From Your Doctor

Doctor-recommended health information

Lichen Sclerosus

By Published August 20, 2012

Lichen sclerosus is a chronic skin problem that usually affects the genital and anal areas, but it can also appear on the upper body.

Lichen sclerosus appears most commonly in women after menopause, but it may occur in both men and women at any age, including childhood.

What Are the Symptoms of Lichen Sclerosus?

Early in the disease, small white spots appear on the skin. The spots are usually shiny and smooth. Later, the spots grow into bigger patches. The skin on the patches becomes thin and crinkled. Then the skin tears easily, and bright red or purple bruises are common. Sometimes the skin becomes scarred. In mild cases, there may be no symptoms.

Other symptoms include:

  • Itching (very common)
  • Discomfort or pain
  • Bleeding
  • Blisters

What Causes Lichen Sclerosus?

Doctors don't know the exact cause of lichen sclerosus. Some think an overactive immune system and hormone problems play a role. Others think family history is involved. Sometimes, lichen sclerosus appears on skin that has been damaged or scarred from a previous injury.

Lichen sclerosus is not contagious.

How Is Lichen Sclerosus Diagnosed?

In severe cases, doctors can diagnose lichen sclerosus by looking at it. But usually a doctor takes a small piece of the skin patch (skin biopsy) and looks at it under a microscope. This rules out the possibility of other diseases.

How Is Lichen Sclerosus Treated? 

Lichen sclerosus of the genital skin should be treated. Even if it isn't painful or itchy, the patches can scar. This can cause problems with urination or sex. There is also a very small chance that skin cancer may develop in the patches.

Topical corticosteroids are most commonly used when first treating lichen sclerosus. Potent corticosteroids, such as clobetasol, may be recommended for daily or twice daily use for an extended period. This helps stop the itching. Then the amount of medication is slowly reduced (tapered). After that, the medication may be used a few times per week to keep the disease from coming back.

Treatment does not fix the scarring that may have already occurred.

You need regular follow-up by your doctor when using these medications, because their use for a long time can cause these side effects:

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

Sometimes, corticosteroids are hindered from resolving the condition by these factors:

  • Low estrogen levels
  • Infection
  • Allergy to the medication

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

  • Topical retinoids
  • Topical immunomodulators, also called calcineurin inhibitors (Elidel, Protopic)
  • Ultraviolet (UV) light treatments (not to be used on skin of the genitals)

Surgery is normally a good option for men. Circumcision (removing the foreskin on the penis) is the most widely used therapy for men with lichen sclerosus. The disease usually does not come back. Surgery is normally not a good option for women. When the lichen sclerosus patches are removed from the genitals of women and girls, they usually come back.

If a young girl gets lichen sclerosus, she may not require lifelong treatment, because it sometimes goes away at puberty. Scarring and changes in skin color may remain, however.

Can People With Lichen Sclerosus Have Sex?

Women with severe lichen sclerosus in the genitals may not be able to have sex. The disease can cause scars that narrow the vagina. Also, sex can hurt and cause the patches to bleed. However, treatment with creams or ointments can help. Women with severe scarring in the vagina may need surgery, but only after lichen sclerosus is controlled with medication.

Is Lichen Sclerosus Related to Cancer?

Lichen sclerosus does not cause skin cancer. However, skin that is scarred by lichen sclerosus is more likely to develop skin cancer. If you have the disease, see the doctor every 6 to 12 months. The doctor can look at and treat any changes in the skin.

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