Lichen Sclerosus

Overview

What is lichen sclerosus?

Lichen sclerosus (say: “like-en skler-oh-sus”) is a skin condition that can cause itching, a rash and scarring. It usually affects the genital and anal areas, but you can also get lichen sclerosus on other parts of your body.

If you are a woman who has lichen sclerosus, you may also develop lichen simplex chronicus (say: “like-en sim-pleks krah-neh-kus”). Lichen simplex chronicus occurs when the skin in and around the vulva (the outside part of the vagina) gets thicker from constant itching and scratching.

Who gets lichen sclerosus?

Lichen sclerosus is more common in women after menopause. However, anyone can develop lichen sclerosus, including men and children.

Symptoms

What are the symptoms of lichen sclerosus?

Sometimes, lichen sclerosus does not have any symptoms. If you do have symptoms, they may include:

  • Smooth, shiny, white spots on the skin
  • Skin that is thin, wrinkled, and may tear easily
  • Skin that is red or bruised, scaly or cracked
  • Bleeding or blistering in the affected area
  • Itching, pain or discomfort in the affected area
  • Painful urination
  • Pain during sex
  • Painful bowel movements and constipation (if lichen sclerosus occurs in the anal area)

What are the symptoms of lichen simplex chronicus?

Symptoms of lichen simplex chronicus may include:

  • Itchiness around the vulva
  • Dark or red skin around the vulva
  • Small cuts on or around the vulva

Causes & Risk Factors

What causes lichen sclerosus?

Doctors don’t know the exact cause of lichen sclerosus. An overactive immune system, hormone problems, injury or a family history of lichen sclerosus may increase your risk of getting it. Lichen sclerosus is not contagious. You can’t catch it from or pass it to someone else.

Diagnosis & Tests

How can my doctor tell if I have these conditions?

Your doctor will perform a physical examination. He or she may ask you about your history of itching and scratching. Your doctor may take a small sample of your skin to examine it under a microscope. (This is called a skin biopsy.)

Prevention

Treatment

How are lichen sclerosus and lichen simplex chronicus treated?

These conditions can’t always be cured, but they can be managed. If you have lichen sclerosus on the genital skin or anus, you will need treatment to prevent scarring, problems with sex and painful urination, and to reduce the risk of skin cancer and vulvar cancer.

Your doctor will probably prescribe a strong cortisone cream or ointment. Cortisone creams and ointments help relieve pain and itching, but they cannot repair scarring that has already happened. Consistent cortisone treatment is usually effective.

While using cortisone creams or ointments, continue to follow up regularly with your doctor. Long-term use of cortisone creams or ointments may cause thinning or redness of the skin, stretch marks where the cream is applied, and genital yeast infections.

Infections or allergic reactions to the medicine can prevent cortisone creams and ointments from working. In these cases, your doctor may prescribe:

A sitz bath (where you sit in a few inches of warm water) can help relieve discomfort from itching and scratching. Over-the-counter antihistamine skin creams may also help with the pain.

  • Retinoids (vitamin A-like supplements), such as isotretinoin or retinol
  • Tacrolimus ointment
  • Ultraviolet light treatments (for skin not near the genital area)

Complications

Are these conditions serious?

Not necessarily. Lichen sclerosus and lichen simplex chronicus can usually be managed with treatment. However, these conditions can have serious physical and emotional effects if left untreated.

Severe cases may make sex painful, which may make you not want to have sex. It can be troubling and embarrassing to have a long-term condition in the genital area.

Without treatment, the scratching associated with lichen simplex chronicus may lead to a bacterial skin infection. Persistent scratching can also cause permanent scars.

Lichen sclerosus can also be a risk factor for skin and vulvar cancer. See your doctor if you have signs or symptoms of lichen sclerosus.

Tips to Relieve Discomfort

  • Wear loose-fitting underwear during the day and none at night.
  • Don’t wear pantyhose, tights and other tight-fitting clothing.
  • Avoid feminine perfume sprays, which may cause irritation.
  • Use a mild skin cleanser. Look for products designed for sensitive skin.
  • Don’t stay in swimsuits or wet clothing for long periods.
  • Avoid scented fabric softeners and dryer sheets.

Questions to Ask Your Doctor

 

  • What treatment is best for me?
  • Do I need a topical cream or ointment?

 

  • Should I take any medicines?
  • Could I have any side effects from treatment?
  • How did I get lichen sclerosus or lichen simplex chronicus?
  • Will these conditions go away on their own?
  • Is there anything I can do at home to make myself more comfortable?
  • Am I at higher risk for skin or vulvar cancer?
  • If my symptoms don’t get better, when should I call my doctor?
  • How can I relieve the pain during sex?

Resources