Lichen sclerosus is a chronic inflammatory disease of the connective tissue of the skin, which usually occurs in the genital area and is manifested by bright, itchy patches. Women are most commonly affected, but lichen sclerosus can also occur in children and men. Early therapy is important to prevent damage to the skin, as are regular check-ups. This is because patients with lichen sclerosus have an increased risk of a certain form of skin cancer. While a cure is possible in men through circumcision, the disease has not yet been curable in women.
What is lichen sclerosus?
Lichen sclerosus et atrophicus (LSA) – the full name formerly used – refers to a skin disorder in which whitish patches appear in the affected area that can harden (sclerose) and thicken (lichenify). Therefore, lichen sclerosus is also called white spot disease – not to be confused with the skin disease vitiligo, which is also called white spot disease. The disease usually progresses chronically over years in episodes.
Most common form: Lichen sclerosus genitalis.
Most cases are genital lichen sclerosus, in which the skin changes affect the genital region. In about 15 to 20 percent, lichen sclerosus occurs in other parts of the body, such as the back, arms, or thighs, and rarely in the oral mucosa.
How does lichen sclerosus develop?
The cause of lichen sclerosus is unknown. An involvement of the immune system is discussed, especially since some patients additionally suffer from an autoimmune disease. Genetic or hormonal influences are also possible. In addition, lichen sclerosus seems to occur more frequently in areas of damaged skin, for example after operations, injuries or severe scratching. The disease is not contagious and therefore cannot be transmitted during sexual intercourse.
What does lichen sclerosus look like?
Lichen sclerosus causes bright spots to appear on the skin, which are often raised and hardened and then feel like papules or nodules. The skin in this area is often vulnerable, so cracking and bleeding can occur, especially from scratching. In women, lichen sclerosus usually occurs on the vulva (external genitalia with labia and vaginal entrance) and around the anus. In men, the glans and foreskin are usually affected.
Other symptoms: Itching and pain
The skin lesions of lichen sclerosus often itch intensely and tend to cause skin tears. Thus, soreness may occur, as well as pain during sexual intercourse, bowel movements, and urination. However, lichen sclerosus can also occur without additional symptoms: The skin symptoms are then usually discovered by chance, for example during a routine examination at the gynecologist.
Who treats lichen sclerosus?
Lichen sclerosus is a multidisciplinary disease – mainly dermatologists, gynecologists and urologists are responsible. However, as a first point of contact, you can also contact your family doctor or pediatrician, who can refer you to a specialist.
Diagnosis: tissue sample in cases of doubt
Lichen sclerosus can often be diagnosed based on its typical appearance. To confirm the diagnosis, a tissue sample (biopsy) of the skin can be taken under local anesthesia. This can be useful to exclude a malignant skin change. Other possible diagnoses such as lichen ruber planus can also be delineated in this way. However, this is usually not done in children, provided the diagnosis of lichen sclerosus is clear.
LSA: treatment with ointments
Treatment of lichen sclerosus is usually initially topical with a strong cortisone-containing ointment. If there is insufficient improvement, the physician may alternatively inject cortisone under the skin in the affected areas. Cortisone has an anti-inflammatory effect and can thus relieve the symptoms of lichen sclerosus. Another alternative may be ointments with stronger immunosuppressive (immune system suppressing) agents such as tacrolimus. Tacrolimus is known by the trade name Protopic). In nongenital (extragenital) lichen sclerosus, creams containing vitamin D and UV therapy may also be used.
Cure possible with circumcision
In men and boys, lichen sclerosus is curable by circumcision.Therefore, this option should be considered in male patients when cortisone ointments do not show sufficient effect. In early stage and mild cases of lichen sclerosus, incomplete circumcision with partial preservation of the foreskin may be considered, but relapse (recurrence) may then occur.
Foreskin constriction as a possible complication
If lichen sclerosus is not treated in time, various complications can occur due to the chronic inflammation. In men and boys, it is not uncommon for a narrowing of the foreskin (phimosis) to occur, because of which circumcision is then often necessary. In women, shrinkage and adhesions of the labia can be the result of untreated lichen sclerosus. In addition, the following complications, among others, are possible in both sexes:
- Infections with damaged skin
- Constriction of the urethra due to adhesions
- Urinary retention due to narrowing of the urethra
- Constipation due to suppression of painful bowel movements.
- Impairment of sexual function due to adhesions and pain
- Scars due to injury to the skin
Surgery for complications
In some cases, surgery is required for complications of lichen sclerosus: Narrowing of the urethra may require surgery, such as when urination is difficult, painful, or impossible. In women with lichen sclerosus, surgery may be appropriate if there is an adhesion of the labia or a narrowing of the vaginal entrance. In addition, skin lesions that are suspicious for cancer should be surgically removed and examined microscopically.
Lichen sclerosus in children
Symptoms and therapy of lichen sclerosus in children are similar to those in adults. Boys, like men, benefit from circumcision as part of treatment – a cure is then often possible. In girls, there may be a spontaneous decrease in symptoms in the course of puberty. However, sexual abuse should be ruled out in girls: Because on the one hand, the skin changes can look similar to the traces of sexual violence, and on the other hand, the injuries in the case of abuse can promote the development of lichen sclerosus.
How dangerous is lichen sclerosus?
Lichen sclerosus is a benign condition that is usually harmless if treated early. However, patients with genital lichen sclerosus are at increased risk for a certain form of skin cancer (squamous cell carcinoma) – especially in the vulva (vulvar carcinoma). Therefore, regular check-ups with a gynecologist should be performed. In men with genital lichen sclerosus, on the other hand, the development of cancer is very rare, and no case of skin cancer has been reported in extragenital lichen sclerorus.
Lichen sclerosus: what you can do yourself
Since in lichen sclerosus the affected skin is very sensitive, you should pay attention to a protective skin care. We give you four tips for this:
- Use mild, ph-skin neutral shower gels – for example, special intimate wash lotions.
- Avoid tight, abrasive clothing and underwear.
- Care for the skin with wound healing ointments, such as with the active ingredient dexpanthenol.
- Use lubricant during sexual intercourse, if necessary.
Since the disease can be very stressful under certain circumstances due to agonizing symptoms as well as restrictions on sexual intercourse, a support group or forum on the subject of lichen sclerosus can provide psychological support through an exchange with other patients.
Naturopathic medicine for lichen sclerosus
In some patients, naturopathic treatments such as homeopathy can help relieve symptoms. Furthermore, there is speculation about the efficacy of preparations containing colostrum in lichen sclerosus. This is the first milk of cows or other mammals, which is supposed to positively influence the immune system. Naturopathic treatments should only be used in addition to, not as a substitute for, therapy prescribed by your physician.
