The Lowdown On Lichen Sclerosus

Although it often affects the genitals, it's not an STD

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Skin changes in the genital region can be alarming, especially if you're sexually active. But an itchy spot or odd looking patch of skin but aren't always signs of a contagious infection. There are plenty of dermatologic diseases that cause such symptoms. One of these is a condition called lichen sclerosus. It mostly affects women, especially after menopause, but men and even kids can develop it as well.

Lichen sclerosus is rarely serious but it's worth being aware of—at the very least so that if you develop it you don't panic or put off seeing a doctor for fear you've got a sexually transmitted disease. Its cause is unknown, although an overactive immune system may play a role. Some scientists believe, for instance, that an infectious bacterium called a spirochete may cause the changes in the immune system that lead to lichen sclerosus.

It's also possible that certain people have a genetic tendency toward the disease, and studies suggest that abnormal hormone levels may also play a role. Here's what it's helpful to know about this relatively uncommon skin disease.

Symptoms of Lichen Sclerosus

Mild cases usually start out as shiny white spots on the skin of the vulva in women or on the foreskin of uncircumcised men. It also sometimes affects the area around the anus. In women it can show up on other parts of the body—particularly the upper torso, breasts, and upper arms—but this is rare: Fewer than 1 in 20 women who have vulvar lichen sclerosus have the disease on another skin surface.

If the disease worsens, itching is the most common symptom, which in rare cases can be extreme enough to interfere with sleep and daily activities. Rubbing or scratching to relieve the itching can cause bleeding, tearing, painful sores, blisters, or bruising—so much so that it's a good idea to avoid having sex, wearing tight clothing or tampons, riding a bike, or any other activity that might cause pressure or friction on the affected areas.

In severe cases in women, lichen sclerosus can lead to scarring that causes the inner lips of the vulva to shrink and disappear, the clitoris to become covered with scar tissue, and the opening of the vagina to narrow. 

In men with severe lichen sclerosus, the foreskin can scar, tighten, and shrink over the head of the penis, making it hard to pull back the foreskin and decreasing sensation in the tip of the penis. Occasionally, erections are painful, and the urethra (the tube through which urine flows) can become narrow or obstructed, leading to burning or pain during urination, and even bleeding during intercourse. When lichen sclerosus develops around the anus, the discomfort can lead to constipation. This is particularly common in children.

How Is It Treated?

When lichen sclerosus affects skin in parts of the body other than the genitals, it rarely needs to be treated. The symptoms tend to be very mild and will usually disappear with time.

However, lichen sclerosus of the genital skin should be treated, even when it doesn't cause itching or pain, to prevent the scarring that can interfere with urination or sexual intercourse or both. The disease has also been linked to certain cancers.

It doesn't cause cancer, but skin that is scarred by lichen sclerosus is more likely to develop cancer. About 1 in 20 women with untreated vulvar lichen sclerosus develops skin cancer. It's important to get proper treatment and to see your doctor every 6 to 12 months to monitor and treat any changes that might signal skin cancer.

Topical corticosteroids are usually the first-line of defense against lichen sclerosus to both cure the disease and to restore the skin's normal texture and strength. However, steroids won't reverse any scarring that may have already occurred. And because they're very strong, it's important while using them every day to check back with a doctor frequently to check skin for side effects when the medication is used every day.

Once symptoms are gone and skin has regained its strength, the medication can be used less frequently, but may still be needed a few times a week to keep lichen sclerosus in remission.

If the disease doesn't clear up after a few months of using a topical steroid cream or ointment, a doctor may move on to prescribing a medication that modulates the immune system, such as Protopic (tacrolimus) or Elidel (pimecrolimus). And for people who can't tolerate other medications, retinoids may be helpful. Sometimes, too, other factors, such as low estrogen levels that cause vaginal dryness and soreness, a skin infection, or irritation or allergy to the medication, can keep symptoms from clearing up.

For men whose lichen sclerosus won't clear up with medication, circumcision almost always is effective. Once the foreskin is removed, the disease usually does not recur. This isn't the case for women, though, and so surgery in the genital area or around the anus generally isn't recommended. But most of the time medication will do the job of getting rid of lichen sclerosus once and for all.

Source:

Mayo Clinic. "Diseases & Conditions: Lichen Sclerosus." Sept 3, 2015.