Lichen sclerosus

We do not know what causes lichen sclerosus.

It could be autoimmune – caused by own immune system making an antibody against part of your skin.

It may also be caused by:

• irritation
• injury
• infection
• hormones
• inherited from your whānau.

In women, lichen sclerosus occurs most in the area around the vagina. In men, lichen sclerosus usually affects the tip of the penis (glans), which becomes white, firm and scarred. 

Symptoms of lichen sclerosus in women

Symptoms include:

• itching around the vulva
• white patches on the skin, which might have spots of colour or bruising
• itching with bleeding or thickened skin
• loss of normal vulval tissue.

You may not have symptoms but will notice the white skin changes.

Images of vulva lichen sclerosus - DermNetexternal link

Symptoms of lichen sclerosus in men

Symptoms include:

• narrowing of the tube that your wee flows through (urethra) resulting in a thin or crooked urinary stream
• difficulty in retracting the foreskin (phimosis)
• painful erections.

Images of lichen sclerosus of the penis - DermNetexternal link

If lichen sclerosus is not treated scarring can cause trouble with weeing (passing urine) or having sex.

If it is a continuing problem that comes and goes, your healthcare provider will discuss how often you should get checked. This is usually once a year. This is because the chance of getting cancer of your vulva or penis is a little higher than for other people. 

If you think you could have lichen sclerosus make an appointment to see your healthcare provider. They can usually diagnose lichen sclerosus by talking with you and looking at your skin.

Your healthcare provider may recommend you have a biopsy if they are not sure of a diagnosis or if you have not responded to treatment.

You will be prescribed a strong steroid ointment or cream for 3 months. This can reverse any skin changes and stop itching.

How to use the ointment

• Apply a thin smear to the white patches (plaques) and rub it in gently.
• Apply the ointment or cream once a day.
• After 1 to 3 months, you can use the ointment less often.
• You may need to continue the treatment once or twice a week to control symptoms or to prevent lichen sclerosus coming back.
• The itching often gets better within a few days, but it may take weeks to months for the skin to return to normal (if at all).
• One 30 gram tube of topical steroid should last 3 to 6 months or longer.

Your healthcare provider should see you after a few weeks of starting treatment to see how you are responding to treatment.

Safety when using the ointment

Topical steroids are safe when used as prescribed. However, using too much ointment or applying the ointment to the wrong area can cause:

• red, thin skin
• a burning feeling
• dermatitis in the area around the vagina or penis
• thrush (candida albicans) infection.

Other treatments for lichen sclerosus

Other treatments include:

• an oestrogen cream or pessaries that you apply inside your vagina. These are usually prescribed if you are postmenopausal
• a non-steroid cream or ointment
• retinoids when your lichen sclerosus is not in your genital area.

Treatment can include medication and antibiotics when lichen sclerosus is:

• severe
• acute
• not responded to ointments or creams.

• Wash gently once or twice daily.
• Use a non-soap cleanser.
• Try to avoid tight clothing, rubbing and scratching.
• You may find that activities such as riding a bicycle or horse may aggravate symptoms.
• If you are incontinent, seek medical advice and treatment.
• Apply emollient products like lanolin or glycerol stearate to help with dryness and itching. These also act as a barrier to protect skin in the genital and anal areas from contact with wee and poo.

If you have lichen schlerosus you should check for:

• a lump which does not go away
• a change in the texture of the skin
• a broken area of skin that does not heal.

If you notice any of these things make an appointment with your healthcare provider as soon as possible.