Lichen Sclerosus

What is Lichen Sclerosus?

Lichen sclerosus (LS) is also known as lichen sclerosus et atrophicus (LSetA) and is a disease of unknown origin that results in white patches on the skin that can cause scarring on the genital or perianal areas.

The condition occurs mostly among post-menopausal women and is not common in children and men. When Lichen sclerosis is found in men it is called balanitis xerotica obliterans. The condition is not contagious.

What are the Symptoms of Lichen Sclerosus?

When found in men the condition may cause a whitish thickening of the foreskin that cannot be retracted easily (phimosis) along with painful erections. Lichen sclerosis tends to occur more frequently among uncircumcised men than circumcised men.

The skin may tear easily and bright red or purple bruises are common along with bleeding, itching, and blisters. Swelling of the skin, overgrowth of the skin, loss of skin tissue, and inflammation are also common symptoms. There may be a shrinkage of the skin of the vulva and vagina that is accompanied by a chronic inflammation in the deeper tissues.

Lichen Sclerosus Causes

While the exact cause of lichen sclerosus remains a mystery, researchers suspect a heightened immune system may play a role. Just as likely, a hormone imbalance may also be a contributing factor. Previous cases suggest that an injury to the skin may instigate a flare-up of lichen sclerosus in the affected area.

It is known that lichen sclerosus is not contagious, nor is it sexually transmitted, even though it commonly affects the skin around the genitals. While the condition does primarily affect women who have undergone menopause, lichen sclerosus has also affected men and children. In children, lichen sclerosus often clears up, as they reach puberty.

Postmenopausal women are often affected around the vulva. In men and boys, the foreskin is the common area of infection, indicating circumcised males are least likely to attract the condition.

How is Lichen Sclerosus Treated?

While there is no cure for Lichen sclerosis improved hygiene and minimizing scratching of the infected area are an important part of treatment. Ultrapotent corticosteroids such as betamethasone dipropionate, clobetasol dipropionate, diflorasone diacetate, and halobetasol propionate may be prescribed to stop itching within days or a couple of weeks.

Prolonged use of ultrapotent corticosteroids may enable the skin to regain its texture and strength. Recent studies in females indicate that the injection of PRP (Platelet-rich plasma) and stems cells into the affected site may reduce symptoms and improve lesions.

Lichen Sclerosus Prevention

There is no known way to prevent the initial onset of lichen sclerosus, but managing and/or preventing symptoms may be possible with treatment. There are a number of ways to manage symptoms and doctors will often prescribe a cortisone cream to get any flare-ups under control. This will reduce pain and itching, but scar cream may be needed to undo the damage to the skin.

In some cases, the onset of lichen sclerosus may produce an infection, or, conversely, the patient may be allergic to cortisone based creams. Under those circumstances, there are a number of alternative medications available. Tacrolimus ointment, retinoids, and vitamin A supplements may all be substituted for cortisone cream or ointments. Additionally, areas not near the genitals may respond well to ultraviolet light therapy.

For mild onsets of lichen sclerosus, over the counter antihistamines may be adequate to relieve pain and itching. Also, doctors recommend wearing loosely fitted underwear during the day and none at bedtime. Likewise, any tight-fitting clothing, such as pantyhose or yoga pants, should be avoided at all times. Vaginal sprays, scented detergents, fabric softeners, and dryer sheets should also be avoided.