Lichen Sclerosus

What is lichen sclerosus?

Lichen sclerosus is a skin condition that can cause a range of issues that can affect the skin on your:

• Vulva (the area outside your vagina).
• Penis.
• Foreskin.
• Urethra.
• Anus.

It often looks like a discolored, thin, itchy and scaly patch. Blisters and sores (usually from persistent itching) may also form on your genitals. But rarely do these symptoms appear on other body parts.

Lichen sclerosus is a chronic (life-long) condition. Without treatment, it can lead to scarring, making it difficult or painful to have sexual intercourse (dyspareunia), urinate (pee) or have a bowel movement (poop). Untreated lichen sclerosus can also increase your chances of developing a type of skin cancer (penile cancer and vulvar squamous cell carcinoma). There isn’t a cure for lichen sclerosus, though treatment can help manage your symptoms.

Other names for lichen sclerosus include balanitis xerotica obliterans (BXO) and white spot disease.

What does lichen sclerosus look like?

When lichen sclerosus first appears, it looks like small, white, shiny, slightly raised spots on your genitals or anus. Over time, more spots may develop and eventually join together to form a white patch that looks like wrinkly parchment or tissue paper.

How common is lichen sclerosus?

Lichen sclerosus isn’t common. About 200,000 people in the United States have it.

Even if you have several risk factors, lichen sclerosus is still rare.

What are the symptoms of lichen sclerosus?

The primary symptoms of lichen sclerosus include white, raised spots on your vulva, anus, foreskin or the tip of your penis (glans). They cause itching, soreness, discomfort or burning. Other symptoms include:

• Ulcers and sores.
• Inflammation.
• Scarring.
• Cracking.
• Pain while peeing (dysuria).
• Pain while having sex.
• Weak pee stream.
• Your pee may spray instead of coming out in a stream.
• Tightening of your foreskin.
• Inability to pull your foreskin back (phimosis).
• Fluid that comes out of your penis that isn’t pee or semen (penile discharge).

Rarely, lichen sclerosus can also affect skin on other body parts, such as your:

• Neck.
• Chest.
• Torso.
• Upper back.
• Wrists.
• Mouth.

What are the risk factors for lichen sclerosus?

It can affect anyone. But postmenopausal people assigned female at birth (AFAB) between the ages of 40 and 60 are more likely to develop it. People AFAB who haven’t gone through puberty also have a higher risk.

Less commonly, lichen sclerosus affects people assigned male at birth (AMAB) who still have their foreskin. You may also have a slightly increased risk if you have an autoimmune disease or allergies.

Diabetes and a body mass index (BMI) greater than 30 (having overweight/obesity) may also increase your risk for lichen sclerosus.

What triggers lichen sclerosus?

Healthcare providers and medical researchers aren’t sure what causes lichen sclerosus. However, they think there may be a link to autoimmune diseases. If you have an autoimmune disease, your immune system attacks healthy cells instead of protecting your body from bacteria and viruses.

Genetics and hormonal changes may also determine who gets the disorder. In some cases, lichen sclerosus develops after someone experiences trauma, such as an injury or sexual abuse. In rare cases, parents may pass lichen sclerosus to their biological children through genetics.

Healthcare providers and medical researchers continue to research lichen sclerosus to pinpoint its exact causes.

Is it contagious?

No, lichen sclerosus isn’t contagious. You can’t spread it to another person.

How is lichen sclerosus diagnosed?

A healthcare provider will diagnose lichen sclerosus. They’ll ask questions about your symptoms and perform a physical examination, which includes an evaluation of your affected areas.

What tests will be done to diagnose lichen sclerosus?

To confirm their lichen sclerosus diagnosis, your healthcare provider may perform a biopsy.

Can lichen sclerosus be cured without circumcision?

If you have a penis, yes; healthcare providers can treat lichen sclerosus without circumcision. Circumcision can sometimes treat lichen sclerosus, but there are other options.

How is lichen sclerosus treated?

Your healthcare provider may recommend the following lichen sclerosus treatments:

• Topical corticosteroid creams. Topical steroid creams are medicines that you apply directly to the affected areas. Providers commonly prescribe clobetasol.
• Phototherapy (light therapy). Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps which may reduce inflammation and minimize itchiness.
• Immunosuppressants. Immunosuppressants help stop your immune system from attacking your healthy cells. Providers commonly prescribe tacrolimus ointment.
• Surgery. A healthcare provider may recommend surgery depending on which part of your body lichen sclerosus affects. Surgeries may include circumcision if lichen sclerosus affects your foreskin or a urethroplasty if lichen sclerosus causes urethral strictures.

An essential part of lichen sclerosus treatment includes regular checkups with a healthcare provider. They’ll watch for signs of skin cancer and help prevent scarring around your genitals.

How soon after treatment will I feel better?

Your recovery depends on the type of treatment you receive.

Topical corticosteroids and immunosuppressants may take weeks to see improvements.

Phototherapy may take several treatments before your affected areas start to look better. It may take up to two months to start getting better.

It may take up to a week and a half to feel better after a circumcision. After circumcision, children should avoid lying on their stomachs or playing on straddle toys (e.g., rocking horse, see-saw, swing or bicycle). Adults should avoid having sexual intercourse or masturbating until a healthcare provider says it’s OK.

If you have a urethroplasty, you’ll need to keep a catheter in your urethra for three to four weeks.

Can lichen sclerosus be prevented?

