Lichen Sclerosus

Lichen sclerosus (LS) is a long-term skin condition that mainly affects the skin of the genitals. It usually causes itching and white patches to appear on the affected skin.

Other areas of the body are also occasionally affected, including the upper arms, back, breasts and shoulders. LS is most common in women who have been through the menopause, although men and children are also sometimes affected. It's not clear what causes LS, but it's thought to be related to overactivity of the immune system. It's not an infection and can't be spread to your partner or other people.

Friction or damage to the skin trigger LS and make it worse. This is called a 'Koebner response'. Irritation from urine leakage, or wearing incontinence pads or panty liners can make the problem worse. Is LS hereditary? Rarely, it can occur in relatives. It can be uncomfortable and distressing, but it's usually possible in most cases to control the symptoms with simple treatments.

Symptoms in women and girls

In women and girls LS tends to affect the vulva (the skin around the entrance to the vagina) and the skin around the anus (back passage). Symptoms can include:

Small white areas that may increase in size and join together to form larger patches – these patches may become cracked and sore, itchiness, which tends to be worse at night and may disturb sleep, the skin becoming fragile and thin, or wrinkly and thickened, red or purple blood blisters, pain when having sex and/or passing stools.

Without treatment, the vulva may gradually scar and shrink. This can make the entrance to the vagina narrower, which makes sex even more difficult and painful. As a general rule, the patches on the general skin surface seldom itch much, but those in the genital area do, and can also be sore if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin, and this can interfere with urination and with sexual intercourse. Tightening of the skin around the anus can lead to problems with constipation.

Symptoms in men and boys

In men and boys, LS tends to develop on the foreskin and end of the penis. The skin around the anus is rarely affected. Symptoms can include: sore or sometimes itchy white patches on the penis, particularly around the tip, but sometimes on the shaft, the skin at the tip of the penis becoming firm and white, difficulty pulling the foreskin back, which can make urination difficult and lead to painful erections if left untreated. For both men and women, it's often easy for a doctor to diagnose LS by asking about your symptoms and examining your skin. However, in some cases, a very simple procedure known as a biopsy, where a skin sample is taken for analysis, may be needled to help make the diagnosis.

How long does LS last?

For most people, LS is a long-term condition that lasts many years and may flare up and down over time. There's currently no cure, but symptoms can normally be controlled with steroid medication applied directly to the affected skin. Occasionally, LS goes away on its own and doesn't come back, but this usually only occurs when children with the condition reach puberty.

Treatments for LS Steroid creams and ointments

The main treatment for LS is steroid ointment or cream, which helps to control symptoms. It should be applied regularly, but relatively sparingly, to the affected areas of skin. Your doctor will advise you on how much to use, how frequently, and for how long. Generally, a 30g tube should last around three months. When used appropriately, the risk of side effects such as thinning of the skin is very low. Symptoms tend to ease after a few weeks of treatment, but it may be a few months before your symptoms are fully under control. Steroid creams and ointments are very effective in most cases. However, if they don't help, other treatments may be suggested by a specialist.

Surgery

In a few cases, surgery may be needed to treat problems caused by LS. For example, a small operation may be needed to divide adhesions if the skin sticks together. If the condition causes a woman's vaginal opening to become very narrow, affecting sex, an operation to widen it may be suggested. Men or boys may need surgery to remove the foreskin if steroid ointments or creams don't help and the foreskin becomes severely affected. This can result in the condition settling fully. Self-help for lichen sclerosus. In addition to the above treatments, the following measures can help keep your symptoms under control:

  • Avoid washing with soap or bubble bath – use plain water or an emollient wash instead, such as aqueous cream (but avoid leaving aqueous cream on the skin after washing)
  • Avoid rubbing or scratching the area
  • Gently dab your genitals dry after urinating, to stop your urine irritating the skin
  • Apply a barrier cream, such as petroleum jelly, after washing, before and after urinating
  • Avoid wearing tight or restrictive clothes and wear underwear made from natural materials such as cotton or silk – women may find it helps to wear stockings rather than tights

For women who find sex painful, it may help to use a lubricant or a vaginal dilator. There is a very small increased chance of developing cancer of the vulva or penis if you have lichen sclerosus. If any skin change develops which does not respond to steroid creams, in particular any skin thickening, soreness or ulceration lasting more than two weeks, you need to tell your doctor without delay. You may need a biopsy to test for skin cancer.

With thanks to the British Association of Dermatologists (BAD), the Association of Lichen Sclerosus and Vulval Health and NHS Choices for assisting with the content and imagery supplied for the article.


Read Collette's personal story about her condition.

Living with Lichen Sclerosus

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