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Lichen Planus and urinary incontinenceFrom: Allan (AllanHo@aol.com)Wed Oct 24 12:23:40 2007
I am treating this 82 yo otherwise very healthy woman for Lichen Planus. Her labial agglutination was so severe that her urethra was hidden behind a flap of tissue created by her labia minora fusing in the mid line. I could not even pass one finger through the small opening that was left the first time I saw. I took down the labial adhesions to expose her urethral meatus. Her vaginal epithelium was bright red. Cervix not present because she had a hysterectomy at age 50. I have been giving her Vagifem in the vagina and Clobetasol on the labia. She has made significant improvement. She is not complaining of anything now except for her vagina appearing bright red. Besides for the atrophic vaginal epithelieum, I see no lesions. Here is the problem - she has mixed urinary incontinence and does not want to do anything about it. I am afraid she may not be getting the maximum benefit of the Clobetasol (I have given her cream and ointment) because of the constant wetness at the introitus. I am thinking about telling her that it is going to be as good as it can get. She is asymptomatic now, so I think systemic therapy would be unnecessary. Any suggestons?
-- Allan Southeasten PA
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