Overview
Lichen sclerosus (LIE-kun skluh-ROW-sus) is a condition that causes patchy, discolored, thin skin. It usually affects the genital and anal areas. Anyone can get lichen sclerosus, but postmenopausal women are at higher risk. It isn't contagious and can't be spread through sexual contact. Treatment typically involves medicated ointments that help restore normal skin color and reduce the risk of scarring. Even if symptoms clear up, they often reappear, so long-term follow-up care is necessary. Symptoms may include smooth discolored skin patches, itching, soreness, easy bruising, fragile skin, and changes in the tube for urine flow (urethra). Complications can include painful sex and scarring, as well as increased risk for vulvar squamous cell carcinoma in women. In children, constipation is a common complication.
Understanding the disease
Symptoms
The symptoms of lichen sclerosus include smooth discolored skin patches, blotchy, wrinkled skin patches, itching, soreness or a burning feeling, easy bruising, fragile skin, changes in the tube for urine flow (urethra), bleeding, blistering or open sores, painful sex, and skin-related signs and symptoms such as hardening and tightening of the skin. If you have any of these symptoms, you should see your healthcare provider.
Risk Factors
The risk factors for developing lichen sclerosus include:
- Postmenopausal women
- Children younger than 10 years old
- Women who have another autoimmune disease, such as forms of low thyroid function (hypothyroidism)
- Men with urinary incontinence or an uncircumcised penis
- People with a family history of the disease It's important to note that anyone can develop lichen sclerosus, but these factors increase the likelihood of getting the condition.
Development
Lichen sclerosus is a condition that causes patchy, discolored, thin skin, primarily affecting the genital and anal areas. The exact cause is unknown, but it's believed to be a combination of factors, including an overactive immune system, genetic makeup, and previous skin damage or irritation. Anyone can get lichen sclerosus, but postmenopausal women and children under 10 years old are at higher risk. Lichen sclerosus is an autoimmune condition, and its development may be influenced by various factors such as genetics, skin irritation, and an overactive immune system.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect you have lichen sclerosus, especially if you have symptoms such as smooth or discolored skin patches, itching, soreness, or a burning feeling in the genital or anal areas. It's important to seek medical attention even if there are no visible symptoms, as lichen sclerosus can lead to complications such as scarring and painful sex. If you've already been diagnosed with lichen sclerosus, make sure to schedule follow-up appointments with your healthcare provider every 6 to 12 months to monitor any skin changes or side effects of treatment.
Diagnosis
To diagnose lichen sclerosus, your healthcare provider will typically examine the affected skin. A biopsy might be necessary to rule out other conditions and confirm the diagnosis. A biopsy involves taking a small piece of affected tissue for examination under a microscope. In some cases, you may be referred to specialists such as dermatologists, gynecologists, urologists, or pain medicine specialists.
Management and Treatment
Complications
Complications of lichen sclerosus can include painful sex and scarring, including covering of the clitoris. Scarring of the penis can cause painful erection, poor urine flow, and an inability to retract the foreskin. People with vulvar lichen sclerosus are also at an increased risk of squamous cell carcinoma. In children, constipation is a common complication.
Treatment
The primary treatment for lichen sclerosus is usually a medicated ointment, which helps return the skin to its usual color and reduces the risk of scarring. Treatment may need to be continued for several months or even years, as symptoms tend to recur even after they have cleared up. This ointment is typically prescribed by a healthcare provider. Additional treatments may be recommended for specific symptoms, such as painful sex or scarring. It is important to follow up with a healthcare provider every 6 to 12 months to monitor for any skin changes or side effects of treatment.
Preparing for medical consultation
To prepare for an appointment for lichen sclerosus, you should make a list of your symptoms and how long you've had them, gather your key medical information, such as other conditions with which you've been diagnosed and any prescription or over-the-counter medications you're using, including vitamins and supplements, and come up with a list of questions to ask your health care provider. You may be referred to specialists in skin conditions (dermatologist), the female reproductive system (gynecologist), urology, and pain medicine.