Lichen sclerosus

Lichen sclerosus is a chronic skin condition, which can involve any part of the skin, but is most often found in the genital area and on the skin around the anus. It is ten times more common in women than men. It can develop at any age but is usually seen in adult women. Itching is the most common symptom but it also causes soreness, which may be due to cracks in the skin, and it can cause pain with sex. In children there may be difficulty urinating (passing urine) or constipation. Children with lichen sclerosus are often initially thought to have been sexually abused.

In some patients there may be no symptoms and the abnormal skin seen by a nurse or a GP when the vulva is examined for another reason such as cervical smear (PAP) taking.

Lichen sclerosus results in a white discolouration and sometimes thickening of the skin of the vulva. Sometimes bruising under the skin develops and there may be small ulcers. It can be very localised affecting only a small area but can affect all of the vulva and extend to the anal area.

Lichen sclerosus is not an infection and you can not give it to your partner .

Lichen sclerosus is an important condition to be aware of for two reasons:

1. Lichen sclerosus can scar the vulva.
Sometimes the clitoris disappears as the skin over the top forms a bridge (the clitoris is still present but is hidden). The small inner lips of the vulva can shrink and sometimes the entrance to the vagina tightens. It is extremely rare for lichen sclerosus to affect the inside of the vagina.

2. Lichen sclerosus is in rare cases associated with cancer of the vulva

How is lichen sclerosus treated?

Lichen sclerosus of the vulva in most women responds well to treatment with a strong topical steroid cream or ointment, and your doctor will instruct you in the use of this. It is important not to be scared of the need for this treatment. It is the best treatment we know for lichen sclerosus and scientific research shows that it is effective and appropriate.

Sometimes other treatments are needed if the response is poor, however this is unusual.

Ongoing maintenance treatment with weaker and or less frequent applications of cortisone cream or ointment is required in most women. Most patients respond very well to treatment, lose their symptoms and are able to resume sexual activity.

Regular follow-up and examination should be arranged every 6-12 months. Occasionally surgery is required to relieve the symptoms caused by the scarring, for example, to widen the vaginal opening.

For more information go to National Lichen Sclerosus Support Group (UK).