Lichen sclerosus

What is lichen sclerosus?

Lichen sclerosus is an uncommon skin condition that can occur anywhere on the body. Most often it affects the genital area - the vulva in women and the foreskin in men - and also the skin around the anus. Anyone can get lichen sclerosus at any age, including children, but women after the menopause have the highest risk. Because lichen sclerosus can cause an intense vulval itch, it can at first be mistaken as thrush.

Symptoms of lichen sclerosus

In lichen sclerosus the skin is inflamed. It is usually red and may have white patches and sometimes a purplish bruised appearance. The skin is often itchy, but may be tender and bruise or tear easily. When severe, there may be bleeding and blistering. As well as intense itching, women with vulval lichen sclerosus may experience pain during intercourse or when passing urine and may notice tiny fissures (cracks) in the skin. Over time lichen sclerosus can lead to scarring. If this affects the vulva, it may narrow the entrance to the vagina, interfering with sexual intercourse.

Diagnosis of lichen sclerosus

Lichen sclerosus can often be diagnosed from the appearance of the skin and, if there is any doubt, confirmed by biopsy. This involves removing a small piece of affected tissue for a pathologist to examine. In adults, it is usually best to confirm the diagnosis in this way.

Treatment of lichen sclerosus

Lichen sclerosus is usually treated by applying a strong steroid cream to the affected area. This is applied daily for several weeks and then less frequently for several months.

You may need to continue applying a steroid cream long-term, a couple of times a week, to prevent lichen sclerosus recurring.

If scarring has occurred this does not usually improve with steroid treatment. If scarring is affecting sexual intercourse, then a simple surgical procedure may help.

How did I get lichen sclerosus?

The cause of lichen sclerosus is not known although there seems to be an inherited tendency. Lichen sclerosus also seems to be associated with autoimmune diseases (conditions where the immune system attacks the body), such as systemic lupus erythematosus and thyroid disease. Lichen sclerosus is more likely to occur in areas of skin that have been damaged in the past.

Importantly, lichen sclerosus is not infectious and your partner cannot catch it during sex.

Follow-up

Lichen sclerosus is associated with a small, but important, increase in the risk of cancer developing at the affected site. If you have been diagnosed with lichen sclerosus then it is advisable to have regular follow-ups every 6 to 12 months to check for any skin changes or treatment side effects.

Last Reviewed: 4 February 2011
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References

1. MayoClinic.com. Lichen sclerosus (last updated 8 May 2010). http://www.mayoclinic.com/health/lichen-sclerosus/DS00725 (accessed Jan 2011).
2. Lichen sclerosus (revised Feb 2009). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2009 Mar. http://online.tg.org.au/complete/ (accessed Jan 2011).
3. Australian and New Zealand Vulvovaginal Society. Lichen sclerosus. http://www.anzvs.org/docs/lichen-sclerosus.html (accessed Jan 2011).
4. Jean Hailes Foundation for women’s health. Investigating vulval itch (last updated 21 Dec 2009). http://www.jeanhailes.org.au/health-professionals/medical-observer/811-2009-dec-investigating-vulval-itch (accessed Jan 2011).
5. Chi CC, Baldo M, Kirtschig G, et al. Topical interventions for genital lichen sclerosus (protocol). Cochrane Database Syst Rev 2010; 1: CD008240. doi: 10.1002/14651858.CD008240. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD008240/frame.html (accessed Jan 2011).
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