Lichen sclerosus

Lichen sclerosus is a skin condition that can occur anywhere on the body. Most often it affects the genital area - the vulva in women and the tip of the penis (glans penis) and foreskin in men - and also the skin around the anus.

Lichen sclerosus can cause itching, pain and scarring of the affected areas, but there are treatments available that can relieve symptoms and prevent and treat scarring.

While anyone can get lichen sclerosus at any age, women after the menopause have the highest risk. In fact, it is about 10 times more common in women than in men. It is possible, but rare, for children to be affected.

Symptoms of lichen sclerosus

Lichen sclerosus appears as lesions or patches of white, thin, wrinkled skin, sometimes with areas that have a purplish, bruised appearance. The skin may also be inflamed and red or ulcerated from scratching.

Skin affected by lichen sclerosus can tear easily, and there may be tiny fissures (cracks in the skin). When severe, there may be bleeding and blistering.

Genital lichen sclerosus

Lichen sclerosus that affects the vulva usually feels intensely itchy. There may also be pain, stinging, burning or discomfort, especially during sex or when urinating.

Lichen sclerosus is a chronic, or ongoing, condition, and over time it can lead to scarring. If this affects the vulva, it may narrow the entrance to the vagina, interfering with sexual intercourse. In men with penile lichen sclerosus, the foreskin may become difficult to retract. Tightening of the foreskin may cause difficulty urinating or painful erections.

When the skin around the anus is affected, pain when emptying the bowels can lead to constipation.

How did I get lichen sclerosus?

The cause of lichen sclerosus is not known, although there seems to be an inherited tendency. It’s thought that an overactive immune system or hormonal changes may also be involved, and it is more likely to occur in areas of skin that have been damaged or scarred in the past.

In women, lichen sclerosus also seems to be associated with autoimmune diseases (conditions where the immune system attacks the body), such as systemic lupus erythematosus, alopecia areata (a type of hair loss) and thyroid disease. It is also more common after menopause, when there is less oestrogen in the body.

In men, lichen sclerosus is much more common in those with an intact foreskin compared to those who were circumcised as babies.

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

Tests and diagnosis

Lichen sclerosus can often be diagnosed from the appearance of the affected skin, especially in children.

In adults, a biopsy may be recommended to confirm the diagnosis. This involves taking a small sample of affected tissue for a pathologist to examine under a microscope. Biopsy is not usually recommended in children.

Your doctor may refer you to a dermatologist (skin specialist) to perform a biopsy or for treatment. In some cases, referral to a gynaecologist (specialist in conditions affecting female reproductive organs) or urologist (specialist in male reproductive and urinary organs) may be recommended.

Treatment of lichen sclerosus

Treatment of lichen sclerosus is aimed at:

  • relieving symptoms of itch and discomfort;
  • healing the lesions (returning the affected skin to its normal colour and texture);
  • preventing the development of scar tissue; and
  • treating any scar tissue that has developed.

Lichen sclerosus affecting skin on parts of the body other than the genital area may not need to be treated and can sometimes get better on its own.

Corticosteroids

Lichen sclerosus is usually treated by applying a strong corticosteroid cream or ointment to the affected area. This is applied daily for several weeks or months and then less frequently (once or twice per week) long-term to prevent a recurrence.

Corticosteroid ointment or cream should be applied only to the white patches and gently rubbed in. Try to avoid applying steroid to the normal surrounding skin to help prevent side effects.

Symptoms such as itch may improve within a couple of days of starting corticosteroid treatment. Healing of lesions generally takes longer.

Other treatments

If corticosteroid treatment is not effective, treatments called calcineurin inhibitors (available as cream or ointment) may be recommended by your specialist. These treatments target the immune system and help control inflammation.

If scarring has occurred, this does not usually improve with steroid treatment. Scarring in females that is affecting sexual intercourse or urination may be helped by surgery.

Uncircumcised males with lichen sclerosus on the penis that has not healed completely with corticosteroid cream may benefit from having a circumcision. Further surgery may also be recommended if there is scarring that affects urination.

Self-care measures for genital lichen sclerosus

The following self-care measures may help in the treatment of lichen sclerosus that affects the genital area.

  • Gently wash the area daily with warm water and non-soap cleanser.
  • Try not to rub or scratch the area.
  • Avoid tight clothing and any activities that may aggravate itching and discomfort, such as bike riding.
  • Your doctor may recommend you apply cream to gently moisturise and protect the area.
  • Women should use a mirror to become familiar with the location and appearance of their genital lesions, and to apply cream or ointment to the affected area of the vulva.

Complications and follow-up

If you have been diagnosed with lichen sclerosus then it is advisable to have regular follow-up appointments with your doctor every 6 to 12 months. During check-ups, your doctor will check the affected area and surrounding skin for response to treatment and treatment side effects.

In addition, genital lichen sclerosus is associated with a small, but important, increase in the risk of cancer developing at the affected site. Frequent check-ups are important to detect any cancers early on, when they can be more easily treated.

Last Reviewed: 22 May 2017
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References

1. Lichen sclerosus (published Nov 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2017 Mar. http://online.tg.org.au/complete/ (accessed May 2017).
2. DermNet New Zealand. Lichen sclerosus (updated Jan 2016). http://www.dermnetnz.org/topics/lichen-sclerosus/ (accessed May 2017).
3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Institutes of Health. What is lichen sclerosus? (updated Nov 2014). https://www.niams.nih.gov/health_info/Lichen_Sclerosus/default.asp (accessed May 2017).
4. Mayo Clinic. Lichen sclerosus (updated 3 Sep 215). http://www.mayoclinic.org/diseases-conditions/lichen-sclerosus/basics/definition/con-20028610 (accessed May 2017).
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