuz that's [17:19] kind of the buzzword right now. How many [17:21] Mediterranean countries are there out [17:22] there? It's a pattern of eating that [17:24] emphasizes fruits, vegetables, [17:25] minimizing red meat consumption, the use [17:28] of olive oil, nuts, seeds, and uh fish [17:31] and seafood is also, you know, part of [17:33] it along with moderate red wine [17:36] consumption. Okay. Whatever that means. [17:37] Yeah, it's it's a pattern of eating that [17:39] makes sense. It's, you know, leans more [17:41] towards whole foods and the good stuff [17:43] and minimizes the refined garbage and [17:46] the, you know, processed meats which are [17:48] inflammatory and not great. Um, so your [17:50] your doctor in a rush state might say, [17:52] "Oh, yeah, Mediterranean diet." Um, but [17:55] um, see if you can't, you know, talk [17:56] with a dietitian about more about that [17:59] and and you know, how to structure your [18:00] eating and in in a a safe way without [18:03] going through these whole, you know, [18:04] elimination diets are going down a [18:06] rabbit hole. You're going to find a [18:07] rabbit hole of every single diet out [18:09] there, okay? You know, some people think [18:11] that you got to live on nothing but [18:13] potatoes. Other people subsist on [18:14] nothing but ribeye. I mean, and I [18:16] wouldn't recommend anybody go down these [18:18] rabbit holes. They can be very [18:20] dangerous. Okay. Lastly, I want to [18:22] emphasize the importance of follow-up. [18:23] Things can change. Your disease can stop [18:25] responding and we got to get control of [18:27] those symptoms so you don't suffer. [18:29] Dermatologist, gynecologist, urologist, [18:32] you need the whole team involved. And [18:33] you need to stay consistent with them. [18:34] They are on your side. Even though [18:36] sometimes they're a little pressed for [18:37] time, they may seem in a hurry. And hey, [18:39] if you're not getting where you need to [18:41] go on with them, move on to someone [18:42] else. Try and move on to someone else. [18:44] Um, it's worth a second opinion. There [18:47] are centers in in throughout this [18:48] country at the very least um and I know [18:50] in other countries as well where they [18:52] are just focusing on these vulvar [18:54] diseases and inflammatory eurogenital [18:57] diseases. Okay, so seek out seek out the [19:00] experts. Okay, you owe it to yourself [19:02] for sure. I really hope today's video [19:04] was helpful, educational, insightful, [19:06] and brought a little something [19:07] additional to the conversation compared [19:08] to my 2023 video as far as an update [19:11] therapeutically speaking. It's still a [19:13] tough disease. We still don't have a [19:14] cure. We still don't know why you have [19:16] it and we still don't have the lychans [19:18] sclerosis diet for you to follow. But we [19:20] do have a little bit of progress. Hey, [19:21] it's only been that was 2023. It's only [19:24] been 3 years. So, I mean, for medicine, [19:26] that's like a ton of new stuff. Okay. [19:29] Realistic expectations here. Jack [19:30] inhibitors might be an option for you. [19:32] PRP, but more more research is needed. [19:35] Laser therapy, even some regenerative [19:37] stuff coming down the pipeline. There's [19:39] hope. There's reason to be hopeful. [19:40] Okay? There's reason to be hopeful, but [19:42] persevere with staying consistent with [19:44] your treatment and your your your health [19:46] care providers. All right, y'all. If you [19:47] enjoyed today's video, give it a thumbs [19:49] up, share it with your friends, and as [19:50] always, don't forget sunscreen and [19:52] subscribe. I'll talk to you guys [19:53] tomorrow. Bye. [20:07] [music]