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Lichen Sclerosus - Causes, Symptoms, and Treatment

Lichen Sclerosus - Causes, Symptoms, and Treatment

Lichen Sclerosus is a chronic, inflammatory skin condition usually appearing on the genitals which is more common in women who have been through menopause, but it can occur regardless of gender or age. Although there is no cure, treatments are available to relieve the itchy or painful white patches of skin it can cause. If you think you might have lichen sclerosus or notice any changes to your skin, it’s always worth getting it checked by a doctor to rule out any underlying causes.

Last reviewed: 21/03/2023 by Dr Babak Ashrafi
Contents

What is Lichen Sclerosus?

Lichen sclerosus is a chronic, inflammatory skin condition that causes thin, itchy, pale patches of skin. It usually affects the genitals and anal area. There is no cure for Lichen Sclerosus, but treatments are available to help relieve the symptoms. 

It is common in women who have been through menopause, but it can affect other people, too. Doctors are not sure of the exact cause of the condition, but it is thought to be caused by the following:

  • your immune system mistakenly attacks your cells (autoimmune)
  • your genes
  • hormonal changes
  • infections 

How common is Lichen Sclerosus?

Lichen Sclerosus is a rare condition believed to affect around 3% of women over 80 years and 0.1% of children. While it mainly affects women who have been through menopause it can also affect men and children, but it is not contagious, so you cannot catch it from someone else. 

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What are the symptoms of Lichen Sclerosus?

The common symptoms of Lichen Sclerosus include:

  • itchy skin
  • itching around the vulva
  • broken skin
  • tearing of the skin
  • scarring
  • thin, white patches of skin
  • constipation (a common symptom in children)

What are the early signs of Lichen Sclerosus?

The early signs of Lichen Sclerosus are usually porcelain white patches of skin surrounded by redness. You may also experience itching, as well as redness and white patches around the anus and/or genitals. 

What does Lichen Sclerosus look like?

Lichen Sclerosus looks like white patches of skin, which can sometimes have pink or red surrounding them. In people who have a darker skin tone, it can look like vitiligo, a condition that causes the skin to lose its pigment.

The white patches of skin can often look shiny or wrinkled. The condition can cause the skin to become fragile, which can lead to cracks or bruising. If left untreated, Lichen Sclerosus can cause permanent scarring. 

What does Lichen Sclerosus feel like?

Lichen Sclerosus can feel itchy, irritated and painful, but this isn’t the case for everyone. Some people find they get the rash without any change in feeling.

Is Lichen Sclerosus painful? 

Yes, it can be painful in some cases because the condition can make the skin fragile, causing it to bruise or crack. If the skin breaks or cracks, it can be sore and lead to pain when peeing or going to the toilet. Because Lichen Sclerosus commonly affects the anus and genitals, it can make sex painful. 

How long does Lichen Sclerosus last?

Lichen Sclerosus is a long-term condition for many people, resulting in flare-ups. Sometimes Lichen Sclerosus goes away on its own and doesn’t return, but this usually happens in affected children when they reach puberty. 

Lichen Sclerosus complications

Some of the long-term complications of Lichen Sclerosus are:

  • scarring
  • painful sex
  • painful urination and bowel movements
  • infections caused by open wounds

People with Lichen Sclerosus have a slightly increased risk of developing a type of cancer called squamous cell carcinoma. For example, women with vulvar Lichen Sclerosus have a 5% chance of developing vulvar squamous cell carcinoma. 

When should I talk to my doctor about Lichen Sclerosus?

You should speak to your doctor if you have the following:

  • an itchy white patch of skin on your genitals, around your anus, or anywhere on your body
  • been diagnosed with Lichen Sclerosus and are experiencing painful sex or find it painful to go to the toilet
  • been diagnosed with Lichen Sclerosus and the treatment you have been prescribed isn’t working

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What causes Lichen Sclerosus?

Doctors are not sure what causes Lichen Sclerosus, but they know that it cannot be spread from person to person. There are theories that the condition is more likely if you have:

  • an autoimmune condition
  • a genetic predisposition
  • a hormonal imbalance
  • previously damaged or irritated skin

What increases your risk of Lichen Sclerosus?

