DEAR DR. ROACH: I’m a 72-year-old female recently diagnosed with lichen sclerosus of the vulva. The issue started about four years ago with a rash on my buttock, for which I used every over-the-counter medication available. I had no positive results, so I went to a dermatologist, who couldn’t identify it (no meds prescribed), then to my family doctor, who also couldn’t identify the problem. She recommended that I see a gynecologist, who made the diagnosis after an internal exam, with no other testing ordered. I haven’t done much research and know only that my GYN has said it needs to be watched and can turn into a nasty cancer. My symptoms are itching and burning periodically, and I am using clobetasol during outbreaks. Is there a test other than an internal exam to determine if the diagnosis is accurate? If so, what would it be? What percentage of cases do result in cancer diagnosis? I feel like I need a second opinion. — E.F.
ANSWER: Lichen sclerosis is a progressive skin condition that can happen to both men and women. It is itchy and painful, and has both inflammation and thinning of the skin. In women, vulvar lichen sclerosis happens most commonly in prepubertal girls or peri- or postmenopausal women. It is very common — as many as one in every 59 women in a gynecology practice — so your gynecologist was able to easily recognize it.
It isn’t known what causes lichen sclerosis. Genetic factors, environmental factors and autoantibodies all may have roles.
Itching usually is the major symptom, both in the vagina and around the anus, but it also may cause pain of those regions, especially during urination, defecation or sex. These symptoms are more common with advanced disease. The diagnosis is made by exam and ideally confirmed by biopsy.
Women with lichen sclerosis are at risk for a particular cancer (squamous cell cancer) of the vagina. Fortunately, studies estimate that less than 5 percent of women with LS will develop cancer. Further, treatment may reduce risk of developing cancer.
Your gynecologist is treating you with what we think is the best available therapy, a super-high-potency steroid. Many gynecologists recommend using it sparingly, once or twice a week, even between outbreaks, to maintain remission.
Some women benefit from estrogen cream as well, especially if atrophy is present.
DEAR DR. ROACH: I am 70 years old and have been dealing with a problem for about a month now that I’ve never read about in your column. The upper joint in my left thumb pops every time I bend it. The lower thumb joint is tender, and it is becoming increasingly difficult to grasp things. The thumb never gets stuck. My right thumb pops only occasionally, and there is no pain there. Can you please tell me the cause of such an anomaly, and the type of doctor that I should be seen by? I am very active, and this has become a bit bothersome, both physically and mentally. — C.G.
ANSWER: If it’s not getting stuck, then the popping sound can be made by one of the tendons snapping over a bony protuberance, or it can be from nitrogen bubbles coming out of solution. Neither of these usually causes much trouble by itself. The fact that you are having pain suggests that you may have some arthritis in the thumb joint. A rheumatologist is the expert in all joint matters, but your regular doctor probably has a fair bit of experience with this as well.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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