Lichen sclerosus (LS) is a chronic, inflammatory skin disease. It causes thin, white, patchy areas of skin that can be painful, tear easily, and itch. These areas can appear anywhere on the body but are usually found on the vulva, around the anus, or on the foreskin of the penis in uncircumcised men. Lichen sclerosis most commonly affects postmenopausal women but can erupt at any age. It currently has no cure. Even though men get this condition, it’s classified as part of a group of vaginal disorders called vulvodynia.
Managing lichen sclerosus involves a proactive approach to treatment and making necessary lifestyle adjustments that influence symptoms. With no known cure, ongoing symptom management through treatments like topical steroids and lifestyle adjustments is essential. Medical management of lichen sclerosus most often involves topical steroid creams like clobetasol and other prescription medications to reduce inflammation in the area. With LS, the body directly attacks the skin in the affected areas. Steroidal agents work by lowering the inflammatory cytokines in the skin or body as a whole. This can help to relieve pain and itching, soften the skin and decrease the risk of scar formation. Because LS can lead to permanent scarring that can have concerning effects on sexual and general health, regular follow-ups with a healthcare provider are critical. Close monitoring also allows intervention if a treatment is not working or causing undesirable side effects.
The Role of Diet in Managing Lichen Sclerosus
Determining the relationship between Lichen Sclerosus (LS) and diet on your symptoms, flares, and condition progression can be confusing. While there is no specific diet proven to cure lichen sclerosus, a balanced anti-inflammatory diet with plenty of whole foods, reduced sugar, and avoidance of processed foods may help support skin health and lower inflammation.
Limited Research and Individualized Approaches
Very little research has been done specifically on diet and lichen sclerosus. The Vulval Pain Society provides some research pointing to the potential benefit of diet changes, like a low-oxalate diet, that may affect pain level. Findings are not conclusive. But, even if there aren’t many studies specifically looking at diet concerning LS, we know that LS is a chronic inflammatory skin condition primarily affecting the anus and genitals’ skin. As such, we can better understand how diet impacts LS through research that looks at gut health, diet and inflammation, or diet and immunity.
"And the thing is, Lichen Sclerosus is an individualized disease, accordingly, your nutrition should be individualized too. Just because one person can’t eat corn doesn’t mean you have to get rid of corn too. Find what works for you! Know that an LS diagnosis doesn’t mean you have to stop eating all of the things that bring you joy and pleasure. Your joy and pleasure matter."
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Evidence-Based Approaches: Balanced Nutrition
Balanced nutrition is key for general and skin health. In many ways, the health of your skin is a direct reflection of the nutrients you supply it with. Therefore, following a balanced diet with valuable nutrients to support skin health can be essential to managing lichen sclerosus. Be sure you are consuming a diet rich in antioxidants, omega-3 fatty acids and vitamins like A, C, D and E. For NHS dietary advice, see NHS Eat Well.
Dietary Strategies to Consider
Beyond being careful about the amount of oxalates you're eating, the following diet tips may help manage symptoms of lichen sclerosus.
Low-Oxalate Diet
There is little-to-no research on the impact of diet on lichen sclerosus. This lack of ironclad evidence doesn’t mean you should not try a low-oxalate diet, especially if a urine test indicates you have high levels of oxalate in your urine. Eliminating high-oxalate food is effective, for some women. You can also talk to your doctor, or dietitian, about the low-oxalate diet, and its potential benefit for you.
Oxalate is a byproduct of your body’s metabolism. It’s produced naturally by the body and is also found in many plants. High-oxalate foods can cause inflammation in the body’s tissues. Oxalate is eliminated from the body through urine and stool. Reducing the amount of oxalate which passes through your system may help to reduce inflammation from occurring around the vulva and anal region. Eating low-oxalate foods may help, especially when coupled with a calcium citrate supplement, or with high-calcium foods. Calcium binds to oxalate, reducing its absorption into the body’s tissues.
The low-oxalate diet eliminates high-oxalate foods and drinks. These include:
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- Spinach, raw and cooked
- Canned pineapple
- Many boxed cereals
- Dried fruit
- Rhubarb
- Rice bran
- Bran flakes
- Soy flour
- Brown rice flour
- Almonds
- Potatoes in all forms, including baked, French fries, and potato chips
- Buckwheat groats
- Beets
- Turnips
- Cocoa powder, and hot chocolate
- Nut products, such as peanut butter
Low-oxalate foods and drinks include:
- Poultry
- Fish
- Beef
- Dairy products, such as cow’s milk, goat’s milk, and cheese
- Avocados
- Apples
- Melon
- Grapes
- Peaches
- Plums
- Broccoli
- Asparagus
- Cauliflower
- Lettuce
- White chocolate
- Green peas
- All oils, including olive oil, and vegetable oil
- Herbs, and seasonings, such as salt, white pepper, basil, and cilantro
- Beer, and most forms of alcohol
- Coffee
- Weak, lightly-steeped green tea
Some tips for sticking to this food plan include:
- Keep a list of high- and low-oxalate foods on hand.
