Lichen Sclerosus: Treatment, Symptoms, Causes

Medically Reviewed by Zilpah Sheikh, MD on February 06, 2024
Written by Stephanie Langmaid
6 min read

Lichen sclerosus is a rare skin condition that usually shows up on your genital or anal areas, though you can also have it in other places. It usually starts as white, shiny, itchy patches that get bigger. The affected skin becomes thin and fragile.  

Lichen sclerosus mostly affects people who've gone through menopause. But other people can get it, too.

It's a long-term condition that tends to go through cycles where symptoms flare up, then calm down. Although there's no cure, there are treatments to manage your symptoms.

 

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

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

Lichen sclerosus isn't contagious, and you can't spread it through sex or other contact.

 

 

Lichen sclerosus risk factors

Certain things seem to make it more likely that you'll get lichen sclerosus. For example:

  • You've gone through menopause or haven't started your period. 
  • You have an uncircumcised penis.
  • Other people in your family have had it.
  • You have autoimmune diseases, particularly vitiligo, alopecia, or Hashimoto's disease (autoimmune thyroiditis).
  • Your skin has been damaged, like from surgery or a piercing.
  • Your genital skin is often irritated, especially by contact with urine--like when you have incontinence and use adult diapers or pads. 
  • You have obesity. 

Changes in the appearance of your skin are the main symptom of lichen sclerosus. You usually see it around your genitals or anus. But less often it can also affect your neck, shoulders, upper back, upper arms, armpits, torso, breasts , wrists, buttocks, and inner thighs. Rarely, you can have it in your mouth.Some people have no other symptoms. But for most people, the lichen sclerosus patches are very itchy. You may also have: 

  • Pain
  • Burning
  • Tears or cracks in your skin
  • Sores
  • Scarring
  • Bruising
  • Blisters
  • Pain when you pee or poop 
  • Pain when you have sex
  • Constipation

What does lichen sclerosus look like?

It starts as small, shiny, and smooth white patches on your skin. These patches can become bigger and grow together into plaques. The skin may become thin and wrinkled, and it can be easily damaged by scratching or by clothing rubbing against it. 

Your doctor can usually tell whether you have lichen sclerosus by doing a physical exam and checking on how your skin looks. 

They might order a biopsy, too if they think you could have skin cancer, or if treatments aren't working. That means they'll remove a small piece of your skin and send it to a lab to be viewed under a microscope. 

Serious complications of lichen sclerosus can happen, especially if you don't get treated.

Your skin becomes fragile and can easily be damaged, with bleeding, tears, and open sores that may get infected. 

Lichen sclerosus can cause serious scarring to the outer part of the female genitals, called the vulva, and change the way your genitals look and feel.

You may end up with chronic, or ongoing, pain in the vulva and a narrowing of the vaginal opening. These complications can make sex difficult and painful.

If your penis is affected, it can make your foreskin thick and less flexible. You may have a hard time retracting it to clean or to pee (phimosis), or your foreskin could get stuck behind the head of your penis (paraphimosis). You may also have pain during sex and trouble peeing. 

 You may also be more likely to develop a type of skin cancer on your vulva or penis.

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. You're more likely to have sex and urinary complications if you don't treat it. Patches on other parts of your body may go away with time.

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 immune-suppressing creams and ointments.

Pimecrolimus and tacrolimus are called calcineurin inhibitors. They calm your immune system by blocking a protein that causes inflammation. That can ease the itching. 

Surgery to treat lichen sclerosus that's on your penis can be a good option. Doctors often do a circumcision, which is removing the foreskin--the tissue that covers the head of the penis. After that, the condition probably won't come back.

If you have severe scarring of your vulva that causes problems with sex, surgery can help. But it's only an option once the condition is under control.

It may be hard, but try not to scratch. That can cause even more damage to fragile skin. 

You may be able to soothe the itch by taking baths in a few inches of plain, lukewarm water. Use only a mild cleanser. 

Gently pat yourself dry and apply a water-blocking ointment like petroleum jelly to the affected skin. Do the same after you pee so urine doesn't stay on your skin.

Avoid tight clothing, perfumed genital sprays, harsh skin cleansers, and scented dryer or fabric sheets. Don't sit around in wet or sweaty clothing after a swim or a workout. 

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

You can usually get relief from the symptoms of lichen sclerosus with treatment, especially if you catch it early. But it probably won't go away entirely. You'll likely go through periods where it flares up for the rest of your life. 

It can cause serious complications, including scarring and sexual dysfunction. 

You'll also need to be screened regularly for skin cancer.

Lichen sclerosus is a rare condition that causes smooth, white, itchy patches on your skin, usually around your genitals and anus. It can cause disfiguring scarring and put you at greater risk of skin cancer on your penis or vulva. Talk to your doctor if you have genital itching or skin changes, because lichen sclerosus can be managed with treatment.

What causes lichen sclerosus to flare up?

Doctors don't know exactly what causes flares, but things that irritate your skin could be one trigger. A flare may also be a sign that you need to use steroid cream or other medication more often.   

What is the best thing to do for lichen sclerosus?

Talk to your doctor if you have itching or skin changes in your genital area. Lichen sclerosus needs to be treated so you don't have serious complications. Steroid medications you put on your skin and other treatments usually work well.

What should you not wear when you have lichen sclerosus?

You want to avoid irritating the skin that's affected. Don't wear scratchy fabrics like wool, or tight clothing that rubs or traps moisture next to your skin. Change out of wet or sweaty clothes as soon as you can.