Lichen Sclerosis

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female gender symbolLichen sclerosis is a rare skin condition that usually affects the vulva and anal areas in young girls, adolescents, and adults, but it’s more common before puberty and after menopause. Similar to other skin conditions, there are treatments available to help the symptoms.

What is lichen sclerosis and what does it look like?

Lichen sclerosis (LS) is a skin condition that makes the vulva look white, slightly shiny, and smooth. The skin’s surface becomes thin and delicate so that it bleeds, tears, and bruises easily, often causing tiny “blood blisters”. Lichen sclerosis can also cause the skin of the inner lips of the vulva to change and shrink or get smaller. In severe cases, scar tissue can form. For example, scar tissue can cover the clitoris which is usually painful.

What causes lichen sclerosis?

The cause of lichen sclerosis is unknown. Scientists have different theories to try to explain the cause, including an overactive immune system, genetic traits, or changes in hormones. Since lichen sclerosis is not caused by an infection, it cannot be spread and is not contagious.

What are the symptoms of lichen sclerosis?

Symptoms of lichen sclerosis may be different from person to person and they can be mild to severe. Lichen sclerosis can occur on any skin surface, but it usually affects the vulva and anogenital area (skin between the anus and genitals). Girls and young women who have this skin condition may have some or all of the following symptoms. All of the symptoms are in the vulvar area:

  • Mild to severe itching
  • Skin that appears fragile, pale, and/or white
  • Bruised skin with broken blood vessels or “blood blisters”
  • Small tears or fissures in the skin
  • Scar tissue covering the labia or clitoris
  • Bleeding when having bowel movements

How is lichen sclerosis diagnosed?

Lichen sclerosis can be a difficult diagnosis to make. It’s not unusual for someone to see more than one health care provider before this skin condition is finally diagnosed. This can be very frustrating for you if the treatment you are receiving isn’t working. Most of the time, health care providers who see a lot of children with lichen sclerosis can make the diagnosis just by looking at the skin. In adolescents and older women, the health care provider may suggest a biopsy (removal and examination of a small sample of affected skin) to make sure the diagnosis is correct.

Will I need treatment?

Even if you don’t have symptoms such as itching or pain, it’s important for you to receive medical treatment for lichen sclerosis. Treatment to genital skin is necessary to try to prevent scarring of the vulva. Scarring may cause parts of the vulva to narrow and problems with passing urine or pain with sexual activity.

Are there medicines to treat lichen sclerosis?

Yes. Prescription medications are available to help with the symptoms of lichen sclerosis. The most common treatment is a strong topical corticosteroid ointment that reduces swelling and itching on your skin and decreases the body’s immune response. Your health care provider will probably tell you to apply this medicine every day for weeks to months depending upon the response to treatment. After the skin is much healthier, a lower dose of medicine is prescribed. Be sure to use the topical ointment the way it is prescribed. It should not be stopped suddenly. You’ll need to gradually use smaller amounts and apply it less frequently.

After several months to years, you may be able to go off treatment, but you need to watch for signs that the condition is returning and see your health care provider for check-ups. You should try to avoid things that might irritate your vulva such as harsh soaps, bubble baths, long bike or horseback rides, or other activities or clothes (such as tight jeans) that can cause a lot of rubbing of your genital area. Treatment may not change the scarring.

Will I need surgery?

Most of the time, the prescription medicine works to control symptoms and return your skin to normal. In rare cases, surgery may be necessary to treat scars.

Can women with lichen sclerosis have sex?

Lichen sclerosis is not contagious since it’s a skin disorder and not an STI (sexually transmitted infection). Most girls treated early for lichen sclerosis can have normal sexual intercourse. However, adolescents and women with severe lichen sclerosis may have scarring around the opening of the vagina and not be able to have sex comfortably. Surgery or vaginal dilators may be needed for the problem.

Does lichen sclerosis cause cancer?

Lichen sclerosis is not skin cancer. However, scientists have found that skin that has been scarred from lichen sclerosis is slightly more likely to develop skin cancer. This is why it’s very important to: see your health care provider 1-2 times a year (at least) for check-ups. Be sure to tell  any new health care providers that you have this condition. Your health care provider can watch for any changes to your skin and treat your symptoms.

If you need treatment for lichen sclerosis, be sure to ask your health care provider how long you need to use it, and what side effects it might have. It’s also important to go to all your appointments. Make sure you wear loose fitting clothes and avoid irritants such as bubble baths or harsh soaps.