Lichen sclerosus (LIE-kun skluh-ROW-sus) is an uncommon condition that creates patchy, white skin that's thinner than normal. Lichen sclerosus can affect skin anywhere on your body. But it most often involves skin of the vulva, foreskin of the penis or skin around the anus.
Anyone can get lichen sclerosus but postmenopausal women have a high risk.
Sometimes lichen sclerosus improves on its own, and you won't need any treatment. If you do need treatment, your doctor can suggest options to return a more normal appearance to your skin and decrease the tendency for scarring.
Sometimes, mild cases of lichen sclerosus cause no noticeable signs or symptoms.
When they do occur, lichen sclerosus symptoms may include:
- Itching (pruritus), which can be severe
- Discomfort or pain
- Smooth white spots on your skin
- Blotchy, wrinkled patches
- Easy bruising or tearing
- In severe cases, bleeding, blistering or ulcerated lesions
- Painful intercourse
When to see a doctor
See your doctor if you have signs and symptoms common to lichen sclerosus.
If you've already been diagnosed with lichen sclerosus, see your doctor every six to 12 months to be checked for any skin changes or treatment side effects.
The exact cause of lichen sclerosus isn't known. An overactive immune system or an imbalance of hormones may play a role. Previous skin damage at a particular site on your skin may increase the likelihood of lichen sclerosus at that location.
Lichen sclerosus isn't contagious and cannot be spread through sexual intercourse.
Lichen sclerosus often occurs in postmenopausal women, but also in men and children. In women, lichen sclerosus usually involves the vulva. In boys and men, uncircumcised males are most at risk, because the condition generally affects the foreskin.
In children, the signs and symptoms may improve at puberty.
Skin cancer may rarely develop in areas affected by lichen sclerosus, though lichen sclerosus doesn't cause skin cancer. Women with lichen sclerosus on the vulva are more likely to develop vulvar cancer. But consistent treatment with topical corticosteroids may reduce this slightly higher risk.
Severe lichen sclerosus can make sex extremely painful for women because itching and scarring may narrow the vaginal opening and affect the ability or desire to have sexual intercourse. In addition, blistering may create extremely sensitive skin to the point that any pressure on the area is unbearable.
Lichen sclerosus may rarely cause tightening and thinning of the foreskin in uncircumcised men. This can cause problems during an erection or when urinating.
If you have signs and symptoms common to lichen sclerosus, make an appointment with your primary care doctor. Your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).
Here's some information to help you get ready for your appointment.
What you can do
Before your appointment make a list of:
- Your symptoms and how long you've had them.
- Your key medical information, such as other conditions with which you've been diagnosed and any prescription or over-the-counter medications you're using, including vitamins and supplements.
- Questions to ask your doctor.
Some basic questions to ask your doctor about possible lichen sclerosus include:
- What’s the most likely cause of my symptoms?
- What treatment approach do you recommend, if any?
- If the first treatment doesn't work, what will you recommend next?
- How much do you expect my symptoms will improve with treatment — and how soon?
- Will I need treatment for this condition for the rest of my life?
- What self-care steps can I follow to ease my symptoms?
- What can I do to help prevent a recurrence?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- How severe is your discomfort?
- Have you noticed any bleeding?
- Do your symptoms include pain with urination or bowel movements?
- Do your symptoms include pain with sexual intercourse?
- Have you had any previous injuries to the affected area?
- What steps have you taken to treat this condition yourself?
- Have you had prescription treatments for this condition?
- Have you been diagnosed with any other medical conditions?
Your doctor may diagnose lichen sclerosus based on:
- A physical examination
- Removal of a small piece of affected tissue (biopsy) for examination under a microscope
If your genital area isn't affected, you may not need treatment for lichen sclerosus, especially if you're not having symptoms. Lichen sclerosus may get better on its own.
If you have lichen sclerosus on or around your genitals or anus, or have a more advanced case on other parts of your body, your doctor will recommend treatment. Treatments help reduce itching, improve your skin's appearance and decrease further scarring.
Corticosteroid ointments or creams are commonly prescribed for lichen sclerosus. Initially, you'll generally have to use cortisone creams or ointments on the affected skin daily. After several weeks, your doctor will likely recommend that you only use these medications twice a week to prevent a recurrence.
Your doctor will monitor you for side effects associated with prolonged use of topical corticosteroids, such as further thinning of the skin.
Other treatment options
If corticosteroid treatment doesn't work or if months of corticosteroid therapy are needed, other treatments your doctor may prescribe include:
- Immune-modulating medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel)
- Ultraviolet light treatment, for nongenital areas
Topical sex hormones have been used in the past to treat lichen sclerosus, but recent research suggests that these medications aren't effective.
Removal of the foreskin (circumcision) in men is a common treatment in cases resistant to other therapies or more advanced cases. Surgery in the genital or anal area generally isn't recommended for women with lichen sclerosus because the condition may just come back after surgery.
Be sure to ask your doctor how often he or she recommends follow-up visits to look for changes in the skin. Follow-up exams are generally recommended every six to 12 months.