Lichen Sclerosus: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate lichen sclerosus et atrophicus:

Woman

Symptoms in women (genitoanal range; approximately 90% of cases).

  • Lichen sclerosus et atrophicans is found preferentially in the vulvar area (entirety of the external primary sex organs) in adult women:
    • Erythema* (redness of the skin).
    • Erythema with petechial hemorrhages* (flea-like bleeding).
    • Brown-red discoloration as in eczema* .
    • Whitish areas, also shiny*
    • White, porcelain-like spots
    • Severe pruritus (itching) in the genital region (in the initial forms).
    • Soreness in the genital region
  • Dyspareunia (pain during sexual intercourse).
  • Painful urination
  • Painful bowel movement
  • Vulnerable skin
  • Frequent bleeding rhagades (“fissures”) with a tendency to superinfection (bacterial or mycotic (“caused by fungi”) infections).
  • In the late stage, different degrees of severity of atrophy (“regression”) of the vulva (totality of the external primary sexual organs):
    • Atrophy of the small and subsequently the large labia (labia majora), in the further late stage:
      • Findings of craurosis vulvae (synonyms: craurosis vulvae, vulvar dystrophy), i.e. degenerative change of the skin, accompanied by atrophy and hyperplasia (“excessive cell formation”). This leads to shrinkage of the vulva with subsequent sclerosis (tissue hardening) of the subcutaneous fatty tissue; stenosis (narrowing) of the introitus vaginae (vaginal entrance), anus, urethra (urethra); disappearance of the clitoris (“burried clitoris”).

* Early stage

Symptoms in girls (possible from the age of 3).

  • Correspond to those of adult women:
    • Itching in the area of the vulva as well as perianal
    • Burning and soreness in the anogenital region (area of the body surrounding the anus (anus) and genitals)
    • Dysuria (pain during urination).
    • Defecation pain (pain during defecation) or constipation.
  • The hymen (hymen) may be destroyed
  • During puberty, an improvement may occur

Man

Symptoms in men (genitoanal range; about 90% of cases).

  • Lichen sclerosus et atrophicans is most commonly found on the glans penis (glans) and prepuce (foreskin) in adult men:
    • White, hardened spots
    • Chronic balanitis (acorn inflammation).
    • Pruritus (itching)
    • Soreness
  • Retraction of the foreskin is difficult (phimosis; foreskin constriction).
  • Weakened urine stream, possibly also painful micturition (“urination”) due tomeatus stenosis (narrowing of the urethral orifice).
  • In the late stage: picture of balanitis xerotica obliterans (BXO) – manifestation at the glans penis (glans) with meatus stenosis or narrowing of the fossa navicularis (ampullary dilation of the male urethra (urethra), which is located in the area of the glans penis just before the external urethral orifice).

Symptoms in boys

  • Retraction of the foreskin is difficult (phimosis; foreskin constriction).
  • Weakened urinary stream, possibly also painful micturition (urination) due to meatus stenosis.
  • Perineal manifestations (rare).

Extragenital (outside the genital region) manifestations

Symptoms of extragenital infestations (approximately 10% of cases).

  • Commonly affects mainly the lateral neck region, skin of the neck, clavicle region, shoulders, presternal (the sternum region), mammary/chest and submammary/lower chest, flexor sides of the lower lamellae, and inner thighs; in rare cases, also the oral mucosa
  • Small (0.1 -3 cm) white – to bluish-white – (ivory) roundish, occasionally hyperkeratotic or also atrophic papules (nodules) or plaques (areal or plate-like substance proliferation of the skin) with slight wrinkling of the skin, which show a “strip-free”, smooth, parchment-like surface when illuminated from the side

Often, affected individuals are symptom-free.