Kids Health Info

Lichen sclerosus

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

    The cause is unknown. Lichen sclerosus is not an infection and it 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 before puberty or around menopause. Overall, it is much more common in adults than in children. 

    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. The general health of a person with lichen sclerosus remains normal, and sometimes there may be no symptoms at all. 

    The most common symptoms include:

    • itchiness;
    • constipation (due to painful cracks in the skin around the anus);
    • pain when urinating (doing wee);
    • initially the skin is red and inflamed but later becomes white, shiny and crinkly;  
    • if lichen sclerosus is found on or near the vulva and is 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 or doing all the following:

    • soaps and bubble baths for washing as these may cause irritation;
    • feminine intimate wash products;
    • talcum powder;
    • antiseptics or non-prescription creams from the chemist or supermarket.

    Try instead:
    Alternatives for washing include:

    • Dermaveen / Cetaphil or QV wash (available from the chemist and some supermarkets);
    • Saline solution (two teaspoons of salt in each one litre of water).

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

    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. However, for some girls the condition can continue on past this time.

    Once the condition is controlled, either by the use of steroid ointment 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 soaps, talcum powder, antiseptics and 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. Have an annual check-up once the condition has cleared.

    For more information

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

Disclaimer
This information 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 easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts.