What is lichen sclerosus?

Lichen sclerosus is a rare chronic inflammatory skin disorder, also known as Lichen sclerosus et atrophicus. It particularly affects the tissue of the genital area in both males and females.

Dermatologists and urologists are the medical specialists that treat lichen sclerosus.

What are the symptoms of lichen sclerosus?

Lichen sclerosus can affect both men and women, but it’s most common in women over 50.

The condition affects women mostly in the genital area, and on rare occasion it may also affect other areas of the skin. These include:

• The breasts
• Wrists
• Shoulders
• The neck
• The back
• Thighs
• The mouth

Lichen sclerosus patches in these non-genital areas rarely cause any symptoms.

In women, the most common lichen sclerosus symptoms include:

• Itching
• A burning sensation;
• Dyspareunia (painful sexual intercourse)
• Vaginal dryness
• Local skin irritation
• White spots or patches appearing on the skin
• Anal fissures
• Labia minora shrinking or flattening

For men, lichen sclerosus mainly affects the tip of the penis. The most common symptoms include:

• Bright, whitish or brownish patches
• Bruises
• Microlesions
• Itching
• Pain
• Dyspareunia (painful sexual intercourse)
• Urethritis
• Urethral stricture
• Phimosis

In children, the most common symptoms include:

• Girls: Itching and burning sensation of the vulva and perineum area;
• Boys: General irritation of the genital area.

How is lichen sclerosus diagnosed?

Lichen sclerosus is generally diagnosed by analysing a small tissue sample taken from the affected area, under a microscope.

What causes lichen sclerosus?

The cause of lichen sclerosus is unknown, but there are some possibilities:

• Overactive immune system
• Hormone imbalance
• Genetic factors
• Poor skin health, or having had any previous injury on your skin

Is lichen sclerosus an autoimmune disease? 

Research suggests the most probable cause of lichen sclerosus is an autoimmune reaction in individuals that are more susceptible to it due to genetics. However, the exact cause of lichen sclerosus is not known.    

What is vulvar lichen sclerosus?

One of the most common areas that lichen sclerosus affects, is the skin around the vulva. Itching occurs frequently with vulvar lichen sclerosus and it may be severe. If the skin breaks or cracks, it can be very sore, and the healing process can tighten the skin. In turn, urination and sexual intercourse is affected if this tightening occurs.

How does lichen sclerosus affect men? 

Lichen sclerosus can affect any part of the skin but it happens most often on the foreskin and tip of the penis.

While causes of lichen sclerosus aren't fully understood, it's clear that:

• Affected skin can be itchy, burning and sore especially during or after sex.
• When the foreskin gets tighter, and becomes more difficult to retract, it can lead to painful erections.
• Men who have been circumcised early in life almost never have it.
• Infection doesn't cause lichen sclerosis.
• It cannot be passed to a sexual partner.
• Friction or damage to the skin can trigger lichen sclerosus, and make it worse.
• The trapping of urine under the foreskin may cause male genital lichen sclerosus.
• The link between lichen sclerosus and penis cancer is rare, but it can occur.
• Lichen sclerosus may affect some men with thyroid disease or diabetes, but this is more common in women.

What is the treatment for lichen sclerosus?

Topical steroid creams: These are the first-line treatment for lichen sclerosus. High-potency corticosteroid creams, such as clobetasol propionate, are commonly prescribed. Patients are typically advised to apply the cream to the affected areas daily for several weeks to months. The steroid cream helps to reduce inflammation, itching, and discomfort associated with lichen sclerosus.

Maintenance therapy: Even after the initial symptoms are controlled, some individuals may require ongoing, intermittent use of a lower-potency steroid cream to prevent recurrence or flaring of the condition. The goal is to keep the skin in a healthy and symptom-free state.

Emollients: Alongside steroid creams, using emollients or moisturisers can be beneficial. These products help keep the skin hydrated and reduce dryness and itching. Non-fragrant, hypoallergenic moisturisers are recommended.

Regular monitoring: It's important for individuals with lichen sclerosus to have regular check-ups with their healthcare provider, as the condition can increase the risk of skin cancer. Skin examinations and biopsies may be recommended periodically.

Alternative treatments: In cases where topical steroid creams are ineffective or cause side effects, other treatments may be considered. These can include calcineurin inhibitors like tacrolimus ointment, which can help reduce inflammation.

Is there a new treatment for lichen sclerosus?

While there is no cure for lichen sclerosus, topical ointment and creams are the current gold standard treatment for lichen sclerosus.