THE VULVAR MICROBIOME IN LICHEN SCLEROSUS: DYSBIOSIS, BARRIER DYSFUNCTION AND THERAPEUTIC IMPLICATIONS

Aleksandra Kujach; Julia Góralska; Melania Popielarczyk; Katarzyna Napiórkowska; Dominik Płaza

doi:10.31435/ijitss.2(50).2026.6146

Authors

Aleksandra Kujach M.D., University Clinical Centre, Gdańsk, Poland https://orcid.org/0009-0004-8338-136X
Julia Góralska Medical University of Gdańsk, Gdańsk, Poland https://orcid.org/0009-0004-7594-0387
Melania Popielarczyk Medical University of Gdańsk, Gdańsk, Poland https://orcid.org/0009-0000-0658-069X
Katarzyna Napiórkowska M.D., Nicolaus Copernicus Hospital in Gdańsk, Gdańsk, Poland https://orcid.org/0009-0002-9736-9252
Dominik Płaza Scientific Circle of Neurotraumatology, Department of Emergency Medicine, Medical University of Gdańsk, Gdańsk, Poland https://orcid.org/0009-0000-6251-3969

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.6146

Keywords:

Vulvar Lichen Sclerosus; Microbiome; Dysbiosis; Vulvar Microbiota; Vaginal Microbiota; Gut-Skin Axis; Lactobacillus; SIRT1; Postbiotics

Abstract

Vulvar lichen sclerosus is a chronic inflammatory and fibrosing dermatosis of the anogenital region, associated with pruritus, pain, dyspareunia, architectural distortion, and an increased risk of vulvar squamous cell carcinoma in a subset of patients. Although its pathogenesis has traditionally been interpreted through autoimmune, hormonal, genetic, and inflammatory mechanisms, emerging evidence suggests that local and systemic microbial dysbiosis may contribute to disease development or persistence. Current studies do not support the presence of a single causative pathogen. Instead, vulvar lichen sclerosus appears to be associated with heterogeneous alterations in the vulvar, vaginal, urinary, and gut microbiota, including changes in Lactobacillus-dominated communities, anaerobic taxa, urinary microbial profiles, and short-chain fatty acid-producing bacteria. These microbial disturbances may interact with epithelial barrier impairment, altered antimicrobial peptide expression, local hormonal changes, urine exposure, and chronic immune activation. Mechanistic data further suggest that microbiota-derived metabolites, particularly butyrate and other short-chain fatty acids, may influence epithelial integrity, inflammatory signaling, and metabolic-epigenetic regulation through pathways involving SIRT1. This review summarizes current evidence on the microbiome in vulvar lichen sclerosus, integrates findings from female and male genital disease models, and discusses potential therapeutic implications. Microbiome-directed strategies, including postbiotics, metabolite-based interventions, and barrier-restorative approaches, remain investigational but may represent promising adjuncts to established anti-inflammatory therapy.

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