What is lichen sclerosus?
Lichen sclerosus (LS) is a common skin condition often occurring in in the genital area. It causes itchy white patches on the genitals or other parts of the body. There’s no cure, but treatment can help relieve the symptoms. LS most commonly affects women over 50, but it can affect men and woman of all ages, and children. It is not infectious and cannot be passed on to other people.
It is thought to be an autoimmune condition. That is a condition where the body ‘attacks itself’ for an unknown reason. Some people who suffer lichen sclerosus are known to have other autoimmune conditions.
How would I know if I had it?
Lichen sclerosus can cause severe itching and soreness of the affected skin. Scratching may cause localised bleeding. The skin in the affected area me=ay become thickened and rough or thin, white and shiny. Little cuts, called fissures, which look similar to paper cuts, may develop. Sexual intercourse can be uncomfortable. There may be stinging of the area when passing urine.
Can it get worse or spread anywhere else?
Lichen sclerosus does not spread internally to the vagina or rectum. In severe cases the opening to vagina may become narrowed. The skin folds in the vulva area may be affected and ‘stick down’ or change in appearance. It is rare for there to be cancerous changes (this may happen to four to five people in every 100). It is important to inform your doctor is a lump develops or if the area does not heal with the prescribed treatment.
How will it be diagnosed?
Often a doctor can make a diagnosis just by looking at the affected area as it has a very characteristic appearance. In some cases a skin biopsy (a sample of tissue) about the size of peppercorn, needs to be taken and examined. This is a usually done if there is no response to the usual treatment or the area has unusual characteristics.
How is it treated?
The usual treatment is using a topical (applied to the affected area). This treatment works well d=for most people.
You will be given a separate information leaflet on the cream including a treatment plan of how to use this.
There are other options if this treatment does not suit you. These will be discussed with you, on an individual basis, should the situation arise.
Skin affected bi lichen sclerosus can sometimes become scarred and tight over time. If the vaginal opening has become narrowed, surgery may be offered, although this circumstance is rare.
How long will I need to use the treatment?
After the four month course, a few people can stop the treatment altogether. Most people need to use the treatment for a few days every few month to treat flare ups of symptoms.
If flare ups happen frequently, you may get better results by applying the cream once or twice a week long-term.
A 30g tube of cream should last at least three months. Using more than this can cause skin thinning.
Lichen sclerosus is a chronic condition, similar to conditions such as asthma. Treatment and lifestyle changes can control symptoms very well, but may not provide a lifelong cure.
Is there anything I should avoid?
- An important part of the treatment is to avoid any chemicals which may worsen the skin irritation. You will be offered a separate leaflet about this.
- Do not scratch or rub the affected skin.
- Avoid wearing tight restrictive clothes- women may find it helps to wear stockings rather than tights.
Other factors such as diet do not seem to affect lichen sclerosus.
Will the treatment cure the condition?
Not in every case. The symptoms can be controlled, in most cases, but may return.
How quickly am I Likely to feel some relief from the symptoms?
The itching should begin to feel better very quickly and the little cuts, fissures, will start to heal. The appearance of the skin folds of the vulva may not always go back to how they looked previously.
Is using steroid cream dangerous?
People often worry about potential side effects of steroid cream usage. Long-term use can cause the skin to become very thin and fragile, so it should be used sparingly. For example a 30 gram tube should last you for at least three months on the treatment regime you will be given.
Can I do anything to help the condition?
Avoid using anything that irritates your skin, especially chemical based products.
You can also:
- Wash with emollient soap substitutes instead of regular soap- ask a doctor or pharmacists about suitable products.
- Gently dab your genitals dry after passing urine.
- Wear cotton or silk underwear. Try washing your underwear in plain water without detergent.
- Use vaginal lubricant if sex in uncomfortable.
Follow up appointment
We will offer you an appointment between three and sic months after you start treatment to see how things are going. If your symptoms are getting better, we would not usually arrange a further routine appointment.
Are there any risks associated with having lichen sclerosus?
There Is a small risk that cancerous changes could develop in long lasting lichen sclerosus. This may affect four to five people in every 100.It is important to let your doctor know if you develop a lump, skin split, or sore in the affected area that does not heal after two to three weeks of treatment with steroid cream.
Usually these symptoms will not be cancer, but we would arrange an appointment for you to check.
Dr Efterpi Tingi
Consultant Obstetrician and Gynaecologist
