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What is lichen sclerosus?
Lichen sclerosus is a type of skin condition. It often affects your genital or anal areas, but you can get it on other parts of your body. It can cause a rash, itching, pain, and scarring. Lichen sclerosus is most common in women after menopause. However, men and children can get it too.
Women may have a subset of the condition called lichen simplex chronicus. This affects a woman’s vulva (the outside part of the vagina). It occurs when the skin in and around the vulva gets thicker from constant itching and scratching.
Symptoms of lichen sclerosus
Some people who have lichen sclerosus do not have any symptoms. Others may have the following symptoms or signs.
- Smooth, shiny, white spots on the skin.
- Skin that is thin, wrinkled, and weak, or easy to tear.
- Skin that is red, 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 it occurs in the anal area.
The symptoms of lichen simplex chronicus may include:
- Itching around the vulva.
- Red or dark skin around the vulva.
- Small cuts on or around the vulva.
What causes lichen sclerosus?
Doctors do not know the exact cause of lichen sclerosus. Possible causes are:
- an overactiveimmune system
- hormone problems
- injury to the affected area.
A family history of the condition may increase your risk of getting it. Lichen sclerosus is not contagious. You cannot catch it from or pass it to someone else.
How is lichen sclerosus diagnosed?
Contact your doctor if you have symptoms of lichen sclerosus. They will perform a physical exam. They will want to know your health history and how long you have had the symptoms. Your doctor may do a skin biopsy. This involves taking a small sample of skin from the affected area to look at in the lab.
Can lichen sclerosus be prevented or avoided?
There is no way to avoid lichen sclerosus, since the cause is unknown.
Lichen sclerosus treatment
Not all cases of lichen sclerosus can be cured. However, there are treatment options to manage or relieve symptoms. Your doctor will probably prescribe a strong cortisone cream. You apply this to the affected area according to the instructions. This can help relieve pain and itching, but cannot repair scars. Ask your doctor about using a scar cream to reduce or prevent scarring.
Repeated use of cortisone cream often is effective. Continue to follow up with your doctor during this treatment. Cortisone cream can have side effects over time. These include thinning or redness of the skin, stretch marks, and genital yeast infections.
Medicines are available if you have an infection or are allergic to cortisone. Options include:
- Tacrolimus ointment.
- Retinoids, such as isotretinoin or retinol. These are similar to vitamin A supplements.
- Ultraviolet light treatments for skin not near the genital area.
Over-the-counter antihistamine skin creams may help with the pain and itching. A sitz bath also can help with pain, itching, and scratching. This is where you sit in a few inches of warm water.
There are other things you can do to help relieve discomfort.
- Wear loose-fitting underwear during the day and none at night.
- Do not wear pantyhose, tights, and other tight clothing.
- Do not stay in swimsuits or wet clothing for long periods.
- Avoid vaginal sprays, which can cause irritation.
- Use a mild skin cleanser. Look for products designed for sensitive skin.
- Avoid scented detergent, fabric softeners, and dryer sheets.
Living with lichen sclerosus
Lichen sclerosus and lichen simplex chronicus often can be managed with treatment. If left untreated, the conditions can have serious effects. Severe cases may cause severe pain during sex. You may be emotional about having a condition in your genital area. Without treatment, the scratching associated with lichen simplex chronicus can lead to a bacterial skin infection. It also can cause permanent scars.
Questions to ask your doctor
- How bad is my case of lichen sclerosus?
- What treatment option is best for me?
- How long do I need to use cream or take medicine?
- What are the side effects of treatment?
- How can I relieve the pain during sex?
- If I have lichen sclerosus, what is my risk of getting lichen simplex chronicus?
- What is my risk of getting skin or vulvar cancer?
- If my symptoms get worse, when should I call the doctor?