Lichen Sclerosus

Vulvar Lichen Sclerosus

What is lichen sclerosus? — Lichen sclerosus is a condition that causes white patches on the skin. It usually happens on the genitals, where it can also cause itching or pain. But it can also affect other parts of the body, such as the breasts. It is more common in women than in men.
Women are most likely to get lichen sclerosus before puberty or after menopause. Puberty is the time in a girl's life when she starts getting periods. Menopause is the time in a woman's life when she stops getting them. But adult women who still have periods can also get lichen sclerosus.
What are the symptoms of lichen sclerosus? — In women and girls, symptoms can include:
Itching of the vulva – This is the area around the opening of the vagina (figure 1).
Itching, bleeding, or pain around the anus – This is the opening where bowel movements come out.
Discomfort or dull pain in the vulva
Fluid that comes out of the vagina – Doctors call this "vaginal discharge."
Pain during sex or urination
Skin changes around the vulva or anus, such as:
•White, wrinkled skin
•Bruises
•Cracked skin that sometimes bleeds
In men, lichen sclerosus is most common in men who are not circumcised. Men who are not circumcised have skin over the tip of the penis. The skin is called the "foreskin." Symptoms in men can include:
A tight foreskin – It might be hard to pull back for cleaning.
Skin changes on the foreskin that look like scars
A penis that is less sensitive than usual
Painful erections
Trouble urinating
Lichen sclerosus can cause white patches in areas other than the genitals. These can happen in women and men, but children do not usually get them. The patches are most common on the upper body, for example on the breasts. People with dark skin might have patches that are darker or lighter than their normal skin.
Should I see a doctor or nurse? — See your doctor or nurse if:
You or your child has itching, bleeding, or pain in the vulva or penis
You have white, light, or dark patches on your skin
Will I need tests? — Yes. Your doctor or nurse will do an exam and learn about your symptoms.
Adults with lichen sclerosus often have a test called a "biopsy." In this test, a doctor takes a small sample of skin from the area with symptoms. Another doctor looks at the sample under a microscope. It can show if lichen sclerosus or a different condition is causing symptoms. Children do not usually need a biopsy.
People with lichen sclerosus sometimes have other health conditions. The doctor might do tests for these, such as:
Tests on a sample of fluid from the vagina, for women – These tests can show if there is an infection in the vagina.
Blood tests – These can show signs of other medical conditions.
How is lichen sclerosus treated? — Doctors cannot get rid of lichen sclerosus that affects the vulva, but they can treat it. It is important for women with this condition to get treatment as soon as possible. Lichen sclerosus that is not treated can make scars form in the vulva. The scars can cause permanent damage.
Lichen sclerosus treatments for women include:
Learning how to keep the vulva healthy (table 1)
Medicines to relieve symptoms and keep scars from forming – These can be an ointment to put on the skin, a shot, or pills taken by mouth.
Surgery to remove scar tissue, if scars have formed.
Lichen sclerosus treatments for men include medicines and surgery. The most common surgery is called "circumcision." In this surgery, a doctor removes the foreskin.
Lichen sclerosus that is not on the vulva or penis might not need treatment. If it bothers you, your doctor or nurse can suggest different treatments to relieve symptoms.
What will my life be like? — Lichen sclerosus is usually a lifelong condition. Most women with lichen sclerosus on the vulva need to use medicine for years. It is important to follow the directions your doctor or nurse gives you. Do not stop using your medicine unless your doctor or nurse tells you to stop.
Adults who get lichen sclerosus on the genitals have a higher risk of cancer in the genital area. They should see a doctor or nurse at least 1 or 2 times a year. The doctor will check for cancer and any other changes. Women should check the vulva every month for any changes. A doctor or nurse can show the right way to check.
Doctors do not think children who get lichen sclerosus have the same cancer risk as adults who get it.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 83960 Version 6.0
Release: 28.2.2 - C28.105
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