Lichen Sclerosus

Lichen Sclerosus

What is lichen sclerosus?
Lichen sclerosus is a relatively uncommon condition in which thin white crinkly patches appear on the skin. It can appear anywhere, but is most troublesome in the genital areas.  
What causes lichen sclerosus?
The cause of lichen sclerosus is not known. Sometimes it is associated with diseases in which the body’s immune system attacks normal tissues such as the thyroid gland (causing an over- or underactive thyroid gland) or the insulin-producing cells in the pancreas (causing diabetes).
Lichen sclerosus can occur in either sex and at any site, but is more common in women, in whom the vulva is the most common site. Lichen sclerosus can affect women of any age and may occasionally develop in girls prior to puberty. A similar process affects men and boys. Despite the tendency to affect genital skin, lichen sclerosus is not an infection - it is quite certain that the disease is not contagious, so sexual partners cannot pick it up.
Is lichen sclerosus hereditary?
No, rarely lichen sclerosus can occur in relatives.
What are the symptoms of lichen sclerosus?
Many patients have none, but the most common symptom of lichen sclerosus is itch. As a rule the spots on the general skin surface seldom itch much, but those in the genital area do, and can also be sore if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin, and this can interfere with sexual intercourse in affected men or women. In men, lichen sclerosus can make the foreskin tight and difficult to retract, and can even partly block the flow of urine.
What does lichen sclerosus look like?
On the main areas of the skin, the spots of lichen sclerosus look like small ivory-coloured slightly raised areas, which can join up to form white patches.  Some have tiny yellowish horny plugs within the pale areas. After a while the surface of the spots can look like wrinkled tissue paper. The most common sites are the bends of the wrists, the upper trunk, around the breasts, the neck and armpits.
Women with lichen sclerosus in other areas of the body often have it on the vulva as well. Sometimes this causes no symptoms and they may not even know it is there. The white thin fragile areas surrounding the vulva and the anus in a figure of eight pattern have a crinkly surface; their fragility may lead to easy bruising and erosions. Later on, the inner lips of the vulva and its opening can shrink, leading to pain on intercourse, but this is unusual in most cases. Less often lichen sclerosus can develop in young girls then get better at puberty. A similar process in men affects the penis (balanitis xerotica obliterans). It can make retraction of the foreskin difficult and interfere with passing water.
How will lichen sclerosus be diagnosed?
The diagnosis of lichen sclerosus can usually be made from the typical appearance of the condition. However, lichen sclerosus can look a bit like vitiligo (though this has a normal skin texture) and lichen planus (which is more purple). If there is any doubt, the examination of a small specimen of skin (a biopsy) under the microscope will help.
Can lichen sclerosus be cured?
No treatment is sure to reverse the changes of lichen sclerosus completely, but the symptoms and signs of the disease can usually be well controlled with a steroid application.
For information on available treatments please visit this page on the website of the British Association of Dermatologists