Lichen sclerosus

Lichen sclerosus is a common skin problem. A patch of skin gets thick, white and crinkled. It usually happens to skin around your genitals. Over years the skin gets scarred.

What causes lichen sclerosus?

We don’t know what causes lichen sclerosus. We think it could be autoimmune – that is your own immune system making an antibody against part of your skin. Or it could come from irritation, injury, infection, hormones or be inherited from your whānau.

It's 10 times more common in women than men. It often starts before puberty for girls or after menopause for women.

There are images of vulval lichen sclerosus on the DermNet page(external link) – note that they are photos and quite graphic. 

Women and girls:

• It usually starts as white spots on your genital skin (vulva) inside your labia (lips)
• Lichen sclerosus doesn’t affect skin with hair, so you don’t get it on the outside of your labia, and you don’t get it inside your vagina.
• It can appear in the skin around your back passage (anus).
• Some people can’t feel these spots, but for most people they are itchy, and it can be sore. The itch is often worse at night and can keep you awake.
• Over months or years the spots can grow and join together.
• The skin looks white, thick and crinkled. It can get easily damaged, and split or crack. You can get bruises and blood blisters.
• Sex can be painful.
• Damaged skin can get infected with yeast (thrush) or skin infections (bacteria.)
• If it's left untreated your skin can scar.

Men and boys:

• It starts as white spots on your foreskin and the tip of your penis.
• These can be sore.
• Over time these can grow together and become scarred.

Other areas of skin:

Small patches of lichen sclerosus can happen on other parts of your body, whether you have it on your genitals or not. These are not itchy or sore.

If you think you could have lichen sclerosus make an appointment to see your GP or nurse practitioner.  They can usually diagnose lichen sclerosus by talking with you and looking at your skin. If they’re not sure they may arrange to take a biopsy (a small sample of skin to send to the lab) or refer you to a skin specialist.

Sometimes your healthcare provider will notice lichen sclerosus when they are checking you out for something else, like a cervical screening test or STI check.

Lichen sclerosus almost always needs treatment from your healthcare provider to avoid scarring, but there are things you can do to help your symptoms.

• Wash with non-perfumed, non-coloured emollient (moisturiser.) For example aqueous cream, non-ionic cream, fatty cream or emulsifying ointment. You can get these from pharmacies or on prescription.
• Avoid tight clothes.
• Don’t use perfumes, douches or perfumed sanitary pads/panty liners.
• Use lubricant when you have sex.

Lichen sclerosus is treated with strong steroid creams for 3 months, usually clobetasol, which can only be prescribed by a doctor or nurse prescriber. They will be very careful to give you a safe dose.

Men are often cured with 1 course of steroid cream. Women and girls are likely to need to use another course of steroid cream if symptoms start again.

Problems caused by scarring are sometimes treated with surgery.

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

If you are one of the people whose lichen sclerosus is a continuing problem that comes and goes, your healthcare provider will discuss with you 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. About 4 out of 100 women who have lichen sclerosus get cancer of the vulva.  About 8 out of 100 men who have lichen sclerosus get cancer of the penis.

Things to look out for are:

• a lump which doesn't go away
• a change in the texture of the skin
• a broken area of skin that doesn't heal.

If you notice any of these things don’t wait, make an appointment with your healthcare provider.