What Is Lichen Sclerosus?
Lichen sclerosus is chronic skin condition in which a person forms patches of white, wrinkly, thin skin, often described as being like "cigarette paper." Most people with this condition will experience it on their anus and genital regions, and some will experience it on other parts of their body [1,2].
The primary symptom of lichen sclerosus is the presence of skin changes as well as bruising, bleeding, inflammation, itching and pain in the affected areas.
The condition slowly progresses over time without treatment. Lichen sclerosus is benign but can cause significant discomfort and disfigurement. Treatment options include topical and oral medications, phototherapy, and circumcision in men to remove damaged skin.
You should go to the doctor in the next few weeks. There, a physical exam and a biopsy can confirm the diagnosis. Treatment involves topical steroids.
How common is lichen sclerosus?
Lichen Sclerosus Symptoms
Most people with lichen sclerosus develop the condition more prominently in the anogenital region — the region that consists of your genitals and anus — primarily on the labia majora and minora. Thus, you may notice pain during intercourse or urination. In children, constipation may be the first indicator of this disease if they are experiencing it in their anal region . Up to 15 percent of people with lichen sclerosus develop lesions on other parts of their body besides the anogenital region, usually on the back, neck, arms, hands, and/or other regions .
This is the first and most predominant symptom of lichen sclerosus.
- Hypopigmented patches of skin that are thin or wrinkly: Women with lichen sclerosus develop hypopigmented patches of skin, primarily around their genitals and anus. These skin patches are described as being like "cigarette paper," or thin, wrinkly areas of pale skin.
- Skin that is easily bruised or that may bleed: The skin may become easily bruised or cracked and can bleed with light rubbing.
- Abnormal appearance of genitals: Without treatment, the inflammation may lead to changes in the appearance of the genitals as the skin folds fuse with each other. In men, these skin changes generally occur near the head of the penis, causing a shrunken or scarred-looking foreskin. This condition usually only occurs in uncircumcised men and may also cause painful erections or difficulty urinating.
- Lesions: Both men and women can sometimes develop similar skin lesions outside of the genital region in approximately 15 percent of cases.
The initial skin changes can progress to further symptoms, including:
- Itching: The patches of affected skin often become itchy. This can cause you to scratch and further irritate the fragile skin.
- Pain: People with lichen sclerosus often complain of pain and discomfort in the affected region. This pain is generally worse with intercourse or urination.
- Vaginal discharge: Women with lichen sclerosus may begin to produce yellow, waxy vaginal discharge.
Lichen Sclerosus Causes
Lichen sclerosus is a disease caused by inflammation within body tissues. Inflammation is one of the means by which your body fights infection and promotes healing. In this case, however, the inflammation is mistakenly targeted toward your skin tissues, leading to damage and thinning of the skin.
While no one is absolutely sure of the cause of lichen sclerosus, it is believed that the disease may be caused by genetic factors, hormonal changes, infection, injury, or autoimmune disease (where your immune system accidentally targets your own tissues) [2,4]. It is not contagious and cannot be spread through sexual intercourse .
Who is most likely to be affected
The majority of people who develop lichen sclerosus are post-menopausal women and prepubertal girls. This disease is relatively common, affecting approximately one in 30 women to some degree. Lichen sclerosus occasionally affects men, but women are six times more likely to be affected .
Treatment Options and Prevention for Lichen Sclerosus
Lichen sclerosus varies in severity. Some people develop only slight skin changes which are barely noticeable, whereas others develop significantly disfiguring skin changes that drastically reduce their quality of life. Early treatment is required to prevent permanent skin changes and to preserve genital function. This treatment can be very effective if appropriately managed.
The most effective therapy for lichen sclerosus is topical corticosteroids. Steroids reduce inflammation and can thus lessen the underlying cause of this disease. With daily application, most people can expect their symptoms to lessen or even resolve within one to three months. Steroids must be used long-term to prevent a recurrence of symptoms. You can also receive injections of steroids to reduce the symptoms. Unfortunately, steroids are not without side effects. These medications can cause skin-thinning and discoloration. However, these side effects are less common in the genital region.
Light and laser therapy
While topical steroids are the standard for treating lichen sclerosus, some studies have demonstrated that phototherapy can reduce symptoms. In this treatment, the affected areas (non-genital areas) are exposed to UV light . Cryotherapy is another option, in which affected areas are carefully subjected to freezing temperatures, as well as laser therapy, in which affected areas are targeted with special lasers .
If prior treatment methods are ineffective, the following may be helpful.
- Additional medication: If topical steroids do not resolve or lessen your symptoms, other second-line medications (both oral and topical) can be attempted to reduce symptoms and progression. These medications have various side effects or less efficacy in general, and so are not used first-line.
- Circumcision: In men with lichen sclerosus, circumcision can be performed to remove the affected skin and reduce symptoms.
Although this condition cannot be prevented, it is important that people with lichen sclerosus practice good genital hygiene and avoid scratching the affected areas. This is done to avoid the risks of infection, scarring, and a worsening of symptoms.
When to Seek Further Consultation for Lichen Sclerosus
If you develop skin lesions on your genitals you should seek evaluation by your primary care physician. There are many causes of skin lesions which vary in severity and require an experienced eye and a number of tests to ensure proper diagnosis and treatment. It is possible to confuse the skin changes of lichen sclerosus with those of other diseases such as skin cancer or various sexually transmitted infections. Additionally, people with lichen sclerosus are at a higher risk of developing skin cancer in the affected areas and thus should be followed regularly.
If you suspect you have this condition
Lichen sclerosus can be a disfiguring disease that causes much personal distress and reduces your quality of life. Early treatment is required to more successfully avoid negative outcomes and permanent scarring. Thus, if you believe you are suffering from this disease, you should seek the advice and treatment of a medical professional especially to screen for the development of skin cancer.
Questions Your Doctor May Ask to Determine Lichen Sclerosus
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you had any changes in your weight?
- Have you experienced any nausea?
- Is your abdominal pain getting better or worse?
- How would you describe the nature of your abdominal pain?
- Do food or drinks get stuck when you swallow?
The above questions are also covered by our A.I. Health Assistant.
- Lichen sclerosus. Mayo Clinic. Published October 9, 2018. Mayo Clinic Link
- Lichen sclerosus. National Organization for Rare Disorders. Updated December 19, 1994. NORD Link
- Nair PA. Vulvar lichen sclerosus et atrophicus. Journal of Mid-Life Health. 2017;8(2):55-62. NCBI Link
- Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: An update. American Journal of Clinical Dermatology. 2013;14(1):27-47. NCBI Link
- Lichen sclerosus. Mayo Clinic. Published October 9, 2018. Mayo Clinic Link