What Is Lichen Sclerosus?
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, it 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.
Although definitive data is not available, lichen sclerosus is considered a rare disorder that can develop in people of all ages. 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.
What Causes Lichen Sclerosus?
Researchers 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.
The condition is not contagious -- you cannot "catch" it from anyone.
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.
In order to make a lichen sclerosus diagnosis, the healthcare provider will ask a number of questions about a person's medical history and will perform a physical exam, looking for signs and symptoms of the disease. He or she may also recommend certain tests and procedures.
Healthcare providers 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 healthcare provider makes a diagnosis, 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, 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 treatment medication most often prescribed is an ultrapotent topical corticosteroid (a very strong cortisone cream or ointment).
