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.
If your child has lichen sclerosus, they should avoid using soap, talcum powder, antiseptics or non-prescription creams. The most successful treatment is strong steroid ointment.
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:
- 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 or thickened patches.
In males, lichen sclerosus can cause the foreskin of 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 thought to be an autoimmune disease, although the trigger 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 and tight.
Treatment for lichen sclerosus
Your doctor may prescribe steroid ointment, which is the most successful treatment for lichen sclerosus. The ointment should be used once a day initially, usually at night and should only be applied to the affected area. 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. Photographs may help in monitoring activity and treatment.
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:
- soap free wash products
- salt-water baths (add two teaspoons of salt per one litre of water).
Your child should also avoid tight clothing, rubbing or scratching and activities such as bike riding and horse riding, which may aggravate symptoms. It it also recommended to apply moisturiser to relieve any dryness or itchiness that your child may experience.
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.
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
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 July 2020.
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