Lichen Sclerosus
Lichen sclerosus is the medical term used to describe chronic inflammation of the skin, usually of the sex organs and the anus.
Who is affected by Lichen Sclerosus?
In females the vulva may be inflamed whereas in males it is normally the penis head. However, the inflammation may also be present on the skin of the upper arms, chest and breasts. Males and females, adults and children, may all be affected by the condition.
Adults and children experience the same symptoms and these are present as white shiny spots initially, becoming enlarged patches of thin and crinkled skin. Bruising occurs as the thin skin tears. Red and purple discoloration may appear on the skin surface. Those with chronic inflammation of the genitalia may experience skin shrinkage and tissue scarring.
In females the vulva inner lips may reduce and no longer exist, and the vulva opening may narrow substantially. Scar tissue can cover the clitoris entirely. In males lichen sclerosus is primarily present in those with uncircumcised penises. The foreskin can shrink and the penis head tighten with scarring. If lichen sclerosus affects skin of the upper body scarring is not guaranteed.
How prevalent is Lichen Sclerosus?
Lichen sclerosus can affect any person at any age but it is considered a rare skin condition. If the genitals are affected, such as the vulva in postmenopausal women, lichen sclerosus is less likely to be present on other parts of the body.
Adults are more likely to experience the condition than children. However, males may require circumcision to remove the foreskin if lichen sclerosus is present. Uncircumcised males are at higher risk of skin inflammation of the penis and foreskin.
What are the symptoms of Lichen Sclerosus?
Typical symptoms of lichen sclerosus include white patches, thinning skin, itching, skin tearing and blistering, skin bleeding and painful skin when touched. Some people experience no symptoms but signs typically vary from person to person.
The genital area inflamed by lichen sclerosus can itch severely, affecting sleep patterns and daily functions. Sexual intercourse may also become painful and skin sores with bleeding become present if the area is scratched. Other activities or items that apply pressure to the genitals, such as bicycle-riding, use of sanitary towels and clothing, can cause similar skin wounds and pain.
Sufferers may experience painful and burning urination with bleeding present. Lichen sclerosus of the anus can result in constipation, particularly in children. The affected skin area can sometimes seem like the signs of abuse in children, when the condition is actually caused by lichen sclerosus.
If left uncircumcised males can experience shrinking of the foreskin, irritation and loss of penis tip sensation. As the urethra narrows due to the skin shrinking urination may become restricted. Erections may also feel painful.
What is the cause of Lichen Sclerosus?
Research suggests that genetics may play a role in lichen sclerosus. Although specific causes are unknown overactive immune systems and abnormal hormone levels are thought to be a contributor. Skin damaged or scarred from injury can also be vulnerable to the development of lichen sclerosis.
Is Lichen Sclerosus contagious?
The condition is not considered contagious but having lichen sclerosus does raise the risk of developing cancer in the affected area of skin.
How is Lichen Sclerosus diagnosed?
Medical practitioners examine the skin for signs of lichen sclerosus. In some cases a skin biopsy is necessary to confirm if lichen sclerosus is present. Inflamed skin does not always show typical symptoms of lichen sclerosus.
How is Lichen Sclerosus treated?
Where the upper body is affected by lichen sclerosus treatment is not always necessary. Symptoms are usually milder in these parts and tend to fade over time. However, where lichen sclerosus is present on the genitals treatment is recommended to prevent the condition from worsening and leading to scarring, shrinkage and desensitisation of the genital area.
If lichen sclerosus is itchy and results in sores and pain, sexual intercourse and urination can become difficult and painful. Treatment also prevents the affected skin becoming potentially cancerous.
Treatment depends on gender, the area affected and severity of the condition, but includes:
- Circumcision in men to remove the foreskin where the foreskin is covered with lichen sclerosus.
- Application of ultra-potent topical corticosteroid creams or ointments where lichen sclerosus is present on the penis in men or vulva in females.
- Application of testosterone or progesterone hormone creams, or tacrolimus ointment.
- Use of Vitamin A medications, such as Retinoid.
- Ultraviolet light treatments, with or without psoralen to activate the UV, for upper body lichen sclerosus inflammation.
- Surgery to remove the skin affected by lichen sclerosus.
A medical doctor assesses the patient's condition to determine the best route of treatment for lichen sclerosus inflammation. These treatments may not be recommended for ongoing long-term use, such as the topical corticosteroid creams as the may cause skin stretching and/or yeast infections.
When caught early treatment is often only temporary to remove the lichen sclerosus and allow for healthy skin development. Hormone creams, such as testosterone, are now largely replaced by topical corticosteroid creams or Vitamin A medications, to prevent masculinisation-type side-effects. Those with low tolerance to topical corticosteroid creams may benefit from Vitamin A medications or steroid-free ointments, such as tacrolimus.
Medical practitioners discuss with patients the relevant treatment options, how the treatment functions, any side-effects and risks and why they are recommending a particular treatment for lichen sclerosus. In young people surgery is sometimes not recommended because of the high risk of reoccurrence. Surgery can be combined with medication treatments for lichen sclerosus to remove scar tissue.
The type of treatment for lichen sclerosus that is recommended will depend on a patient's tolerance to certain medication ingredients, the strength of their immune system, if infection is present and the level of symptoms experienced.
Is it safe to have sexual intercourse if you have Lichen Sclerosus?
In females lichen sclerosus can cause intense itching of the vulva, sores and pain. Sexual intercourse may feel painful and therefore women are sometimes inclined not to want to have sexual intercourse. Lichen sclerosis may narrow the vagina opening and skin may be thin, tear and bleed. Usually topical corticosteroid ointments are prescribed unless surgery is recommended to remove scar tissue.
Males with foreskins inflamed from lichen sclerosus may need circumcision. If present on the penis topical corticosteroid creams can also be recommended. Urination can become painful for men as the urethra narrows from skin shrinking. The penis tip may become less sensitive or, as with females, the skin can become irritated and sore.
Is there a link between Lichen Sclerosis and cancer onset?
Although lichen sclerosis is not recognised as a cause of skin cancer, the condition can damage skin and cause scarring that raises the risk of cancerous cell development. Further research is needed in this area to determine if a direct link exists between cancer and lichen sclerosis skin inflammation. The affected skin should be assessed by a medical practitioner for treatment and monitored twice yearly.