What is lichen sclerosus?
Lichen sclerosus is a disorder that usually affects skin on the vulva (the area outside the vagina), anus or penis. It causes the skin to become discolored, thin, irritated and itchy. Blisters and sores may also form on the genitals. Rarely, these symptoms can appear on other parts of the body.
Untreated, lichen sclerosus can lead to scarring, which can make it difficult or painful to have sex, urinate or have a bowel movement. There is no cure for lichen sclerosus. Healthcare providers can treat symptoms, but they may return after treatment. People with lichen sclerosus have an increased risk of developing a type of skin cancer called squamous cell carcinoma.
How common is lichen sclerosus?
Lichen sclerosus is rare. About 200,000 people in the United States have the condition. It affects people of all genders. Girls and women are more likely to develop the condition than men.
Lichen sclerosus (also called lichen sclerosus et atrophicus) is most common in women who have been through menopause. It’s most likely to develop between ages 40 and 60. Girls who haven’t started puberty also have a higher risk. Less commonly, lichen sclerosus affects men who haven’t been circumcised.
Symptoms and Causes
What are the symptoms of lichen sclerosus?
Lichen sclerosus symptoms can range from mild to severe. Some people with the disorder don’t have any symptoms. In women, symptoms usually affect the vulva, anus and perineum (the area between the anus and the vulva). The condition can also affect skin on other parts of the body, such as the neck, breasts, torso, upper back, wrists and mouth.
In uncircumcised men, lichen sclerosus causes the foreskin of the penis to be irritated and itchy. The opening at the top of the foreskin can become scarred and narrowed, leading to painful erections.
- Itching and irritation: Vaginal itching and discomfort can be severe. Riding a bike or wearing tight clothing can make symptoms worse. In addition to an itchy vulva, you may feel burning in the vagina.
- Skin changes: Small white spots may appear on the genitals. As the white patches grow, skin becomes white, smooth, shiny, thin or transparent. In women, these changes usually affect the skin around the vulva and the anus, making a figure-eight pattern. In men, the foreskin on the penis looks white and shiny.
- Ulcers and sores: Blisters, fissures (cracks) and genital sores can develop, especially if you’ve scratched the area to relieve itching. The skin may bruise, crack and bleed with the slightest touch.
- Scarring: Untreated, lichen sclerosus can lead to scarring around the vulva, anus or penis. Scarring can cause problems peeing or pooping (constipation), and it can lead to pain during sex.
What causes lichen sclerosus?
Healthcare providers aren’t sure what causes lichen sclerosus. Experts believe that it’s an autoimmune disease. Autoimmune disorders cause the body’s immune system to attack healthy cells.
Genetics and hormonal changes may also determine who gets the disorder. In some cases, lichen sclerosus develops after someone has experienced trauma, such as an injury or sexual abuse. Lichen sclerosus is not a sexually transmitted disease (STD), and it’s not contagious.
Diagnosis and Tests
How is lichen sclerosus diagnosed?
Your healthcare provider will examine you and ask about your symptoms. In some cases, your provider may order a biopsy. During this procedure, your provider takes a skin sample and sends it to a lab for testing.
Management and Treatment
How is lichen sclerosus treated?
Providers treat lichen sclerosus with:
- Topical medicine: Strong corticosteroid ointments and creams can relieve itching and inflammation. Follow your provider’s instructions about when and how to apply the medicine to your skin.
- Phototherapy (light therapy): Providers use narrowband ultraviolet B (NB-UVB) light to treat lichen sclerosus. Using a special lamp, your provider shines a light on your skin over a series of several treatments.
- Immunosuppressive medications: These drugs weaken the immune system so it no longer attacks healthy cells.
- Circumcision: Uncircumcised men might need surgery to remove foreskin at the tip of the penis. Circumcision can relieve pain and pressure.
An essential part of treatment for lichen sclerosus includes regular checkups with your provider. Your provider will watch for signs of skin cancer and help you prevent scarring around the genitals.
Can I prevent lichen sclerosus?
There is no way to prevent lichen sclerosus. You may be able to relieve symptoms with lifestyle changes.
To reduce friction and irritation, you should:
- Avoid horseback riding and long bike rides.
- Wear loose-fitting underwear and clothing.
- Use unscented soaps and laundry detergent. Avoid bubble baths — the suds can cause irritation that makes itching worse.
- Change out of wet swimsuits and clothing right away.
There isn’t a recommended lichen sclerosus diet. But some studies show that dietary changes can relieve symptoms of lichen sclerosus. Talk to your provider about foods you should avoid and how to make healthy choices.
Outlook / Prognosis
What is the outlook for people with lichen sclerosis?
Lichen sclerosus is a chronic (lifelong) condition. Treatment for lichen sclerosus can relieve symptoms, but they may come back. For some people, genital scarring can cause problems going to the bathroom or having sex. Some of these problems may be severe.
People with lichen sclerosus have a higher risk of developing a type of skin cancer called squamous cell carcinoma. If you have lichen sclerosus, it’s essential to see your provider for regular checkups. Your healthcare provider will monitor your health and help you detect any problems as early as possible.
When should I see my healthcare provider about lichen sclerosis?
If you have irritation, itching or discomfort in the genital or anal area, see your provider. It’s essential to determine what’s causing your symptoms so you can be treated. Many conditions cause symptoms that are similar to lichen sclerosus, including sexually transmitted diseases (STDs).
If you have lichen sclerosus and your symptoms return after treatment, see your provider right away. By treating symptoms immediately, you may be able to prevent scarring. Your provider will also monitor you for signs of skin cancer.
A note from Cleveland Clinic
If you have lichen sclerosus, be open and honest with your healthcare provider about your symptoms. Be sure to tell your provider right away if symptoms get worse or come back after treatment. Through regular checkups, your provider will track your health, treat your symptoms and help you prevent scarring and long-term problems. Because people with lichen sclerosus have a higher risk of squamous cell carcinoma, you’ll need to see your provider often to check for signs of skin cancer.