Lichen Sclerosis and prone to thrush

[cherrywood]

Hi there,

I have recently been diagnosed with early vulval lichen sclerosis after living with on/off thrush for two years.

I have crohns disease and have been on immunosuppressants since 2021 which unfortunately cause thrush as a side effect. I managed to access thrush maintenance therapy in January 2024, which eased my thrush symptoms somewhat, however it can sometimes still flare when I do my fortnightly injections.

When I attempt to use a topical steroid for LS it causes the thrush to flare. I have tried dermovate and betnovate. Candida has been picked up in my sample despite the thrush maintenance therapy.

I don’t have a dermatologist, the nhs waiting list where I’m based is 2/3 years, so care is currently GP led and they are not sure how to proceed. I am trying to access a referral to a sexual health clinic (there are no walk-in options).

My symptoms are primarily redness and inflammation of the vulva and vagina, blood spots around my urethra and clitoral hood, vaginal burning, pain with insertion (paper cut feeling) and vaginal cuts have been observed during my internal vaginal examinations.

I have not had a biopsy as of yet, is this something I should request? Can you please suggest what treatment options are available for someone newly diagnosed with LS who also has a condition or takes medication that makes them prone to thrush?

Thank you for your help with this.

[Dr Rosalind Simpson]

This is quite a challenging situation to manage, sorry you are having a difficult time.

Please ensure that any discharge, or the red skin has been swabbed to confirm candida (thrush) infection and check the type of thrush (there is more than one type, some species are more tricky to treat than others).

Combination topical steroid/antifungal creams can be very helpful in this situation. Your GP should be able to prescribe one of these to you.

A biopsy may be helpful in confirming the diagnosis, however, it is unlikely that your GP will do this and you'll need to wait until you are seen by a specialist.

If the wait to be seen by a specialist is very long, the GP could always request advice and guidance from a local specialist team, if this is something that is offered, to help you in the meantime.