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Why are Patch Tests so Important for Lichen Sclerosus?

08Nov 2022 by Jaclyn
Image of a doctor administering a patch test on the back of a patient with pale skin and blonde hair.

Introduction

Have you ever used a product on your vulva and ended up having a bad reaction to the product? Maybe you experienced new redness, pain, and itch after using a new emollient the internet was raving about? If so, you are not alone. Many vulvar products can cause an allergic reaction or contact dermatitis. In this post, I discuss the types of vulvar products you may use if you have lichen sclerosus, what a patch test is, the importance of patch tests, and more.

Vulvar Products You May Use if You Have Vulvar Lichen Sclerosus

If you have vulvar lichen sclerosus, your care routine may involve using some of the following products:

  • Steroid cream/ointment (e.g., Clobetasol)
  • Calcineurin inhibitors (e.g., Tacrolimus, Pimecrolimus, etc.)
  • Hormone cream (e.g., estrogen, testosterone, or a combination of both)
  • Emollient/vulvar moisturizer (if you're new to emollients, check out my blog post on this product here or check out my video on YouTube)
  • Cream/ointment for pain (e.g., Lidocaine, compounded Gabapentin/amitriptyline, etc.)
  • Lube (to make insertion easier).
  • Vulvar cleanser (e.g., SweetSpot labs or Cerave)
  • Other
Image of Alni Body Care LLC's CBD lubricant. The bottle is a very dark green with pink and blue circular label saying 'Alni CBD' on the bottle. Image used with permission from Alni Body Care LLC.
image of a coconut and a jar of oil next to it.

Steroid ointment and calcineurin inhibitors are considered treatments for lichen sclerosus. Hormone creams are adjuncts and can help bring more moisture and elasticity to the vulva; they may also be prescribed for other, non-lichen sclerosus reasons. Emollients are used to protect and moisturize the skin. Lube is used for sexual activity to help reduce friction and increase pleasure. Finally, even though most dermatologists and gynecologists recommend washing the vulva with warm water, some folks opt to use a cleanser nonetheless.

Of course, you may not need to use every one of these products. However, it's likely that you use at least a couple, and may occasionally introduce a new product from time to time. Each time you introduce a new product to the vulva, I recommend doing a patch test.

What is a Patch Test?

A patch test is where you test out a substance – in the context of this post, a cream, ointment, gel, etc – to see if it causes any allergic reaction or contact dermatitis. ⁠

Image of a person with a patch of irritated skin on their arm. While it's not their vulva, this image represents the kind of irritation that can occur from an allergic reaction or contact dermatitis.

Signs and symptoms of an allergic reaction or contact dermatitis include new redness/skin color change, itch, swelling, and/or irritation. The word ‘new' is important. If you already have swelling and redness and you use a new product, the new product may not be the culprit since those signs were already present. However, if you use a new product and shortly after you see redness and feel raw and irritated, this could be an indication that you are experiencing an allergic reaction or contact dermatitis from the new product.

Why are Patch Tests so Important?

If you are reading this and have vulvar lichen sclerosus, I don't need to tell you how awful it is to live with symptoms like vulvar pain and itch. Given this, you don't want to add something like an allergic reaction or contact dermatitis on top of vulvar lichen sclerosus. This can take your pain and discomfort level from a 6 to a 10 really fast. We want to reduce pain and discomfort, not do things to add to it and compound the issue.

Many things in life are out of our control. Luckily, we do have control over what products we put on our vulva.

Enter patch tests!

Image of a doctor administering a patch test on the back of a patient with mid-length blonde hair.

A patch test allows you to test out new vulvar products in a more systematic and controlled way. Instead of simply slapping on a ton of new product over the whole vulva, you strategically introduce a small amount of product to an area of the vulva to test for any reactions. This way, if you do have a negative reaction, that reaction is specific to a small area of the vulva instead of the entire vulva, which would be way more uncomfortable. Of course, having a negative reaction means you should probably stop using the product.

How to do a Patch Test

The following is how I patch test; it is not medical advice.

Anytime I add a new product to my LS regimen, I do a patch test.

Step #1

Apply a pea-sized amount of product to a small area of the vulva. I usually do my left labia minora, but you can pick which area you want to test out.

*If you feel nervous about patch-testing on your vulva, you can start by testing on a non-vulvar area first and then after 24-48 hours, test on a small area of the vulva.

Step #2

Wait approximately 24-48 hours after application before applying the product again. During that time, be sure to monitor the area for any new signs of redness, swelling, itch, and irritation.

Step #2.1

If you do see any new signs of redness, swelling, itch, or irritation, discontinue use. It is likely that you are allergic or sensitive to an ingredient in the product.

Step #3

If there are no new signs of redness, swelling, itch, or irritation 24-48 hours after application, repeat the process using a bigger amount of product on a larger area of the vulva. For example, instead of a pea-sized amount I apply double that amount and instead of a small spot on my left labia minora, I test out the whole right side of my labia minora.

Step #4

Wait approximately 24-48 hours after application before applying the product again. During that time, be sure to monitor the area for any new signs of redness, swelling, itch, and irritation.

Step #4.1

If signs of allergic reaction or contact dermatitis occur, discontinue using the product.

Step #5

If no signs of allergic reaction or contact dermatitis are seen, you are good to go with your new vulvar product. You are now OK to use/apply the product according to the directions provided by your healthcare provider (in the context of steroids, calcineurin inhibitors, hormone creams) or to the whole vulva (emollients/moisturizers/lube, etc.).

This whole process usually takes me about a week. I know it can be a bit tedious, but trust me, it's worth it if it can help you avoid a full-blown allergic reaction/contact dermatitis on the vulva.

The Bottom Line

In sum, patch-testing products can help avoid full-blown vulvar allergic reactions and contact dermatitis. Any time you are using a new product like an emollient or hormone cream, I recommend patch-testing the product first.

Be sure to bookmark this page so you can revisit the steps for patch testing above each time you try a new product.

Reach Out to Me

If you want to chat with me, I can be reached at:

Instagram: @thelostlabiachronicles

Facebook: @TheLostLabiaChronicles

Email: lostlabiachronicles@gmail.com

1:1 Lichen Sclerosus Peer Support Calls with Jaclyn from TLLC

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If you are struggling with grief and emotions, feel free to book a 1:1 call with me. Simply click on this link to learn more about lichen sclerosus peer support calls.