Lichen Sclerosus

Lichen sclerosus is a recurring skin disorder that can affect anyone, but is most common in women. Symptoms vary, but often include itching and small white spots. Doctors can diagnose an advanced case by looking at the skin. However, early or mild cases often require a biopsy. Treatments for lichen sclerosus depend on how severe the condition is and what areas are affected.

 

Lichen Sclerosus: An Overview

Lichen sclerosus is a chronic inflammatory skin disorder that can affect men, women, or children, but is most common in women. It usually affects the vulva (the outer genitals) and the anal area. While lichen sclerosus appears predominantly in women who have gone through menopause, this skin condition is also known to develop on the head of the penis in men. Occasionally, lichen sclerosus is seen on other parts of the body, especially the upper body, breasts, and upper arms.
 
Lichen sclerosus is also known as lichen sclerosus et atrophicus.
 

Who Does Lichen Sclerosus Affect?

Although definitive data is not available, lichen sclerosus is considered a rare disorder that can develop in people of all ages. It usually appears in postmenopausal women and primarily affects the vulva. It is uncommon for women who have vulvar lichen sclerosus to have the disease on other skin surfaces. The disease is much less common in childhood. In boys, it is a major cause of tightening of the foreskin, which requires circumcision. Otherwise, it is quite uncommon in men.
 

Causes of Lichen Sclerosus

Lichen sclerosus research scientists are not sure what causes lichen sclerosus. At this point, they think that an overactive immune system may play a role. Some people may have a genetic tendency toward the disease, and studies suggest that abnormal hormone levels may also be a factor. Lichen sclerosus has also been shown to appear at sites of previous injury or trauma where the skin has already experienced scarring or damage.
 
Lichen sclerosus is not contagious. You cannot "catch" it from anyone.
 

Symptoms of Lichen Sclerosus

The symptoms of lichen sclerosus can vary, depending on the location and severity of the disease.
 
Early in lichen sclerosus, small, subtle white spots appear. These areas are usually slightly shiny and smooth. As time goes on, the spots develop into bigger patches and the skin surface becomes thinned and crinkled. As a result, the skin tears easily, and bright red or purple discoloration from bleeding inside the skin is common. In someone with severe lichen sclerosus symptoms, rubbing or bumping the skin can cause pain.
 
When lichen sclerosus occurs on parts of the body other than the genital area, most often, there are no symptoms other than itching.
 
Lichen sclerosus symptoms are usually the same in children and adults.
 

Diagnosing Lichen Sclerosus

In order to make a lichen sclerosus diagnosis, the doctor will ask a number of questions about a person's medical history and will perform a physical exam. looking for signs and symptoms of lichen sclerosus. He or she may also recommend certain tests and procedures.
 
Doctors can diagnose lichen sclerosus in advanced cases just by looking at the skin. However, early or mild lichen sclerosus often requires a biopsy (removal and examination of a small sample of affected skin). Because other diseases of the genitals can look like lichen sclerosus, a biopsy is advised whenever the appearance of the skin is not typical of lichen sclerosus.
 
A number of other medical conditions can have symptoms similar to lichen sclerosus. Before the doctor makes a diagnosis of lichen sclerosus, he or she will consider these other possible conditions, including:
 
  • Psoriasis
  • Discoid systemic lupus erythematosus (SLE or lupus)
  • Cicatricial pemphigoid
  • Hidradenitis suppurativa
  • Vitiligo
  • Scleroderma
  • Lichen simplex chronicus.
     

Treatment for Lichen Sclerosus

Patients with lichen sclerosus affecting non-genital skin often do not need treatment for lichen sclerosus, because the symptoms are mild and usually go away over time. The amount of time involves varies from patient to patient.
 
However, lichen sclerosus of the genitals should be treated, even when it is not causing itching or pain, because it can lead to scarring that may narrow openings in the genital area and interfere with urination, sexual intercourse, or both. There is also a small chance that skin cancer may develop within the affected areas.
 
Medications are the treatment of choice for lichen sclerosus and are usually recommended for:
 
  • Vulvar lichen sclerosus
  • Non-genital lichen sclerosus that is causing symptoms
  • Lichen sclerosus of the penis that is not cured by circumcision.
     
The lichen sclerosus treatment medication most often prescribed is an ultrapotent topical corticosteroid (a very strong cortisone cream or ointment).
 
(Click Treatment for Lichen Sclerosus for more information on treating this condition.)
 
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Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD