Kids Health Info

Lichen sclerosus

  • Lichen sclerosus (like-en scluh-ro-sus) is an uncommon skin condition that causes a distinctive rash, and usually affects the genital skin around the vulva and anus. The full name is lichen sclerosus et atrophicus. It most often looks like white patches on the skin. It can last for years and can cause permanent scarring.

    While lichen sclerosus can affect females and males of any age, it is most common in females, and it usually occurs before puberty or around menopause. It is much more common in adults than in children. 

    If your child has lichen sclerosus, they should avoid using soap, talcum powder, antiseptics or non-prescription creams. The most successful treatment is steroid ointment. Current research also suggests it usually gets better naturally.

    Signs and symptoms of lichen sclerosus

    Lichen sclerosus can be anywhere on the body, but usually affects genital skin around the vulva and anus. It does not affect the inside of the vagina. The general health of a person with lichen sclerosus remains normal. 

    The most common symptoms include:

    • itchiness
    • constipation (due to painful cracks in the skin around the anus)
    • pain when urinating
    • red and inflamed skin at the beginning, that later looks like white, shiny, wrinkled patches.

    In males, lichen sclerosus can cause the foreskin on the penis to become tight and difficult to draw back. In some cases, a circumcision is required.

    What causes lichen sclerosus?

    The cause of lichen sclerosus is unknown. It is not an infection and it is not contagious (cannot be spread from one person to another).

    There may be a family history of lichen sclerosus or other types of autoimmune disease (where the immune system mistakenly attacks part of its own body), for example, vitiligo (loss of skin pigment), alopecia (loss of scalp or body hair), diabetes, psoriasis or pernicious anaemia. 

    In adult women, lichen sclerosus may be associated with thyroid gland problems.

    When to see a doctor

    If your child shows signs of lichen sclerosus, see your GP. Lichen sclerosus can be diagnosed by inspection alone, but a biopsy (small sample of the affected skin) may be taken to confirm the diagnosis.

    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 for lichen sclerosus

    Your doctor may prescribe steroid ointment, which is the most successful treatment for lichen sclerorus. The ointment should be used once a day initially, and usually at night. Over time it may be used less often, depending on symptoms. Continued use once or twice per week may be needed for some time.

    If the lichen sclerosus turns into scarring, surgery may be required.

    Care at home

    Because genital skin is very delicate, it is important to protect it when lichen sclerosus is present. If your child has lichen sclerosus, they should stop using the following:

    • soaps and bubble baths (these may cause irritation)
    • vaginal wash products
    • talcum powder
    • antiseptics or non-prescription creams from the chemist or supermarket.

    Alternatives for washing include:

    • Dermaveen, Cetaphil, Hamiltons or QV wash (available from chemists and some supermarkets)
    • salt-water baths (add two teaspoons of salt per one litre of water).

    Current research suggests that lichen sclerosus around the anal and genital area will get better naturally with no treatment in two out of every three females before or around the time they start having periods. However, the condition can continue past this time for some people.

    Follow-up

    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 GP. 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, and current research also suggests it usually gets better naturally.
    • An annual check-up is important once the condition has cleared.

    For more information

    Common questions our doctors are asked

    What can I do to relieve the itch in the genital area caused by lichen sclerosus? 

    Steroid ointments are the most common treatment for lichen sclerosus and treating the lesions will reduce the itch. Symptom relief can also be achieved with salt-water baths.

    How high is the risk of skin cancer after having lichen sclerosus? 

    Scientists have found that skin that has been scarred from lichen sclerosus is slightly more likely to develop skin cancer. That is why it is important to have a check up each year, so the doctor can monitor any changes to the skin. The risk of cancer is higher in adults with lichen sclerosus, compared to children with the condition. 


    Developed by The Royal Children's Hospital Dermatology department. We acknowledge the input of RCH consumers and carers.

    Reviewed June 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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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. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.