What Is Lichen Sclerosus?
Lichen sclerosus (LS) is a chronic skin condition that commonly affects the genital skin (vulva and penis) and anal areas. However, LS may occasionally appear on the upper body parts including arms and breasts.
What causes Lichen Sclerosus?
The exact cause of LS is not clearly known. Some evidence points out that increased activity of immune system (hypersensitivity or autoimmune) and hormonal problems play significant roles in the onset and development of LS. The genetic inheritance of LS trait from parents is also believed to increase the likelihood of developing the disease among the children. Although LS is not a contagious disease, sometimes it may appear on the previously infected skin or scarred from some other forms of injuries.
Who is at risk?
Anyone can get lichen sclerosus around the world. However, it commonly occurs among women, uncommon in men, and rare among children. Postmenopausal women are the most at risk of getting LS.
The onset of lichen sclerosus often manifests as small white-shiny spots appearing on the skin. As the disease progresses, the white spots also grow into bigger rashes making the affected areas of the skin crinkled and thin. Afterwards, the skin easily tears and becomes scarred where purple or bright red bruises/lesions are common. In severe cases, the disease is characterized by common symptoms such as itching, blisters, bleeding, as well as discomfort or pain, especially when passing urine and/or during sexual intercourse (dyspareunia). Scarred skin by LS is to some extent more vulnerable to developing skin cancer.
Lichen sclerosus is typically diagnosed in advanced cases by examining the symptoms on the affected skin. In mild cases, a thorough clinical and physical examination coupled with a detailed patient medical history is critical. The dermatologists perform a skin biopsy to help identify the characteristic physical features of LS and rule out other skin conditions with similar symptoms such as vitiligo, lichen planus, low estrogen levels, hemorrhoids, and pemphigoid.
Treatment and Prevention
The treatment options for LS depend on the severity of symptoms on the affected areas of the skin. The patches on the upper body or arms do not require treatment as they usually go away over time. Topical steroids or ointments, such as clobetasol propionate and hydrocortisone creams, are typically effective in reducing itching and inflammation for genital LS in the majority of women. Sometimes oral or topical tricyclic antidepressants, like desipramine, amitriptyline, or nortriptyline, may be prescribed for persistent vulvar pain management notwithstanding the use of steroids. For men, circumcision is normally the best widely used treatment and prevention measure against the risks of genital LS. Other measures that may help prevent the risks of LS include:
- Using moisturizers instead of soaps to wash and clean the genital areas.
- Avoid exposure of genital areas to allergic products or skin irritants such as the use of bubble baths, detergents, scented soaps, perfumes, and synthetic fabrics
MedicineNet. (November 2014). Lichen Sclerosus. Retrieved 31st, August 2017 from http://www.medicinenet.com/lichen_sclerosus/article.htm
National Institute of Arthritis and Musculoskeletal and Skin Diseases (2014). Fast Facts: Lichen Sclerosus. Retrieved 31st, August 2017 from https://www.niams.nih.gov/health_info/Lichen_Sclerosus/default.asp
National Organization for Rare Disorders. (December 2004). Lichen Sclerosus.. Retrieved 31st, August 2017 from https://rarediseases.org/rare-diseases/lichen-sclerosus/