What Is Lichen Sclerosus?
Lichen sclerosus (LIKE-in skler-O-sus) is a skin disorder
that can affect men, women, or children, but is most common in women. It
usually occurs on the vulva (the outer genitalia or sex organ) in women,
but sometimes develops on the head of the penis in men. Occasionally,
lichen sclerosus is seen on other parts of the body, especially the
upper body, breasts, and upper arms.
The symptoms are the same in children and adults. Early in
the disease, small, subtle white spots appear. These areas are usually
slightly shiny and smooth. As time goes on, the spots develop into
bigger patches, and the skin surface becomes thinned and crinkled. As a
result, the skin tears easily, and bright red or purple discoloration
from bleeding inside the skin is common. More severe cases of lichen
sclerosus produce scarring that may cause the inner lips of the vulva to
shrink and disappear, the clitoris to become covered with scar tissue,
and the opening of the vagina to narrow.
Lichen sclerosus of the penis occurs almost exclusively in
uncircumcised men (those who have not had the foreskin removed). The
foreskin can scar, tighten, and shrink over the head of the penis. Skin
on other areas of the body affected by lichen sclerosus usually does not
How Common Is It?
Although definitive data are not available, lichen
sclerosus is considered a rare disorder that can develop in people of
all ages. It primarily affects the vulva. Fewer than 1 in 20 women who
have vulvar lichen sclerosus have the disease on other skin surfaces.
The disease is much less common in childhood. In boys, it is a major
cause of tightening of the foreskin, which requires circumcision.
Otherwise, it is very uncommon in men.
What Are the Symptoms?
Symptoms vary depending on the area affected. Patients
experience very different degrees of discomfort. When lichen sclerosus
occurs on parts of the body other than the genital area, most often
there are no symptoms, other than itching. If the disease is severe,
bleeding, tearing, and blistering caused by rubbing or bumping the skin
can cause pain.
Very mild lichen sclerosus of the genital area may cause
itching, but often causes no symptoms at all. If the disease worsens,
itching is the most common symptom. Rarely, lichen sclerosus of the
vulva may cause extreme itching that interferes with sleep and daily
activities. Rubbing or scratching to relieve the itching can create
painful sores and bruising, so that many women must avoid sexual
intercourse, tight clothing, tampons, riding bicycles, and other common
activities that involve pressure or friction. Urination can be
accompanied by burning or pain, and bleeding can occur, especially
during intercourse. When lichen sclerosus develops around the anus, the
discomfort can lead to constipation. This is particularly common in
Most men with genital lichen sclerosus have not been
circumcised. They sometimes experience difficulty pulling back the
foreskin and have decreased sensation in the tip of the penis.
Occasionally, erections are painful, and the urethra (the tube through
which urine flows) can become narrow or obstructed.
What Causes Lichen Sclerosus?
The cause is unknown, although an overactive immune system
may play a role. Some people may have a genetic tendency toward the
disease, and studies suggest that abnormal hormone levels may also play
a role. Some scientists believe that an infectious bacterium, called a
spirochete, may cause the changes in the immune system that lead to
Is It Contagious?
No, lichen sclerosus is not contagious.
How Is It Diagnosed?
Doctors can diagnose an advanced case by looking at the
skin. However, early or mild disease often requires a biopsy (removal
and examination of a small sample of affected skin). Because other
diseases of the genitalia can look like lichen sclerosus, a biopsy is
advised whenever the appearance of the skin is not typical of lichen
How Is It Treated?
Patients with lichen sclerosus of nongenital skin often do
not need treatment because the symptoms are very mild and usually go
away over time. (The amount of time involved varies from patient to
However, lichen sclerosus of the genital skin should be
treated, even when it is not causing itching or pain, because it can
lead to scarring that may narrow openings in the genital area and
interfere with either urination or sexual intercourse or both. There is
also a very small chance that cancer may develop.
In uncircumcised men, circumcision is the most widely used
therapy for lichen sclerosus. This procedure removes the affected skin,
and the disease usually does not recur.
Prescription medications are required to treat vulvar
lichen sclerosus, nongenital lichen sclerosus that is causing symptoms,
and lichen sclerosus of the penis that is not cured by circumcision. The
treatment of choice is an ultrapotent topical corticosteroid. Daily use
of these creams or ointments can stop itching within a few days and
restore the skin's normal texture and strength after several months.
However, treatment does not reverse the scarring that may have already
Because ultrapotent corticosteroid creams and ointments
are very strong, frequent evaluation by a doctor is necessary to check
the skin for side effects when the medication is used every day. Once
the symptoms are gone and the skin has regained its strength, medication
can be used less frequently, although use must continue indefinitely,
several times a week, to keep vulvar lichen sclerosus in remission.
Prescription in the United States
Young girls may not require lifelong treatment, since
lichen sclerosus can sometimes, but not always, disappear permanently at
puberty. Scarring and changes in skin color, however, may remain even
after the symptoms have disappeared.
Because ultrapotent topical corticosteroids are so
effective, other therapies are rarely prescribed. The previous standard
therapy was testosterone ointment or cream, but this has recently been
proven to produce no more benefit than a placebo (inactive) cream.
Another hormone cream, progesterone, was previously used to treat the
disease, but also has little beneficial effect. Retinoids, or vitamin
A-like medications, may be helpful for patients who cannot tolerate or
are not helped by ultrapotent topical corticosteroids.
Patients who need medication should ask their doctor how
it works, what side effects it might have, and why it is the best
treatment for lichen sclerosus.
For women and girls, surgery to remove the affected skin
is not an acceptable option. Surgery may be useful for scarring, but
only after lichen sclerosus is controlled with medication.
Sometimes, people do not respond to the ultrapotent
topical corticosteroid. Other factors, such as low estrogen levels that
cause vaginal dryness and soreness, a skin infection, or irritation or
allergy to the medication, can keep symptoms from clearing up. Your
doctor may need to treat these factors as well. If you feel that you are
not improving as you would expect, talk to your doctor.
Can People With Lichen Sclerosus
Have Sexual Intercourse?
Women with severe lichen sclerosus may not be able to have
sexual intercourse because of pain or scarring that narrows the entrance
to the vagina. However, proper treatment with an ultrapotent topical
corticosteroid should restore normal sexual ability, unless severe
scarring has already narrowed the vaginal opening. In this case, surgery
may be needed to correct the problem, but only after the disease has
Is Lichen Sclerosus Related to
Lichen sclerosus does not cause skin cancer. However, skin
that is scarred by lichen sclerosus is more likely to develop skin
cancer. About 1 in 20 women with untreated vulvar lichen sclerosus
develops skin cancer. The frequency of skin cancer in men with lichen
sclerosus is not known. It is important for people who have the disease
to receive proper treatment and to see their doctor every 6 to 12
months, so that he or she can monitor and treat any changes that might
signal skin cancer.
What Kind of Doctor Treats Lichen
Lichen sclerosus is treated by dermatologists (skin
doctors) and by gynecologists if the female genitalia are involved.
Urologists and primary care health providers with a special interest in
genital diseases also treat this disease. To find a doctor who treats
lichen sclerosus, ask your family doctor for a referral, call a local or
State department of health, look in the local telephone directory, or
contact a local medical center. The American Academy of Dermatology also
provides referrals to dermatologists in your area, and the American
College of Obstetricians and Gynecologists can refer you to a
gynecologist. The Directory of Medical Specialists, available at most
public libraries, lists dermatologists, gynecologists, and urologists in
Keeping on Top of Your Condition
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