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Lichen sclerosus

  • Lichen sclerosus is an uncommon skin condition that causes a distinctive rash, usually affecting genital skin around the vulva and anus. It most often looks like white patches on skin. It can last for years and can cause permanent scarring.

    The cause is not known. Lichen sclerosus is not an infection and is not contagious. It usually affects females but can also affect men and boys. In boys the foreskin can become tight and difficult to draw back. It can happen at any age but is most common around menopause or before puberty. Overall it is much more common in adults. 

    Soap, talcum powder, antiseptics or non-prescription creams should be avoided. The most successful treatment is steroid ointment. Current research also suggests it usually gets better naturally.

    Signs and symptoms

    There may be a family history of lichen sclerosus or other types of autoimmune disease such as vitiligo (loss of skin pigment), alopecia (loss of scalp or body hair), diabetes or pernicious anaemia. In adult women, lichen sclerosus may be associated with thyroid gland problems.

    Lichen sclerosus can be anywhere on the body but usually affects genital skin around the vulva and anus. It does not affect the insides of the vagina. General health remains normal. Sometimes there may be no symptoms at all. 

    The most common symptoms include:

    • itch
    • constipation (due to painful cracks in the skin around the anus)
    • pain when urinating
    • initially the skin is red and inflamed but later becomes white, shiny and crinkly  
    • if lichen schlerosus is found on or near the vulva, left untreated the labia may shrink and the opening to the vagina may become narrow

    Treatment

    Stop:
    The genital skin is very delicate. It is important to stop using all the following:

    • soaps and bubble-baths for washing as this may cause irritation
    • talcum powder
    • antiseptics or non-prescription creams from the chemist

    Try:
    Alternatives for washing include:

    • Dermaveen / Cetaphil or QV wash (available from the chemist)
    • Saline solution (2 teaspoons of salt in each 1 litre of water)

    The most successful treatment is steroid ointment, which is used once a day initially, usually at night. A thirty gram (30gm) tube should last at least three months and is quite safe. Gradually it is used less often, depending on symptoms. Continued use may be needed for some time of about once or twice per week.

    Follow up

    Current research suggests that anogenital lichen sclerosus will get better naturally in two out of every three girls before or around the time they start having periods. For some girls though the condition can continue.

    Once the condition is controlled, either by cream or naturally, it is important to have an annual check up with your family doctor. Very rarely a skin cancer can develop when there has been long-standing chronic inflammation of the skin.

    Key points to remember

    • lichen sclerosus is an uncommon skin condition. It is not contagious and usually affects females
    • lichen sclerosus usually affects genital skin around the vulva and anus 
    • avoid soap, talcum powder, antiseptics or non-prescription creams
    • the most successful treatment is steroid ointment. Current research also suggests it usually gets better naturally
    • very rarely a skin cancer can develop when there has been long-standing inflammation. Get an annual check-up once the condition is cleared

    For more information

    Developed by the RCH Department of Dermatology. Updated November 2010.

Disclaimer
This is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. The Royal Children's Hospital accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.
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