What is Lichen Sclerosus?

Lichen sclerosus is a rare skin condition that usually shows up on your genital or anal areas. But it can also affect your upper arms, torso, and breasts.

The condition mostly affects adult women after menopause. But other people can get it, too.

Although there’s no cure, there are treatments to manage your symptoms.

Causes

Doctors don’t know why some people get lichen sclerosus.

They think it may be due to genes, hormones, an infection, or some combination of these things. Another theory is that your immune system attacks your skin. It may even be caused by an old skin injury.

Symptoms

If you have it, you may notice small, shiny, and smooth white patches on your skin. These patches can become bigger and the skin may become thin and wrinkled. Your skin may tear easily, causing large bruises (which may be red or purple) to appear. Itching is very common. So are scarring, bleeding, or blistering.

But some people may not have any symptoms at all.

Diagnosis

Your doctor may do a physical exam and check on how your skin looks. He may order a biopsy, too. That means he will remove a small piece of your skin and send it to a lab to be viewed under a microscope. This will confirm or rule out the diagnosis.

Complications

Serious complications can happen, but they’re rare.

If it affects the genitals, you might be slightly more likely to develop a type of skin cancer called squamous cell cancer.

Women who have it are also at slightly higher risk for vulvar cancer, which is cancer that affects the outer part of the genitals, called the vulva. It can also cause changes to the way your genitals look.

Some women may have chronic, or ongoing, pain in the vulva or a narrowing of the vaginal opening. These complications can make sex difficult.

Treatments

Although there’s no cure for lichen sclerosus, there are treatments that can help.

If you have it on your genitals, you should get it treated, even if you don’t have symptoms. When left untreated, it can lead to problems with sex or urination. Patches on other parts of the body usually go away with time.

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Your doctor will probably first give you a steroid cream to put on the problem area. This can stop the itching. But it may take longer -- a few weeks or months --for the skin to return to a more normal appearance.

You may need to use these creams or ointments for a long period of time to keep the condition from coming back.

You’ll need to keep up with your doctor appointments, since long-term use of steroid creams or ointments can make the skin become red or thin and cause stretch marks. The treatment can also cause genital yeast infections.

If the cortisone cream or ointment doesn’t work for you, there are other treatment options. They include vitamin A-like drugs called retinoids, ultraviolet light therapy, or tacrolimus ointment.

Tacrolimus ointment, as well as one called pimecrolimus ointment, are creams that help your immune system recognize lichen sclerosus as an invader.

Do I Need Surgery?

Surgery to remove patches on the genital area of women doesn’t happen much, since the patches return. If a woman has severe vaginal scarring that causes problems with sex, surgery can help. But it’s only an option once the condition is under control.

Surgery to treat lichen sclerosus in men can be a good option. Doctors often do a circumcision, which is removing the foreskin of the penis. After that, the condition probably won’t come back.

Ways to Feel Better

Add a few inches of warm water to your bathtub and relax. A bath can help with discomfort caused by itching and scratching.

Talk to your doctor about over-the-counter antihistamine skin creams to help with any discomfort.

Avoid tight clothing, perfumed genital sprays, harsh skin cleansers, and scented dryer or fabric sheets.

It may also help to wear cotton underwear during the day and no underwear when sleeping at night.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on September 5, 2018

Sources

SOURCES:

American Journal of Clinical Dermatology: “Diagnosis and Treatment of Lichen Sclerosus, An Update.”

National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin Diseases, “What is Lichen Sclerosus?”

GARD: Genetic and Rare Disease Information Center, National Institutes of Health, “Lichen Sclerosus.”

American Cancer Society, “What are the risk factors for vulvar cancer?”

Mayo Clinic, Diseases and Conditions, “Lichen Sclerosus.”

Dermatologic Therapy: “Abstract: Lichen sclerosus: a review and practical approach.”

American Academy of Family Physicians, FamilyDoctor.org, “Lichen Sclerosus.”

HealthyWomen.org: “Genital Itchiness: What You Need to Know About Lichen Sclerosus.”

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