Signs and symptoms
- Women are more commonly affected than men, particularly around and after menopause
- The condition most commonly occurs on the vulva and around the anus with ivory-white elevations that may be flat and glistening
- In males, the disease may take the form of whitish thickening of the penile foreskin, which cannot be retracted easily (Phimosis)
- In men, this genital involvement has traditionally been known as balanitis xerotica obliterans
- Itching (pruritus), which can be severe
- Discomfort, which is generally greater if lichen sclerosus appears on or around your genital or anal areas
- Smooth white spots on your skin that may grow into blotchy, wrinkled patches
- Tenderness of the affected areas of your skin
- Easy bruising or tearing
- In severe cases, bleeding, blistering or ulcerated lesions
- Painful intercourse
Although it is not clear what causes lichen sclerosus, However, the condition may be related to a lack of sex hormones in the affected skin or to an overactive immune system.
Both bacterial as well as viral pathogens have been implicated, mostly by HPV, hepatitis C, spirochete infections
Primarily found in women with a low estrogen state.
Local skin changes
It can be initiated through scarring or radiation
Tests and diagnosis
Removal of a small piece of affected tissue (biopsy) for examination under a microscope
- Persistent lichen sclerosus in one location may slightly increase your risk of skin cancer, although this has not yet been definitively proved.
- For this reason, make sure that you have follow-up examinations every six to 12 months
- Severe lichen sclerosus may narrow the vaginal opening and affect the ability or desire to have sexual intercourse
- The tightening and thinning of the foreskin of penis may create complications during erections or when urinating
Asymptomatic extra genital lichen sclerosus usually requires no treatment as control of pruritus other than resolution of the lesion, which is a more realistic goal of therapy. Also, these lesions rarely itch.
- Topical steroids
- Immune-modulating medications, such as tacrolimus and pimecrolimus
- Circumcision may benefit male lichen sclerosus and the phimosis that may accompany it.
- Vulvar surgery is not recommended unless an associated malignancy is present. Extra genital lesions may be excised but some caution should be taken as lichen sclerosus has arisen in old surgical scars.
- Cryotherapy or laser therapy (PUVA) of affected genital lesions is also reported to reduce the area involved after one or a series of treatments