Lichen sclerosis (pronounced: like-en skler-o-sus) is a chronic inflammatory skin condition that affects the vulvar area (the outside parts of the female genitalia) and the anal area. It can affect men, but it is most common in women.

What are the signs of lichen sclerosis? 

• Early in the disease, small white spots appear and may make the vulva look white, slightly shiny and smooth. As time goes on, the spots develop into bigger patches, and the skin surface becomes thinned and crinkled. As a result, the skin tears easily and bright red or purple discoloration from bleeding inside the skin is common.

What are the symptoms of lichen sclerosis? 

• Symptoms differ from woman to woman and may improve or become worse at various times. Symptoms may be worse during hot summer months with increased sweating and moisture causing skin irritations.
• Very mild lichen sclerosis often causes no symptoms at all, but itching is the most common symptom. Rarely, lichen sclerosis may cause extreme itching that interferes with sleep and daily activities. Rubbing or scratching to relieve the itching can create painful sores and bruising. Urination can be accompanied by burning or pain, and bleeding can occur, especially during intercourse.
• More severe cases of lichen sclerosis produce scarring that may cause the inner lips of the vulva to shrink and disappear, the clitoris to become covered with scar tissue, and the opening of the vagina to narrow. When lichen sclerosis develops around the anus, bleeding or tearing of the skin can occur when having a bowel movement.

What causes lichen sclerosis? 

• Many studies have been done to try and determine the cause of lichen sclerosis. The exact cause is still unknown, although an overactive immune system may play a role. Some people may have a genetic tendency toward the disease, and studies suggest that abnormal hormone levels may also play a role. Lichen sclerosis has also been shown to appear at sites of previous injury or trauma where the skin has already experienced scarring or damage.

Is lichen sclerosis contagious? 

• No, lichen sclerosis is not contagious. Since this problem is not due to an infection, it cannot be passed from one person to another.

How is lichen sclerosis diagnosed? 

• Sometimes, lichen sclerosis can be diagnosed just by looking at the skin, but most often, a biopsy (removing a small sample of affected skin) is required. The biopsy is especially important to rule out other possible causes of skin changes, such as vulvar cancer that can look similar to lichen sclerosis.

How is lichen sclerosis treated? 

• Lichen sclerosis should be treated, even when it is not causing itching or pain. Without treatment, there can be scarring that causes parts of the vulva to narrow and cause problems with passing urine or pain with sexual intercourse.
• Prescription medications are available to help with the symptoms of lichen sclerosis. The treatment of choice is a very strong topical corticosteroid, which is a type of ointment or cream that reduces swelling and itching on your skin. These ointments or creams will need to be applied daily for several weeks, which is usually sufficient to stop the itching. However, long-term application (two or more times per week) will be needed to keep the lesions from reactivating and to help restore the skin’s normal texture and strength. Treatment does not reverse the scarring that may have already occurred.
• Sometimes, lichen sclerosis does not respond to the prescription corticosteroid. Other factors, such as low estrogen levels, an infection, irritation or allergy to the medication, can keep symptoms from clearing up. Your doctor may need to treat these as well. If you feel that you are not improving, talk with your doctor.