About Lichen sclerosus

Lichen sclerosus (LI-kun skluh-RO-sus) is an uncommon condition that creates patchy, white skin that’s thinner than normal. Lichen sclerosus may affect skin on any part of your body, but most often involves skin of the vulva, foreskin of the penis or skin around the anus.

Anyone can get lichen sclerosus, but postmenopausal women and children who have not reached puberty are at highest risk. Left untreated, lichen sclerosus may lead to other complications.

You may not need treatment because sometimes lichen sclerosus improves on its own. If you do need treatment, your doctor can suggest options to return a more normal appearance to your skin and decrease the tendency for scarring.

Symptoms

Lichen sclerosus can affect the skin on any part of your body. Sometimes, no symptoms are present.

When they do occur, lichen sclerosus symptoms may include:

  • Itching (pruritus), which can be severe
  • Discomfort, which is generally greater if lichen sclerosus appears on or around your genital or anal areas
  • Smooth white spots on your skin that may grow into blotchy, wrinkled patches
  • Tenderness of the affected areas of your skin
  • Easy bruising or tearing
  • In severe cases, bleeding, blistering or ulcerated lesions
  • Painful intercourse

Causes

The exact cause of lichen sclerosus isn’t known. However, the condition may be related to a lack of sex hormones in the affected skin or to an overactive immune system. Previous skin damage at a particular site on your skin may increase the likelihood of lichen sclerosus at that location.

Although lichen sclerosus may involve skin around your genitals, it isn’t contagious and cannot spread through sexual intercourse.

Lichen sclerosus occurs most often in postmenopausal women, but it also occurs in men and children. In women, lichen sclerosus usually involves the vulva. In boys and men, uncircumcised males are most at risk, because the condition generally affects the foreskin. In children, the signs and symptoms may improve at puberty.

Diagnosis

Your doctor may diagnose lichen sclerosus based on:

  • A physical examination
  • Removal of a small piece of affected tissue (biopsy) for examination under a microscope

Persistent lichen sclerosus in one location may slightly increase your risk of skin cancer, although this has not yet been definitively proved. For this reason, make sure that you have follow-up examinations every six to 12 months.

Other potential complications:

  • For women, the uncomfortable itching and scarring that accompanies severe lichen sclerosus may narrow the vaginal opening and affect the ability or desire to have sexual intercourse. In some cases, the blistering may create extremely sensitive skin to the point that any pressure on the area is unbearable.
  • For men, lichen sclerosus can in rare cases involve the foreskin. The tightening and thinning of the foreskin may create complications during erections or when urinating.

Treatment

If lichen sclerosus isn’t in your genital area, you may not need treatment for lichen sclerosus, especially if you’re not having symptoms. In fact, many cases disappear on their own.

But, for adults and children with lichen sclerosus on or around the genitals or anus, or with a more advanced case on other parts of the body, doctors most commonly prescribe corticosteroid ointments or creams, which are usually quite effective. Prolonged use of these medications isn’t recommended because they can lead to thinning of the skin.

Other treatments for lichen sclerosus that your doctor may suggest include:

  • Immune-modulating medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel)
  • Prescription sex hormones
  • Ultraviolet light treatment, for nongenital areas

Treatments cause your skin to assume a more normal appearance and decrease its tendency for further scarring.

For men with lichen sclerosus on the foreskin, removal of the foreskin (circumcision) is a common treatment in cases resistant to other therapies or more advanced cases. Surgery generally isn’t recommended for women with lichen sclerosus because the condition may just come back after surgery.