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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z





Lichen sclerosus

What is lichen sclerosus?

Lichen sclerosus is common chronic skin disorder that most often affects genital and perianal areas.

Older names for lichen sclerosus (LS) include lichen sclerosus et atrophicus, kraurosis vulvae (in women) and balanitis xerotica obliterans (in males).

Who gets lichen sclerosus?

Lichen sclerosus can start at any age, although it is most often diagnosed in women over 50. Pre-pubertal children can also be affected.

What causes lichen sclerosus?

The cause of lichen sclerosus is not fully understood, and may include genetic, hormonal, irritant and infectious components.

Lichen sclerosus is classified as an autoimmune disease. Autoimmune diseases are associated with antibodies to a specific protein.

Male genital lichen sclerosus is rare in men circumcised in infancy. It has been suggested that it may be caused by chronic, intermittent damage by urine occluded under the foreskin.

What are the clinical features of lichen sclerosus?

Lichen sclerosus presents as white crinkled or thickened patches of skin that have a tendency to scar.

Vulval lichen sclerosus

Lichen sclerosus primarily involves the non-hair bearing, inner areas of the vulva.

Lichen sclerosus can be extremely itchy and/or sore (pruritus vulvae).

Lichen sclerosus causes adhesions and scarring.

Images of vulval lichen sclerosus ...

Images of perianal lichen sclerosus ...

Penile lichen sclerosus

In men, lichen sclerosus usually affects the tip of the penis (glans), which becomes white, firm and scarred.

Images of penile lichen sclerosus ...

Extragenital lichen sclerosus

Extragenital lichen sclerosus refers to lichen sclerosus at other sites.

One or more white dry plaques may be found on the inner thigh, buttocks, lower back, abdomen, under the breasts, neck, shoulders and armpits.

Lichen Sclerosus Lichen Sclerosus Lichen Sclerosus
Lichen Sclerosus Lichen Sclerosus Lichen Sclerosus
Non-genital lichen sclerosus

More images of extragenital lichen sclerosus ...

What are the complications of lichen sclerosus?

Lichen sclerosus of anogenital sites is associated with an increased risk of vulval, penile or anal cancer (squamous cell carcinoma, SCC).

Extragenital lichen sclerosus does not appear to predispose to cancer.

How is lichen sclerosus diagnosed?

An experienced clinician can often diagnose lichen sclerosus by its appearance. Skin biopsy is frequently recommended.

Biopsy may also be recommended at follow-up, to evaluate areas of concern or to explain poor response to treatment.

What is the treatment for lichen sclerosus?

Patients with lichen sclerosus are best to consult a doctor with a special interest in the condition for accurate diagnosis and treatment recommendations.

They are advised to become familiar with the location and appearance of their lichen sclerosus.

General measures for genital lichen sclerosus

Topical steroid ointment

Topical steroids are the main treatment for lichen sclerosus. An ultrapotent topical steroid is often prescribed, eg clobetasol propionate 0.05%. Lower potency topical steroids may be used in mild disease or when symptoms are controlled.

The doctor should reassess the treated area after a few weeks, as response to treatment is quite variable.

Topical steroids are safe when used appropriately. However, excessive use or application to the wrong site can result in adverse effects. In anogenital areas, these include:

It is most important to follow instructions carefully and to attend follow-up appointments regularly.

Other topical therapy

Other topical treatments used in patients with lichen sclerosus include:

Oral medications

When lichen sclerosus is severe, acute, and not responding to topical therapy, systemic treatment may rarely be prescribed. Options include:

Surgery

Surgery is essential for high-grade squamous intraepithelial lesions or cancer.

In males, circumcision is effective in lichen sclerosus affecting prepuce and glans of the penis. It is best done early if initial topical steroids have not controlled symptoms and signs. If the urethra is stenosed or scarred, reconstructive surgery may be necessary.

In females, release of vulval and vaginal adhesions and scarring from vulval lichen sclerosus may occasionally be performed to reduce urination difficulties and allow intercourse if dilators have not proved effective. Procedures include:

Unfortunately, lichen sclerosus sometimes closes up the vaginal opening again after surgery has initially appeared successful. It can be repeated.

Other treatments

Other reported treatments for lichen sclerosus are considered experimental at this time.

What is the outlook for lichen sclerosus?

Lichen sclerosus is a chronic disease and usually persists for years.

Long-term follow-up is recommended to monitor the disease, optimise treatment and ensure early diagnosis of cancer.

Related information

References:

  1. Bunker CB, Shim TN. Male genital lichen sclerosus. Indian J Dermatol. 2015 Mar-Apr;60(2):111-7. doi: 10.4103/0019-5154.152501. Review. PubMed PMID: 25814697; PubMed Central PMCID: PMC4372901.
  2. New Surgical Approach to Lichen Sclerosus of the Vulva: The Role of Adipose-Derived Mesenchymal Cells and Platelet-Rich Plasma in Tissue Regeneration. Casabona F, Priano V, Vallerino V, Cogliandro A, Lavagnino G. Plastic & Reconstructive Surgery. 126(4):210e-211e, October 2010. doi: 10.1097/PRS.0b013e3181ea9386
  3. British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010, SM Neill, FM Lewis, FM Tatnall, NH Cox, BJD, Vol. 163, No. 4, October 2010 (p672-682) – British Association of Dermatologists
  4. Kirtschig G, Becker K, G√ľnthert A, Jasaitiene D, Cooper S, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol. 2015 Jul 22. doi: 10.1111/jdv.13136. [Epub ahead of print] PubMed PMID: 26202852. Download.

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Lichen Sclerosus

Author: Dr Amanda Oakley, Dermatologist, Website Manager and Chief Editor, Hamilton, New Zealand. Updated January 2016.



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