Lichen sclerosus is a long-term inflammatory skin condition. It creates patches of shiny white skin that’s thinner than normal. The condition can affect any part of your body, but it most commonly affects skin in the genital and anal regions. Lichen sclerosus may appear as white spots on the vagina and is most common on the vulvas of women but may occur in other areas.
When lichen sclerosus affects non-genital regions, it is called extragenital lichen sclerosus.
Mild cases of lichen sclerosus sometimes go unnoticed because they don’t cause any symptoms aside from the visible and physical symptoms of white, shiny skin. The areas of skin may also be slightly raised. It tends to occur on inner areas of the vulva that can grow hair.
Because the affected areas are often around the vulva and genital area, they may not be noticed unless other symptoms occur.
If you do experience symptoms from lichen sclerosus, you may notice:
- itching, which can range from mild to severe
- smooth white patches, often on private areas such as the vulva and anus
- painful sexual intercourse
- painful urination
Because the skin affected by lichen sclerosus is thinner than normal, it can bruise or blister more easily. You may experience bruises or blisters from wearing tight clothes or sitting down. In severe cases, these injuries can result in ulcerated lesions, or open wounds.
Lichen sclerosus can affect a small area or spread to surrounding skin.
Scientists aren’t yet sure what causes lichen sclerosus. They have determined that it isn’t contagious, and it can’t be spread through contact, including sexual intercourse.
However, there are several theories about what contributes to its development. These include:
- previous damage to that area of your skin or irritation
- an imbalance of hormones
- an autoimmune disorder
- genetic predisposition
Lichen sclerosus can affect people of all races and genders. But some people do have a higher risk for developing it, including:
- postmenopausal females
- people with uncircumcised penises, as the condition often affects the foreskin
- children who haven’t yet gone through puberty
If you suspect that you have lichen sclerosus, a doctor can diagnosis it for you. You can make an appointment with a primary care physician. Many women make an appointment with a gynecologist.
The doctor will ask about your physical history. They’ll also do a physical exam and look at the affected areas. In many cases, they’ll be able to diagnose lichen sclerosus on appearance alone, though they may take a skin biopsy for a definite diagnosis.
If they conduct a skin biopsy, they’ll numb the affected area with a local anesthetic before using a scalpel to shave off a small portion of skin. This piece of skin will be sent to a lab for testing.
Lichen sclerosus can lead to bruises, blisters, and even ulcerated lesions, which are open wounds. If these wounds aren’t kept clean, they can become infected. Because they’re often in the genital and anal regions, it can be hard to prevent infections.
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Except in cases involving children, which sometimes resolve on their own, lichen sclerosus can’t be cured. However, it can be treated.
Treatment options include:
- topical corticosteroids, which are often applied daily
- removal of the foreskin in severe cases involving those with uncircumcised penises
- ultraviolet light treatment for affected rashes not on the genitals
- immune-modulating medications like pimecrolimus (Elidel), ciclosporin, or methotrexate
- other medications like oral corticosteroids or oral retinoids
For those experiencing painful sexual intercourse due to tightening of the vagina, a doctor can prescribe vaginal dilators, a water-based lubricant, or, if needed, a numbing cream like lidocaine ointment.
Other protective measures may include:
- washing the affected area daily with a gentle, non-soap cleanser
- avoiding clothing that may cause friction to the area
- avoiding bike and horseback riding
- applying moisturizer to relieve itching and dryness and to create a protective barrier on the skin
In the cases of childhood lichen sclerosus, the condition may disappear when the child goes through puberty.
Adult lichen sclerosus can’t be cured or even treated entirely, but there are treatment options to help reduce symptoms. Self-care measures can help prevent future complications. These include:
- carefully cleaning and drying the area after urinating
- avoiding harsh or chemical soaps on the affected area
- monitoring the affected areas for signs of skin cancer
- regularly following up with a doctor
The disease may relapse and remit.