Lichen sclerosus

What is lichen sclerosus?

Lichen sclerosus is a rare autoimmune condition where patches of skin become thinner and more pale. It tends to affect the skin around the genital area, but can also appear anywhere else on the body. 

What are the symptoms of lichen sclerosus?

Lichen sclerosus can present with new patches of skin that are:

• Initially red and irritated, then turn ivory white

• Thin and prone to bleeding when rubbed or scratched

• Itchy, which can be worse at night

• The lesion can grow if damaged or scratched – known as Koebner’s phenomenon

Symptoms of lichen sclerosus can appear anywhere, but they’re usually on the:

• Vulva (the area around the opening of the vagina)

• Anus

• Foreskin and end of the penis

Other parts of the body that can be affected include the neck, wrists, thighs, upper back and shoulders.

How common is lichen sclerosus?

It’s estimated that in the UK less than 1 out of every 300 people has lichen sclerosus, and most of these are women over the age of 50. Men and children can also have lichen sclerosus but it’s less common.

What causes lichen sclerosus?

Lichen sclerosus is an autoimmune condition which means your own immune system attacks and damages the body – in this case, the skin. It’s believed that a group of cells known as T cells get confused and mistakenly release interleukins 1 and 4, which cause inflammation and activation of fibroblasts.

As a result, these fibroblasts make white scar tissue in the skin, which creates the characteristic white and thin skin patches.

There are some factors that make you more likely to develop lichen sclerosus:

• Genetics – if you or someone in your family lives with any other autoimmune condition

• Hormonal changes – for example if you’re a girl going through puberty or a woman going through menopause

• Being uncircumcised – lichen sclerosus tends to affect the foreskin

How is lichen sclerosus diagnosed?

A GP will usually diagnose it after asking you some questions and taking a look at the affected skin patches. They will also look at the rest of your skin to rule out other skin conditions and make sure you’ve not missed other areas that need treatment.

If it’s not easy to diagnose right away, the doctor will take a biopsy of your skin to be looked at under a microscope to confirm lichen sclerosus.

How to treat lichen sclerosus

As lichen sclerosus cannot be cured, treatment is used to reduce discomfort and stop further scar tissue forming. Lichen sclerosis treatments include:

• A steroid cream such as clobetasol propionate, for up to a month at a time. It’s important to follow a GP’s instructions as too much cream can damage the skin

• Emollient cream to use regularly

• Topical calcineurin and imiquimod

• Circumcision for men with an affected foreskin

• Surgery – this is considered only if lichen sclerosus causes complications, as the white patches can grow back after being removed

When should I seek help?

Lichen sclerosus can cause difficulties in some people and will need urgent further attention if:

• The patch grows into the urethra or anus and you’re experiencing pain or difficult when going to the toilet

• Lichen sclerosus has lead to loss of sexual function

• The foreskin has tightened causing painful erections

Rarely, lichen sclerosus can cause squamous cell carcinoma, a form of cancer. Symptoms include a new lump, change in skin texture or an ulcer that does not heal.