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Lichen Sclerosus

Definition


Disease: Lichen Sclerosus Lichen Sclerosus
Category: Dermatological diseases
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Disease Definition:

The uncommon condition that creates patchy, white skin that is thinner than normal is called lichen sclerosus. It usually affects the skin of the vulva, foreskin of the penis or the skin around the anus; however, it could also affect any part of the body.

Even though anyone could get lichen sclerosus, postmenstrual women and children who have not reached puberty have the highest risk for this condition. Lichen sclerosus could lead to other complications if it's left untreated.

In some cases, lichen sclerosus could improve on its own, so that treatment may not be needed. However, if someone does need treatment, they may be suggested options to decrease the tendency for scarring and return a more normal appearance to their skin.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The skin on any part of the body could be affected by lichen sclerosus. In some cases, it may not show any symptoms. However, when signs and symptoms do occur, they may include:

 

  • Itching (pruritus), which could be severe
  • Easy bruising or tearing
  • Smooth white spots on the skin that could grow into blotchy, wrinkled patches
  • Painful intercourse
  • Tenderness of the affected areas of the skin
  • Discomfort, which becomes greater if lichen sclerosus appears on or around the genital or anal areas
  • Bleeding, blistering or ulcerated lesions in some severe cases.

Causes:

What exactly causes lichen sclerosus is still not clear. However, this condition could be related to an overactive immune system or a lack of sex hormones in the affected skin. Someone’s chances of developing lichen sclerosus at a particular location on their skin will be increased if they’ve had previous skin damage at that part.
Lichen sclerosus isn't contagious and can't spread through sexual intercourse despite the fact that it could involve skin around the genitals.

Postmenstrual women are most commonly affected by lichen sclerosus, but it could also develop in children and men. In boys and men, because this condition usually affects the foreskin, uncircumcised males are most at risk. The signs and symptoms of children could improve once they reach puberty.

Complications

Complications:

Someone’s risk of skin cancer could be slightly increased if they have persistent lichen sclerosus in one location, but this hasn't been definitively proven yet. Because of this, a person should make sure to have follow-up examinations every 6 to 12 months.

Some of the other potential complications may include:

For men:
In some rare cases, lichen sclerosus could involve the foreskin. During erections or when urinating, the tightening and thinning of the foreskin could create complications.

For women:
The vaginal opening could be narrowed and the ability or desire to have sexual intercourse affected due to the uncomfortable itching and scarring that occurs with severe cases of lichen sclerosus. The blistering could sometimes create an extremely sensitive skin to the point that any pressure on the area may be unbearable.

Treatments:

People may not need treatment for lichen sclerosus in case it's not in their genital area and they’re not having any symptoms. As a matter of fact, many cases disappear on their own.

However, corticosteroid ointments or creams could be prescribed for adults and children who have lichen sclerosus on or around the genitals or anus, or with a more advanced case on other parts of the body. This treatment is usually quite effective. However, because these medications could lead to thinning of the skin, their prolonged use is not recommended.

Some of the other treatments that someone may be suggested for lichen sclerosus may include:

 

  • For non-genital areas, ultraviolet light treatment (phototherapy)
  • Pimecrolimus, tacrolimus or other immune-modulating medications
  • Prescription sex hormones


The skin could assume a more normal appearance and its tendency for scarring could be decreased as a result of treatment.
For women with lichen sclerosus, surgery isn't recommended because after the surgery, the condition could just come back.
In case men develop lichen sclerosus on the foreskin, have more advanced cases, or if they have become resistant to other therapies, they may be recommended removing the foreskin (circumcision).

Prognosis:

Not Available

Expert's opinion

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