- Eat calcium-rich foods, or take a calcium citrate supplement daily.
- Keep a daily oxalate journal, to track your food intake, symptoms, and progress, over time.
- If you plan on eating out, review the restaurant’s menu on line, and call ahead to inquire about ingredients used in the dish you wish to order.
- Drink lots of water and other low-oxalate beverages to help flush out your system.
- Use an oxalate app tracker to check out the oxalate content of foods, such as breakfast cereals, in the store, and on the go.
- Having your urine tested to determine if it’s high for oxalate may provide information about this food plan’s ability to work for you.
Important note: Findings are not conclusive, and a low-oxalate diet has been refuted by another study.
Autoimmune Protocol (AIP) Diet
Around 20 to 30 percent of women with lichen sclerosus have an autoimmune disease, such as rheumatoid arthritis. As more research is published, a stronger argument exists to class LS as an autoimmune condition. Other possible contributors include chronic irritation or trauma and autoimmune conditions, particularly autoimmune thyroid disorders. Approximately 12% of individuals with LS have either Hashimoto’s thyroiditis or Graves’ disease. If so, you may also wish to discuss the potential benefits of the autoimmune protocol diet with your physician, to determine which food plan is best for you to try.
Although there are no direct recommendations for a lichen sclerosus diet, there is a strong link to autoimmune disorders, hormone imbalances, and autoantibodies, so a diet used to control autoimmune disorders could potentially help with symptoms. The autoimmune protocol diet consists of an elimination phase during which grains, legumes, nightshades, dairy, eggs, coffee, alcohol, nuts and seeds, refined/processed sugars, oils, and food additives are removed from the diet. This diet is maintained for several weeks and sometimes foods are slowly reintroduced to observe if symptoms return. This can help target offending foods. In other cases, people with autoimmune diseases may choose to keep these foods out of the diet indefinitely. This type of elimination diet can be tricky to do on your own, so it's a good idea to enlist the help of your doctor or a dietitian to make sure you're still getting the nutrients you need.
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Elimination Diet
Let’s take what we’ve learned about potential nutritional triggers and put it into practice. An elimination diet provides a way to identify food triggers by eliminating all foods that you suspect may be causing inflammation and then reintroduce them one at a time. The reintroduction period is slow. One potential pitfall is that restrictive eating can trigger disordered eating patterns. Elimination diets also fail to recognize that most of us have social, emotional, and cultural connections to food.
Mediator Release Testing (MRT)
The shortcut I use in the clinic is food sensitivity testing, specifically, Mediator Release Testing or MRT. The MRT simplifies highly complex metabolic reactions. Our role is to use self-directed lab work to break the cycle of trial and error once and for all.
Other Dietary Considerations
- Nightshade Vegetables: In one case, a patient with vulvar LS found complete resolution of symptoms after eliminating tomatoes and other nightshade vegetables, including all varieties of peppers, from her diet.
- Sugar: The Standard American Diet (SAD) and the consumption of high-sugar soft drinks often lead to an elevated blood glucose level known as hyperglycemia.
- Gluten: Since a lot of evidence supports gluten’s role in inflammation, gluten is high on the list when it comes to LS foods not to eat. Beyond celiac disease, gluten, or more specifically gliadin, the protein found in wheat, has been shown to cause non-celiac gluten sensitivity, activating T-cells and triggering a pro-inflammatory response associated with autoimmunity.
Beyond Diet: Additional Lifestyle Adjustments
While diet can play a significant role in managing lichen sclerosus, other lifestyle adjustments can also contribute to symptom relief and overall well-being.
Stress Management
While LS can have many underlying factors, stress can be one of them to acknowledge. Stress impacts overall health and may influence the severity of lichen sclerosus. Research from 2019 in the Open Access Journal of Urology suggests that oxidative stress contributes to LS by damaging DNA and lipids, potentially leading to skin lesions. To work toward reducing stress, things like mindfulness, yoga, getting enough sleep and regular physical activity can help.
Skin Care
One of the most important things you can do at home if you have LS is to be attentive to keeping the skin clean and moisturized while avoiding scratching as much as possible.
Staying Hydrated
Drink Plenty of WaterMake sure to drink plenty of H2O throughout the day, which will help you stay hydrated but also thin out your urine, which can prevent the buildup of chemicals that can irritate lichen sclerosus.
The Importance of a Healthcare Team
With lichen sclerosus, having a good care team on your side can be exceptionally important. At Coyle Institute, we build personalized treatment plans and use revolutionary LS treatments like the TULIP® procedure developed by Dr. Michael Coyle to support your quality of life and encourage healing.