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Lichen sclerosus is a long-term skin condition. It causes the skin to become thin, white, and wrinkly. Lichen sclerosus is most common in women who have gone through menopause. It can also happen in men and children, and women who have not gone through menopause.
Skin has several layers. The outermost layer is the epidermis. Under this is the dermis. The dermis contains blood vessels, nerve endings, hair roots, and sweat glands. With lichen sclerosus, the epidermis may become thin. Inflammatory cells invade the dermis. It may swell and have broken blood vessels. Stretchy fibers in the skin (elastic and collagen) may break. All of this can lead to symptoms such as itching, pain, and blisters.
It usually affects the genital and anal areas. Vulvar lichen sclerosus is a common form of the condition that affects a woman’s external genital areas. Less often, it can affect other parts of the body. These may include the neck, shoulder, breast, thighs, or mouth.
Researchers are still working to understand what causes lichen sclerosus. It runs in families, so researchers think that certain genes may play a role. It does not appear to be contagious, so you can’t catch it from another person. Some factors that may lead to the condition are:
You may have an increased risk for lichen sclerosus if you have an autoimmune disease, such as:
Other factors that can increase your risk include:
Circumcision greatly lowers the risk of lichen sclerosus in men.
Lichen sclerosus causes skin changes. Very early on, you might not have any symptoms at all. A little later, small white spots might appear on your skin. Later, these spots might grow into larger, thin and wrinkled patches extending from the labia to the anus.
Common symptoms might include:
Lichen sclerosus doesn’t affect the inner reproductive organs, such as the vagina or uterus.
Your healthcare provider will ask about your medical history and symptoms. You will also have a physical exam. This will include a close physical exam of the affected areas.
Often, this is enough for a diagnosis. In some cases, you may have a skin biopsy. For a biopsy, small pieces of skin are removed and checked in a lab.
You may be treated by a primary healthcare provider, a skin healthcare provider, or a healthcare provider specializing in the reproductive organs.
Often, patches outside the genital and anal area may go away with time. Your healthcare provider may choose to watch these areas before beginning treatment. Symptoms in the genital and anal region don’t usually get better without treatment.
Treatment is done to relieve symptoms and keep the lichen sclerosus from getting worse. The treatment often starts with steroid ointment. This reduces pain, itching, and inflammation. When used regularly, this helps manage symptoms for most people. Other possible treatments include:
For men, removal of the foreskin (circumcision) is often a successful treatment. In women, surgery is often not a preferred treatment because lichen sclerosus usually comes back.
These treatments usually reduce most of the symptoms and keep the condition from getting worse. You will likely need to use medicine on a regular, long-term basis. If untreated, the condition tends to get worse over time.
Vulvar lichen sclerosus may slightly increase the risk of squamous cell skin cancer in women. Men with lichen sclerosus on the penis may also have an increased risk. (Lichen sclerosus on other areas of your body does not seem to increase your risk of cancer.) Your healthcare provider may need to check your skin on a regular basis. You may need a biopsy of any abnormal areas to check for skin cancer. You should also check yourself regularly for lumps or sores that don’t heal.
Untreated advanced lichen sclerosus may permanently change the look of your genitals. The opening of the vagina may narrow. The outer and inner lips of the vulva may stick together. You may need surgery to correct these changes. In men, the foreskin may scar and shrink. This leads to trouble pulling back the foreskin. In both men and women, the condition may cause pain with intercourse.
Treatments for lichen sclerosus can also cause complications. For example, using steroid ointment over a long period of time may cause genital yeast infections.
Practicing good hygiene may help you reduce some of the symptoms of lichen sclerosus. Your healthcare provider may advise that you:
You can support from the Association for Lichen Sclerosus and Vulval Health (www.lichensclerosus.org).
Tips to help you get the most from a visit to your healthcare provider:
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