Lichen Sclerosus

Lichen sclerosus is a chronic inflammatory skin disorder which usually results in a patchy white skin which is much thinner than normal.This disease generally affects the skin of vulva, foreskin of the penis or the skin around the anus. This disease is ten times more common in women than men. 

The person with this disease usually has a family history of autoimmune conditions like thyroid disease (about 20% of patients), pernicious anemia, or alopecia areata.  Lichen sclerosus can be recovered with proper treatment.

In mild cases, lichen sclerosis does not show any clear sign and symptom, but in severe cases the common symptoms include:

1. Itching (pruritus)
2. Small white spots appear on the skin, which are often shiny and smooth
3. Discomfort or pain
4. Bleeding
5. Blisters or ulcerated lesions
6. Wrinkled patches 
7. Easy bruising or tearing
8. Painful intercourse

If one sees any of the above mentioned symptoms, he/she must consult a doctor. As the condition is recurring one must see the doctor every six to twelve months in order to tract the changes.

The exact cause of lichen sclerosus is not known, but it is considered that the immune system plays an important role in the disease as inflammation is seen in the affected areas. 

Any previous skin damage and autoimmune disorders like thyroid disorder, vitiligo or pernicious anemia increases the risk of lichen sclerosus. The disease is not contagious, thus it does not spread through sexual intercourse.

The person must consult his/her primary health care provider if any sign of lichen sclerosus appears to receive a diagnosis. The doctor may refer you to the skin specialist, if needed. Some important points to be considered before visiting a doctor:

List down the signs and symptoms.

Take note of medical history, which may include any kind of prescribed medication, vitamins or supplements.

Prepare a list of the questions you may ask your doctor, which may include:

• What are the causes behind your symptoms?
• What treatment is to be followed?
• Anticipation of success of treatment.
• Does the treatment last for rest of my life?

The doctor will ask you certain questions:

• What is the extent of the severity of discomforts?
• Is there any kind of bleeding?
• Do you feel pain while urinating or bowel passage?
• Do you experience pain during sexual intercourse?
• Are there any kind of previous injuries?
• Whether you have taken any kind of treatment for your condition?
• Whether diagnosed with any medical condition?

The doctor may then do the physical examination of the affected area to diagnose your condition. He may also take out a small portion of the affected area to be viewed under microscope.

If you are diagnosed with lichen sclerosus, the doctor may recommend you for the treatment which may help in reducing the itching and scarring, and improving the skin appearance. The doctor may prescribe:

• Corticosteroids: These medicines are prescribed for the treatment of lichen sclerosus in the form of cream or ointment to be applied daily. The doctor will also follow up for any kind of side effects of using this cream.
• Immune-modulating medications: If the corticosteroid treatment does not work the doctor may suggest you the immune modulating medication like tacrolimus (Protopic) and pimecrolimus (Elidel) 
• Your doctor may recommend ultraviolet light based treatment for non-genital areas.
• Topical sex hormones: These medications were used earlier, but recent studies have shown that these are not effective. 
• Surgical treatment: In case of men, if the penis foreskin is affected, removal of the foreskin (circumcision) is the most common treatment, but surgery is not advised for women with the disease because it may lead to recurrence.

Lifestyle modifications are necessary in order to manage the symptoms of lichen sclerosus.

In addition to the above treatments, the following measures can often help keep your symptoms under control:

• Avoid washing the affected area with soap or bubble bath. You can use plain water or an emollient wash instead 
• Avoid rubbing or scratching the affected area
• Gently dab your genitals dry after peeing, to stop your urine irritating the skin
• Apply a barrier cream or ointment, such as petroleum jelly to the affected areas after washing and before and after urinating 
• Avoid wearing tight or restrictive clothes and wear underwear made from natural materials such as cotton or silk 
• For women who find sex painful, using a lubricant or a vaginal dilator may help.

There are several risks associated with lichen sclerosus.

In rare cases, Lichen sclerosus may result in the development of skin cancer, but use of topical corticosteroids may reduce the risk. In women sit may also reduce the desire of having sexual intercourse. 

Blistering can result in sensitive skin to such a level that you may not be able to bear any kind of pressure. In case of men it may result in tightening and thinning of the foreskin in uncircumcised men, which may result in problem during erection and urination.