Lichen sclerosus is a skin condition. It is more common in women after menopause but can happen to anyone, at any age. It usually affects genital skin but can affect any other area of skin. It mostly occurs near the clitoris, on the labia (lips of the vulva) and around the anus, or on the foreskin and the head of the penis.

What causes lichen sclerosus?

The cause is unknown but may be linked to genes, hormones and irritation. It is thought to happen because your immune system is mistakenly attacking your own healthy skin cells (also known as an auto-immune process). It is not contagious.

What are the signs and symptoms of lichen sclerosus in the genitals?

The condition causes a white thickening of the skin. It can be in just one area of the genitals or affect the whole area.

It can cause:

• itching around your vulva and anal area
• skin splits which can cause bleeding and pain
• bruising and blood blisters
• painful sex
• the skin around your clitoris may tighten, your labia may appear smaller and constrict, and the entrance to your vagina may become tight due to changes in your skin
• areas on the skin of your penis become itchy, firm, and discoloured or white in appearance
• less sensation at the tip of your penis
• shrinking and tightening of your foreskin which can then become difficult to retract
• problems passing urine
• white patches on the inner thigh, buttocks, under breasts, on the neck, shoulders and armpits.

How is lichen sclerosus diagnosed?

Your health care provider will ask you about your symptoms and examine you. They may suggest you have a biopsy of the skin, which involves the removal of a very small piece of skin under local anaesthetic. This skin is sent to a laboratory and tested to confirm the diagnosis.

What is the treatment for lichen sclerosus?

Steroid ointments that you put on your skin are used to treat lichen sclerosus. Itch will usually settle within a few days; however, it can take weeks or months for your skin to improve. Once your skin has improved, your health care provider may reduce the strength of topical steroid ointment. Long term use is usually necessary to prevent more skin changes.

Gentle skin care can also help. Avoid using soap. Wash, shower or bathe with plain water or a non-soap cleanser like sorbolene or aqueous cream. Try to avoid rubbing and scratching.

It is important to go to follow-up appointments with your health care provider. Once your symptoms and skin improve, a check-up once a year is usually recommended so that lichen sclerosus can be monitored after treatment.

The good news is that treatments are very effective. Symptoms will improve for most people when they follow the treatment their health care provider recommends.

Will I need surgery?

Surgery is rarely needed and is only required if skin shrinkage is causing problems during sex or when passing urine. Removal of the foreskin (circumcision) may be needed in some cases.

What can happen if lichen sclerosus is not treated?

If you are not treated your symptoms may get worse. If you have lichen sclerosus, you have a higher risk of developing vulval or penile skin cancer. Vulval skin cancer is estimated to affect up to 5% of patients with vulval lichen sclerosus but this risk is much lower if the condition is well controlled. For this reason, long-term treatment and follow-up is important.

Other resources:

If you need more information, contact the Canberra Sexual Health Centre on (02) 5124 2184.

References:

• Oakley, A., DermNetNZ (2016) Lichen sclerosus. http://dermnetnz.org/immune/lichen-sclerosus.html
• UpToDate – Lichen sclerosis Vulvar lichen sclerosus: Clinical manifestations and diagnosis - UpToDate
• Yeon J et al. Vulval lichen sclerosus: An Australasian management consensus. Australas J Dermatol. 2021 Aug;62(3):292-299.