Lichen sclerosus

Causes of lichen sclerosus

It's not clear what causes lichen sclerosus. It's thought to be related to overactivity of the immune system. It's not an infection and can't be spread to your partner or other people.

Lichen sclerosus can be uncomfortable and distressing, but it's usually possible to control the symptoms with simple treatments.

Symptoms in women and girls

In women and girls, lichen sclerosus tends to affect the vulva (the skin around the entrance to the vagina) and the skin around the anus (back passage).

Symptoms include:

• small white areas that may increase in size and join together to form larger patches – these patches may become cracked and sore
• itchiness, which tends to be worse at night and may disturb sleep
• the skin becoming fragile and thin, or wrinkly and thickened
• red or purple blood blisters
• pain when having sex and/or passing stools

Without treatment, the vulva may gradually scar and shrink. This can make the entrance to the vagina narrower, which makes sex even more difficult and painful.

Symptoms in men and boys

In men and boys, lichen sclerosus tends to develop on the foreskin and end of the penis. The skin around the anus is rarely affected.

Symptoms can include:

• sore or sometimes itchy white patches on the penis, particularly around the tip, but sometimes on the shaft
• the skin at the tip of the penis becoming firm and white
• difficulty pulling the foreskin back, which can make peeing difficult and lead to painful erections if left untreated

For both men and women other areas of the body are also occasionally affected, including the upper arms, back, breasts and shoulders.

It's often easy for a doctor to diagnose lichen sclerosus by asking about your symptoms and examining your skin. In some cases, a procedure known as a biopsy, where a skin sample is taken for analysis, may be needed to help make the diagnosis.

How long lichen sclerosus lasts

For most people, lichen sclerosus is a long-term condition that lasts many years and may flare up and down over time.

There's currently no cure, but symptoms can normally be controlled with steroid medication applied directly to the affected skin.

Occasionally, lichen sclerosus goes away on its own and doesn't come back. This usually only occurs when children with the condition reach puberty.

Treatments for lichen sclerosus

The main treatment for lichen sclerosus is steroid ointment or cream, which helps to control symptoms. It should be applied regularly, but quite sparingly, to the affected areas of skin. Your doctor will advise you on how much to use, how often, and for how long.

Symptoms tend to ease after a few weeks of treatment, but it may be a few months before your symptoms are fully under control. After three or four months of regular treatment, you might only need to use the cream once or twice a week, or sometimes even less, to stop symptoms returning.

Steroid creams and ointments are very effective in most cases. However, if they don’t help, other treatments may be suggested by a specialist. In a few cases, surgery may be needed to treat problems caused by lichen sclerosus. Your doctor will advise if they think surgery is necessary for you.

Self-help for lichen sclerosus

The following measures, along with the above treatments, can often help keep your symptoms under control:

• avoid washing with soap or bubble bath – use plain water or an emollient wash instead, such as aqueous cream (but avoid leaving aqueous cream on the skin after washing)
• avoid rubbing or scratching the area
• gently dab your genitals dry after peeing, to stop your urine irritating the skin
• apply a barrier cream or ointment, such as petroleum jelly, to affected areas after washing and before and after urinating
• avoid wearing tight or restrictive clothes and wear underwear made from natural materials such as cotton or silk – women may find it helps to wear stockings rather than tights

For women who find sex painful, it may help to use a lubricant or a vaginal dilator.

Cancer risk

Women with lichen sclerosus have a slightly increased risk of developing cancer of the vulva. This affects up to 1 in 20 women with the condition.

It's therefore important to check your vulva regularly for any symptoms of vulval cancer, as the earlier any cancer is detected, the easier it is to treat.

Check for:

• thickening of the skin
• any lumps, blisters or sores

Use a mirror and feel the area with your fingers.

Men with lichen sclerosus may have a slightly higher risk of developing cancer of the penis, so it's also important for them to keep an eye out for any unusual changes, such as growths or sores.

If you have lichen sclerosus, you should report any changes like these to your doctor.

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