Lichen Sclerosus can affect everyone; men, women, and children of all ages, but some people have a higher risk than others. 

  • women who have been through menopause. It is thought that between 1 in 30 and 1 in 50 postmenopausal women are affected by Lichen Sclerosus. Some studies estimate that 3% of women over 80 have the condition. 
  • people with uncircumcised penises. While it is unknown why or how many men are affected by Lichen Sclerosus, it’s more common in people with uncircumcised penises.
  • children who haven’t yet been through puberty. It is estimated that the condition affects 0.1% of children. Some research shows that up to 15% of Lichen Sclerosus cases occur in girls aged between 4 and 6. 

Why do I keep getting Lichen Sclerosus?

Lichen Sclerosus is a long-term inflammatory condition which means you can keep getting flare-ups throughout your life. Although there is no cure for the condition, treatments are available to help control the symptoms.

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How is Lichen Sclerosus diagnosed?

Lichen Sclerosus must always be diagnosed by a doctor. This is important to make sure you’re getting treatment for the right condition and to rule out any underlying causes.

If you think you have Lichen Sclerosus, you should speak to your doctor for advice. They will ask you about your medical history and examine the affected area.

In most cases, a doctor will be able to diagnose Lichen Sclerosus just by looking at your skin. Still, sometimes they may take a small skin sample, called a biopsy, for further analysis. 

How do I know if I have Lichen Sclerosus?

You may have Lichen Sclerosus if you have any of its symptoms, including itchy, white, cracked, smooth or wrinkled patches of skin. These patches are most likely to appear around the opening to the vagina (vulva), the anus, the foreskin, or the end of the penis.

You shouldn’t diagnose the condition yourself, and you should speak to your doctor if you suspect you have the condition.

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How is Lichen Sclerosus treated?

Lichen Sclerosus can be treated with steroid creams prescribed by a doctor. While it can not be cured, you can manage the symptoms to deal with flare ups and improve your quality of life.

Can Lichen Sclerosus be cured? There is no cure for Lichen Sclerosus, but prescription steroid creams can help to relieve the symptoms.

How to treat Lichen Sclerosus

Lichen Sclerosus is often treated with topical corticosteroids, which are creams applied directly to the affected skin. Steroids help to reduce inflammation which can cause itchy, painful, red, and swollen skin. They should only be used as directed by your doctor because using them too much can cause side effects. The types of treatment available include:
  • Clobetasol propionate

Clobetasol propionate

Clobetasol propionate cream [0.05%], also known as Dermovate, is a type of topical corticosteroid which has been shown to improve the appearance of skin affected by Lichen Sclerosus as well as reducing its symptoms. 

It is often prescribed to be used twice a day for up to three months. Up to 70% of people find their symptoms disappear after using this treatment. 

You may also be prescribed an emollient to use to wash with as an alternative to soap which can irritate your skin. Examples of emollients are:
  • Aveeno lotion
  • Cetraben cream 

How to treat Lichen Sclerosus naturally

There are some things you can do to help treat Lichen Sclerosus, such as:
  • wash with soap substitutes like emollients
  • apply barrier cream or petroleum jelly to the affected area 
  • wear cotton or silk underwear 
  • use lubricants if sex is uncomfortable
  • gently dab the affected area dry after bathing or showering
  • try to avoid rubbing or scratching the affected area

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How to prevent Lichen Sclerosus

As the cause of Lichen Sclerosus is not known, there is little you can do to stop the condition from occurring. If you have a family history of Lichen Sclerosus or believe you may be at a higher risk of developing it, it may help to:
  • avoid wearing tight-fitting clothing
  • avoid bike or horse riding
  • use water-based lubricants during sex
If you have been diagnosed with Lichen Sclerosus, you should:
  • carefully clean and dry the affected area after going to the toilet
  • avoid using harsh soaps or chemicals to wash with
  • monitor the affected areas for changes in appearance
  • regularly visit your doctor for follow-up appointments

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Sources

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