Lichen Sclerosus

A condition most frequently affecting the genital area

​Lichen sclerosus, also known as lichen sclerosus et atrophicus (LS and A, LS et A, LS & A) is a condition of the skin which most frequently affects the genital area.  In women, this condition most frequently affects the vulva.  Lichen sclerosus can affect areas outside of the genital region as well, and these cases are referred to as extragenital lichen sclerosus.

What is lichen sclerosus?

Lichen sclerosus is a skin condition where the skin can become itchy, irritated, or painful.

  There is inflammation of the skin, especially early on in the condition.  With time, the skin can become tight and scarred.

What does lichen sclerosus of the vulva look like? 

Lichen sclerosus can present in many different ways.  It can start out reddish or pinkish.  There may be whitish areas of varying sizes.  When more extensive, this white area can encompass the whole vulvar area and also the entire area around the anus, leading to a “figure eight” configuration.

What are symptoms associated with lichen sclerosus?

Common symptoms that are reported include itch, burning or discomfort.  Sexual intercourse may be uncomfortable (known as dyspareunia).  Sometimes, this condition is only minimally uncomfortable, especially in the beginning. Difficulty with urination can also occur, especially if scarring around the urethral opening occurs, narrowing the opening.  If the area around the anus is affected, discomfort with stooling may result.

How is lichen sclerosus diagnosed?

Your history and examination of the area by your health care practitioner will help with diagnosis of this condition.  A biopsy of the skin is sometimes performed to confirm this diagnosis and exclude other diagnoses.  Other diagnoses which could mimic lichen sclerosus include vitiligo, irritant dermatitis, contact dermatitis, and lichen planus, among others.

What does a biopsy of lichen sclerosus show?

Specific biopsy findings of lichen sclerosus may vary based on the stage and location of lichen sclerosus.  Some findings often seen include thinning (atrophy) of the top layer of skin and a homogenized appearance of the dermis with a “band” of immune cells called lymphocytes underneath.

Does having lichen sclerosus of the vulva increase risk for other conditions?

Having vulvar lichen sclerosus may increase the risk of vulvar squamous cell carcinoma (SCC).  It is thought that if this risk increases, it is still a small risk.  Nevertheless, routine examination by the patient and health care provider is a good idea, and changes in the area, new growths, or resistant areas should be further diagnosed.  If there is a suspicion for a vulvar SCC, the suspicious area should be biopsied.

How is lichen sclerosus treated?

The first step in management consists of topical corticosteroid use, often one called clobetasol.  Another alternative treatment is a topical calcineurin inhibitor such as tacrolimus.

  It is important to properly treat the area.  Prior to leaving your health care provider’s office, ensure you know exactly how much medication to use, where to apply the medication, for how long, and what to expect.  It is suggested to have a follow-up examination to assess progress.

What is the course of lichen sclerosus?

Lichen sclerosus can lead to scarring without treatment.  If it affects the vulvar area, it can lead to tightening of the area around the vagina, leading to pain during sexual intercourse.  When it affects areas such as the urethral opening (where urine comes out of) or the anal area, it can lead to tightening of those areas, leading to difficulty urinating or defecating, respectively.  Untreated lichen sclerosus may also increase the risk of squamous cell carcinoma formation.

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