Lichen sclerosus: Description
Lichen sclerosus is a rare, inflammatory connective tissue disease that mainly affects adult women. It is less common in children and men.
In those affected, whitish, hard skin nodules form individually or in groups, often associated with itching. The skin changes can fuse together and resemble scar tissue. The genital region is most frequently affected. However, the skin changes can also occur in the area around the anus, in the back-shoulder region or on the inner thighs. If only the genitals are affected, this is also referred to as genital sclerosus lichen.
The causes of the connective tissue disease are still unclear. However, lichen sclerorus is not contagious.
Because many sufferers are reluctant to go to the doctor with the disease, many patients are not recognized or are only recognized late.
Lichen sclerosus: symptoms
In advanced stages of the disease, scarring and tissue loss (atrophy) can lead to pain during sexual intercourse. Atrophy can cause the labia to recede in women. In men, the foreskin can no longer be pushed back or can only be pushed back with difficulty (phimosis) due to adhesions in the skin – lichen sclerosus is the most common cause of a non-congenital narrowing of the foreskin. The constriction can impair erection and ejaculation and make sex painful. It also makes intimate hygiene more difficult, which favors infections under the foreskin. A possible consequence is inflammation of the glans (balanitis).
Both sexes may also experience pain when urinating or defecating as a result of scarring and skin shrinkage.
Lichen sclerosus: causes and risk factors
The exact cause of lichen sclerosus is still unclear. Experts discuss various theories, ranging from genetic predisposition to possible infections and hormonal imbalance. However, none of these theories has been sufficiently proven.
The theory of hormonal influence is supported by the fact that women who take the pill before the menopause have an increased risk of lichen sclerosus. Other scientists believe that lichen sclerosus is an autoimmune disease – a disorder of the body’s own immune system.
According to current scientific knowledge, lichen sclerosus is neither contagious nor transmissible through sexual intercourse.
Lichen sclerosus: examinations and diagnosis
The first suspicion of lichen sclerosus usually arises for the doctor when examining the skin changes. However, there are many other diseases that can cause similar changes. The doctor therefore takes a skin sample, which is examined under a microscope in the laboratory. In this way, infectious and malignant skin changes can be ruled out and the suspected diagnosis of lichen sclerosus can be confirmed.
Lichen sclerosus: treatment
If cortisone is not tolerated, a so-called calcineurin inhibitor such as tacrolimus is sometimes used as an alternative. It suppresses the immune system (like cortisone).
In some cases, surgery may be necessary – for example, if the vaginal entrance in women is so narrowed by the disease that regular stretching with so-called dilators is no longer of any use. And in male patients with foreskin constriction as a result of lichen sclerosus, the foreskin of the penis should be circumcised at an early stage.
Proper skin care is also generally important for lichen sclerosus. The sensitive areas of skin should be regularly treated with moisturizing products (such as ointments, oils, etc.). This reduces the feeling of tension and dryness.
New therapeutic approaches
Various types of laser have been used to treat lichen sclerosus for several years. Some of the procedures are still being researched in studies. Their effectiveness cannot yet be conclusively assessed. Anyone interested in laser treatment should seek advice from a doctor who has sufficient experience with both laser therapy and the clinical picture of lichen sclerosus – and does not want to laser at any price.
Lichen sclerosus: course of the disease and prognosis
In principle, lichen sclerosus is a benign disease. However, those affected have an increased risk of skin cancer. Regular check-ups with a dermatologist are therefore important. In this way, possible malignant skin changes can be detected and treated at an early stage.
