Why You Shouldn’t Be Afraid to Use Steroids for Lichen Sclerosus
The truth about what really protects your vulva.
Lichen sclerosus is one of the most misunderstood vulvar conditions out there—and unfortunately, so is the treatment. Many patients are told they need a steroid… and then promptly told to “use it sparingly,” “only if needed,” or worse, not at all. Cue the confusion, fear, and flare-ups.
Let’s clear this up.
First, what is lichen sclerosus?
Lichen sclerosus (LS) is an autoimmune condition that affects the skin—most commonly the vulva, though it can also involve other areas. It causes whitening of the skin, irritation, pain, and over time can lead to scarring and architectural changes. That can mean adhesions around the clitoris, narrowing of the vaginal opening, and even difficulty with sex, pleasure, or just peeing comfortably.
While the skin looks thin, it’s actually not just thinning—it’s becoming sclerotic: stiff, scarred, and less flexible.
So why steroids?
Because they work.
We need super potent topical steroids (like clobetasol) to permeate the outer layer of vulvar skin and treat the active inflammation and scarring underneath. These medications aren’t “too strong”—they’re exactly the strength needed to calm down the immune response and restore healthier, more pliable tissue.
Here’s what these steroids do:
Decrease inflammation and immune overactivity
Improve color and flexibility of the skin
Prevent long-term scarring and fusion
Reduce the risk of vulvar cancer
And here’s what they don’t do:
Systemically affect your entire body
Ruin your vulva
Turn your skin into tissue paper
But isn’t steroid use dangerous? Won’t it thin my skin?
This is where the fear lives—and where we need to bust some myths.
Yes, steroids can thin the skin if misused—but not when they’re used properly on vulvar tissue.
The inner labial skin is a modified mucous membrane, not like the skin on your arm or leg. It responds differently and is much less likely to thin with appropriate treatment.
In fact, many patients need to thin the sclerotic tissue—that’s how we improve symptoms and restore function. What you’re seeing as “whitening” or “thinning” is often that scar-like buildup. Steroids treat that. It’s a good thing.
Treatment isn’t short-term. It’s a long-term relationship.
Lichen sclerosus doesn’t go away. But it can go into remission and stay there—with consistent treatment.
Here’s how I typically approach it:
Induction phase: Use the steroid daily or almost daily for a few weeks to calm the inflammation and get symptoms under control.
Maintenance phase: Continue using it 2–3 times per week to prevent flare-ups and future damage.
Combo therapy: I often recommend alternating steroid use with vaginal estrogen cream on the vulva. Estrogen helps plump up the tissue and pairs beautifully with the steroid to keep things healthy.
What happens when patients are too afraid to treat?
Unfortunately, this is common—and it leads to real harm.
When LS is left untreated or undertreated, it can:
Cause progressive scarring
Bury the clitoris under adhesions
Narrow the vaginal opening
Make sex and pleasure painful or impossible
Increase the risk of vulvar cancer
Avoiding steroids doesn’t protect your vulva—it puts it at risk.
If I had lichen sclerosus, would I use clobetasol on my vulva?
Yes. In a heartbeat.
I don’t have LS (yet), but if I did, I would absolutely use topical steroids—and I wouldn’t be afraid of them. Because I’ve seen what happens when we treat this condition well… and what happens when we don’t.
You deserve care that’s based in science, not fear.
And your vulva deserves to feel like yours.
