Lichen Sclerosus

What is Lichen Sclerosus?

Lichen sclerosus is a chronic, usually itchy, skin disease that mainly affects the genital skin. It is much more common in women than men and can occur in children. The skin outside the genital region is much less commonly involved. This condition appears as white, fragile, skin patches that can sometimes look crinkled with a shiny cellophane-like surface.

What causes lichen sclerosus?

The cause of lichen sclerosus is an autoimmune disease. Autoimmune diseases are conditions where the immune system attacks our own tissues. Other examples of autoimmune diseases include lupus, Crohn’s disease, rheumatoid arthritis and Hashimoto’s thyroiditis. Lichen sclerosus is not an infection and is not contagious. It cannot be passed on to a sexual partner. Autoimmune diseases are often familial and the children of patients with lichen sclerosus have an increased risk of also having lichen sclerosus.

What are the symptoms and what do I see?

  • Itching is the most common symptom and some people experience soreness and burning.
  • The skin becomes pale and white in appearance. This may be patchy or involve all of the vulva extending down to the anus. The skin may split causing stinging and pain.
  • Small purplish/red areas may be seen on the white background. These are due to tiny areas of bleeding into the skin, often because of scratching.
  • Vulvar “architectural changes”-There may be scarring that causes loss of vulvar tissue or shrinkage of the vulvar areas, which can cause pain and interfere with sexual intercourse and even cause problems with urination.
  • It does not involve the vagina.

Some people have no symptoms and the diagnosis may be made when the area is examined for another reason.

How is it diagnosed?

Doctors familiar with the condition may diagnose it by looking at the skin and seeing the characteristic appearance. The diagnosis is usually confirmed by taking a small piece of skin to be looked at microscopically. This is called a biopsy. This is a simple procedure that can be done in the doctor’s office with a local anesthetic.

What should I watch for?

Patients with lichen sclerosus are more likely to develop cancer of the vulva than people without the disease. Cancer occurs in about 5% of patients with lichen sclerosus. Any new raised lesions, non-healing sores or a major change in your symptoms should be reported. We advise patients with lichen sclerosus to have regular check ups at three to six months intervals.

What is the treatment?

There is no absolute cure for lichen sclerosus, but the symptoms can be controlled extremely well by the use of topical medication. The appearance of the vulvar skin can be improved, but if there is a lot of scarring, the changes may not be reversed. Appropriate treatment should prevent progression of further inflammation and scarring.

The most effective treatment for lichen sclerosus is a topical steroid ointment such as clobetasol. Topical steroids can be used safely in the genital area for this condition. Many patients find that simple moisturizers such as an emollient ointment like Aquaphor or Emuoil can be soothing.

Dr. Brooks is now offering PRP Therapy/O-Shot to treat this condition. Learn how this cutting edge treatment at the Arizona Vulva Clinic can change your life!