Overview

What is lichen sclerosus?

Lichen sclerosus is a long-term problem that usually affects the skin in the genital and anal areas. Sometimes, lichen sclerosus appears on the upper body, breasts, and upper arms.

The disease does not cause skin cancer but may increase your likelihood of developing it if your skin is scarred. You should see your doctor every six to 12 months in order to follow and treat and skin changes.

Who Gets

Lichen sclerosus appears:

  • Most often in women (usually after menopause).
  • Less commonly in men.
  • Rarely in children.

Lichen sclerosus is more likely in women, especially after menopause. It is rare in children. You may have inherited an increased risk for lichen sclerosus from your parents.

Symptoms

There may be no symptoms in mild cases of the disease. If you do have signs, they can include:

  • Small white spots on the skin (early in the disease).
  • Spots that grow into bigger patches, with skin over patches becoming thin and crinkled.
  • Skin that tears easily, producing a bright red or purple bruise.
  • Skin that becomes scarred.
  • Itching, which is very common.
  • Discomfort or pain.
  • Bleeding.
  • Blisters.

Causes

Lichen sclerosus is not contagious. Doctors don't know the exact cause of lichen sclerosus. Some possible causes include:

  • An overactive immune system.
  • Hormone problems.
  • Inheriting an increased likelihood of getting the disease.
  • Previous injury that damages or scars the skin.

Diagnosis

Usually a doctor will take a small piece of skin and look at it under a microscope to diagnose lichen sclerosus. In more severe cases, doctors can just look at you to diagnose the disease based upon how it has affected your skin.

Treatment

Patches on the arms or upper body usually don’t need treatment. They will go away over time. Patches of the genital skin should be treated, even if they aren’t painful or itchy. These patches can scar, causing problems with urination or sex. There is also a very small chance that skin cancer may develop in the patches. You should see your doctor every six to 12 months in order to follow and treat any skin changes.

If a young girl gets lichen sclerosus, it may go away at puberty. This means that lifelong treatment may not be necessary, although scarring and changes in skin color may remain.

Possible treatments for lichen sclerosus include:

  • Surgery. Circumcision is the most widely used therapy for men with lichen sclerosus, and the disease does not usually come back after this procedure. However, surgery is not a good option for women, as the disease usually comes back after lichen sclerosus patches are removed from their genitals.
  • Medications, including strong cortisone creams or ointments on the skin. These should be applied to skin patches every day for several weeks to stop the itching. Using the cream or ointment two times a week for a long time can keep the disease from coming back. Treatment does not fix the scarring that may have already occurred.

See your doctor on a regular basis, since long-term use of these creams and ointments can cause:

  • Thinning and redness of the skin.
  • Stretch marks where the cream is applied.
  • Genital yeast infections.

Sometimes, you don't get better when using the cortisone creams. Reasons for this can include

  • Low estrogen levels.
  • Infection.
  • Allergy to the medication.

When creams and ointments don't work, your doctor may suggest:

  • Retinoids, or vitamin A-like drugs.
  • Tacrolimus ointment to suppress the body’s misguided immune system.
  • Ultraviolet light treatments (not used on skin of the genitals).

If you need medicine, ask your doctor:

  • How does the medicine work?
  • What are its side effects?
  • Why is it the best treatment for my lichen sclerosus?

Who Treats

Lichen sclerosus is treated by:

  • Dermatologists (doctors who treat the skin).
  • Gynecologists (doctors who treat the female reproductive system).
  • Urologists (doctors who treat the urinary or urogenital tract).
  • Primary health care providers.

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