How is lichen sclerosus treated?
Treatment is required when lichen sclerosus affects the genital/anal areas. The goal of treatment of lichen sclerosus in the genital/anal areas is to reduce symptoms and prevent scarring. Strong steroid ointments (such as clobetasol) are the first line of treatment. If not treated early, scar tissue can form on the vulva (the area around the opening of the vagina). This can make sex painful and interfere with urination. Surgery, to remove scar tissue, may be needed if scars have formed on the vulva.
A strong steroid ointment is usually applied to the affected areas every day for several weeks to months. Once the skin has returned to normal texture and color, a lower dose of a steroid is used.
Lichen sclerosus is usually a lifelong condition. Some patients will achieve complete remission of their symptoms; others will experience flare-ups followed by remissions. Your healthcare provider will recommend how often you need to be seen, how long treatment needs to be continued, and when (or if) it can be stopped.
Important. Steroids should never be stopped abruptly. The dose and frequency of applying the ointment need to be gradually reduced. Never stop treatment without talking with your healthcare provider first.
Other treatments. Other treatment options are available for patients who can’t tolerate the steroid ointment or in whom the ointment doesn’t work. Tacrolimus (Protopic®) and pimecrolimus (Elidel®), a class of drugs called calcineurin inhibitors, are other options to treat lichen sclerosus that occurs on the vulva. Other alternatives are retinoid treatments (such as isotretinoin), ultraviolet light (for treating skin not near the genital area), and photodynamic therapy (a treatment that uses special drugs and light).
Treatment in men. A strong steroid ointment is also the first-line treatment for lichen sclerosus in men. If steroid treatment is not successful or if scarring has led to physical changes in the normal shape and function of the penis, surgery is often recommended. Surgery involves removing the foreskin of the penis (a procedure called circumcision).