Lichen Sclerosus

Lichen sclerosus can affect both males and females, but it most commonly occurs in young girls before puberty or in post-menopausal women. It isn’t contagious and can’t be spread through sexual contact. While lichen sclerosus mainly affects the skin of the vulva and anus, it may also affect the skin on the back, shoulders, upper arms and breasts.

The exact cause of lichen sclerosus is unknown. Contributing factors may include any overactive immune system, genetics and a history of other skin-related issues.

Lichen Sclerosus Symptoms

Mild lichen sclerosus may have no symptoms. Other symptoms may include:

• Patchy, discolored, blotchy or wrinkled skin
• Burning sensation
• Itching
• Fragile or thin skin
• Bleeding or blistering skin
• Pain during intercourse
• Skin that is easily bruised

Lichen Sclerosus Complications

Potential complications of lichen sclerosus include:

• Scarring, including scarring that covers the clitoris.
• Scarring of the penis in males can cause painful erection, poor urine flow and problems retracting foreskin.
• Increased risk of squamous cell carcinoma.
• Chronic constipation in children with lichen sclerosus.

Risk Factors for Lichen Sclerosus

People who are at a higher risk for lichen sclerosus include:

• Children under 10 years old
• Postmenopausal women
• Women with autoimmune diseases
• Family history of lichen sclerosis
• Men with urinary incontinence
• Uncircumcised men

Lichen Sclerosus Diagnosis and Treatment

A healthcare provider can diagnose lichen sclerosus by looking at the affected areas of the skin during a physical exam. A biopsy may be needed to confirm the diagnosis or if it does not respond to typical treatment. This may also be used if needed to rule out cancer.

Once diagnosed, the recommended treatment options can vary depending on severity and location of the symptoms. With treatment, symptoms should improve or go away. There is still a chance of recurrence even when the initial treatment is successful.

Treatment options include:

Topical steroid ointments: Steroid ointments such as clobetasol are commonly prescribed to treat lichen sclerosus. The ointment can be applied to the affected areas every day during the initial few weeks of treatment, then may be reduced to once or twice weekly to prevent the return of symptoms. Prolonged use of topical steroids can cause certain side effects, so patients should be monitored by their healthcare provider while using the medication.

Topical calcineurin inhibitors: This type of medication works by suppressing the immune response to reduce skin inflammation. One commonly prescribed immunosuppressant ointment is tacrolimus, or Protopic.

Phototherapy (light therapy): Exposure of affected areas of skin to certain wavelengths of ultraviolet light can reduce inflammation and itching.

Oral Immunosupressants: Common medications used to suppress the immune response and reduce inflammation include methotrexate and mycophenolate mofetil.

Surgery: In some cases, surgery may be recommended as a treatment. This can include surgery to remove scar tissue or circumcision for uncircumcised males with lichen sclerosus.

Follow-Up Care and Management

Once symptoms are controlled, patient with lichen sclerosus should continue to have follow-up exams with their healthcare provider once or twice a year. Lichen sclerosus is a chronic condition that cannot be cured, so ongoing management is necessary to treat flare-ups and prevent potential complications.