All about lichen sclerosus in men
Lichen sclerosus in men is a relatively uncommon but often overlooked and potentially serious skin disorder. It primarily affects the genital area, particularly the foreskin and glans (head) of the penis. Although it can occur at any age, it is most frequently diagnosed in middle-aged and older men. Despite its significance, awareness of this condition remains limited, which can delay diagnosis and treatment.
Lichen sclerosus is caused by chronic exposure to urine. Research has shown that people with lichen sclerous have microdribbling, where small amounts of urine dribble out the end of the penis. The urine gets trapped behind the foreskin, leading to inflammation. Other factors that increase exposure to urine include urological surgical procedures and penile piercings.
Other factors such as genetic predisposition, the cutaneous (skin) microbiome and chronic irritation from detergents in soaps are also thought to contribute. It is not a sexually transmitted infection, and it is not contagious.
In men, lichen sclerosus often presents with noticeable changes in the skin of the penis. Common symptoms include white, patchy, or shiny areas of skin that may appear thin and wrinkled. The affected skin can become fragile, leading to tearing, bleeding, or blistering. Many men experience itching, discomfort, or pain, particularly during sexual activity. Over time, the condition can cause scarring, which may lead to tightening of the foreskin—a condition known as phimosis—making it difficult or impossible to retract the foreskin.
If left untreated, lichen sclerosus can lead to complications. Persistent inflammation and scarring may interfere with normal urinary and sexual function. Long-standing lichen sclerosus can lead to penile pre-cancer and cancer if untreated, making early diagnosis and ongoing monitoring especially important.
Diagnosis is typically based on clinical examination by a healthcare professional, often a dermatologist or urologist. In some cases, a skin biopsy may be performed to confirm the diagnosis and rule out other conditions, such as infections or precancerous changes.
Treatment aims to control symptoms, prevent disease progression, and reduce the risk of complications. The first-line therapy usually involves potent topical corticosteroids, which help reduce inflammation and improve skin appearance. Using a barrier cream to protect the penile skin is also important, as is avoiding soaps and showers gels.
Patients are also advised to squeeze out urine and dab the penis dry after urinating to minimise contact with urine. These steps are generally very effective in 50% of patients when used as directed. In cases where these steps don’t work, or if there is phimosis or severe scarring, circumcision may be recommended. Removing the foreskin eliminates the ‘trap’ for the urine, and allows the skin on the glans (head) of the penis to thicken. This is curative in approximately 90% of patients.
Avoiding irritants can also help manage the condition. Patients are advised to use gentle, fragrance-free products and to keep the area clean and dry. Regular follow-up with a healthcare provider is important to monitor the condition and detect any early signs of complications such as precancerous changes.
Living with lichen sclerosus can be physically and emotionally challenging. The symptoms may affect self-esteem, sexual health, and overall quality of life. It often takes patients a long time to see a dermatologist, as the symptoms are often dismissed or treated as an infection. Open communication with healthcare providers and, when appropriate, partners, can play a key role in managing these impacts.
In conclusion, lichen sclerosus in men is a chronic but manageable condition. Early recognition, appropriate treatment, and ongoing care are essential to minimise symptoms and prevent complications. Increased awareness can help ensure that affected individuals receive timely diagnosis and effective treatment.