Though you can’t prevent lichen sclerosus, you may be able to relieve symptoms with lifestyle changes.

To reduce friction and irritation, you should:

• Establish a skincare routine, including regularly washing with soap and clean water and moisturizing, and follow your healthcare professional’s recommendations for keeping your skin healthy.
• Wear loose-fitting underwear and clothing.
• Avoid clothing that can irritate your skin, including wool and silk.
• Use mild soap for your bath or shower and pat your skin dry instead of rubbing it. Apply a moisturizing cream or ointment immediately after patting dry to help seal in the remaining moisture.
• Take baths or showers with lukewarm water, not hot water.
• Avoid bubble baths. The suds can cause irritation that makes itching worse.
• Use unscented laundry detergent.
• Avoid long bicycle rides, motorcycle rides and horseback riding.
• Change out of wet swimsuits and clothing right away.

Early circumcision may also reduce the odds of developing lichen sclerosus.

What can I expect if I have lichen sclerosus?

Lichen sclerosus is a chronic condition. Most people respond well to treatment, but your symptoms may come back later. You may develop scarring, which can make going to the bathroom and having sexual intercourse difficult or uncomfortable. For people with lichen sclerosus of the meatus (opening of the urethra at the end of the penis), getting treatment sooner may prevent scar tissue from forming in the rest of the urethra.

You also have a risk of developing squamous cell carcinoma penile cancer. Schedule regular checkups with your healthcare provider so they can check for signs of cancer.

What’s the outlook for lichen sclerosus?

The sooner a healthcare provider can diagnose lichen sclerosus and provide treatment, the better the outlook. However, even with early diagnosis and treatment, symptoms may appear randomly for the rest of your life.

What foods should I avoid with lichen sclerosus?

There isn’t a recommended lichen sclerosus diet. Some studies show that changes to your eating patterns can reduce your risk and relieve symptoms. Talk to a healthcare provider about foods you should avoid and how to make healthy choices.

When should I see a healthcare provider?

Lichen sclerosus has many varying symptoms that may look like other conditions, so it’s important to see a healthcare provider as soon as you notice any changes to your genitals or surrounding areas.

If you have lichen sclerosus, see a provider if your symptoms return after treatment. You should also schedule regular appointments so they can check for signs of cancer.

When should I go to the ER?

Go to the emergency room if lichen sclerosus prevents you from being able to pee at all.

What questions should I ask my doctor?

You can ask your provider:

• How can you tell that I have lichen sclerosus?
• If I don’t have lichen sclerosus, what other condition might I have?
• What treatment option do you recommend?
• What are the side effects of your recommended treatment?
• Is it safe for me to have sexual intercourse or masturbate?
• Should I see a dermatologist or other specialist?

Is lichen sclerosus cancerous?

Lichen sclerosus isn’t cancer, and if you have lichen sclerosus, it doesn’t mean you’ll definitely develop cancer. However, there may be an association between lichen sclerosus and penile cancer and vulvar squamous cell carcinoma. If you have lichen sclerosus, it’s important to schedule regular checkups with a healthcare provider so they can check for signs of cancer. Let a provider know if you notice a change in how your skin looks.

Is lichen sclerosus an STI?

No, lichen sclerosus isn’t a sexually transmitted infection (STI), and it isn’t contagious. However, lichen sclerosus can look like an STI. Until you receive a lichen sclerosus diagnosis from a healthcare provider, it’s a good idea to avoid having sex.

Can I have sex if I have lichen sclerosus?

Yes, you can have sexual intercourse or masturbate if you have lichen sclerosus. However, sexual intercourse can cause further irritation. If you have sex or masturbate, wearing a condom or internal condom may help protect your skin and reduce discomfort.

Even though lichen sclerosus isn’t an STI and your partner(s) can’t catch lichen sclerosus from you, it’s a good idea to be honest with them about your condition. If they have any questions, encourage them to talk to a healthcare provider.

Is lichen sclerosus an autoimmune disease?

There’s not enough data available to classify lichen sclerosus as an autoimmune disease. But people with lichen sclerosus do commonly have autoimmune disorders, including:

• Alopecia areata.
• Vitiligo.
• Pernicious anemia.
• Type 1 diabetes.
• Some thyroid diseases.

The close associations between these conditions and lichen sclerosus suggest that the condition may arise from autoimmune responses in your body.

What is the difference between balanitis and lichen sclerosus?

Balanitis is a condition that affects your glans, usually due to a yeast infection. It typically affects people who have foreskin because the warm, moist area between the glans and foreskin creates an environment for yeast and other bacteria to grow. You can treat balanitis with antifungal creams, antibiotics, circumcision and regularly cleaning and drying your foreskin, glans and the area under your foreskin.

Lichen sclerosus can affect your genitals, anus and urethra. Providers aren’t sure exactly what causes lichen sclerosus, but they think it may relate to your immune system. Treatment includes topical corticosteroid creams, phototherapy, immunosuppressant medications and surgery.

What is the difference between BXO and lichen sclerosus?

Balanitis xerotica obliterans (BXO) and lichen sclerosus are the same condition. Lichen sclerosus is the term that healthcare providers prefer to use now.

A note from Cleveland Clinic

Lichen sclerosus isn’t common, and it isn’t an STI. Still, any condition that affects your genitals or anus can be alarming and embarrassing. Talk to a healthcare provider when you first notice changes or discomfort to your genitals. Even though it’s a chronic condition and symptoms may appear throughout your life, early treatment often leads to a better outlook.