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Lichen sclerosus is a chronic skin condition characterized by patchy, discolored, and thin skin, predominantly affecting the genital and anal areas. Although it can affect anyone, postmenopausal women are particularly susceptible to this non-contagious disease that cannot be transmitted through sexual contact. The condition often manifests as itchy, scaly patches, with blisters and sores potentially developing from persistent itching, primarily on the vulva, penis, foreskin, urethra, and anus, but it can occasionally appear on other parts of the body.
Treatment typically involves the application of medicated ointments aimed at restoring the skin’s normal appearance and minimizing the risk of scarring. Despite the effectiveness of treatment in managing symptoms, lichen sclerosus is prone to recurrence, necessitating ongoing follow-up care to monitor and manage the condition over time.
If left untreated, lichen sclerosus can lead to severe complications such as scarring that interferes with sexual intercourse, urination, and bowel movements. Moreover, the chronic nature of the condition elevates the risk of developing certain types of skin cancer, such as penile and vulvar squamous cell carcinoma, underscoring the importance of treatment and regular monitoring to manage symptoms and prevent serious health issues.
Symptoms
Lichen sclerosus is characterized by the appearance of white, raised spots primarily on the vulva, anus, foreskin, or glans of the penis. The condition can lead to a variety of symptoms including:
- Blistering and a feeling of scorching skin
- Easy bruising
- A burning sensation
- Tightening of the foreskin
- Itching
- Pain during sexual intercourse
- Discharge from the penis
- Soreness
- Development of ulcers and sores
- A weak urine stream or spraying rather than a steady stream during urination
Although lichen sclerosus may sometimes present without symptoms, especially in milder cases, it can also affect other areas of the body, such as the neck, chest, torso, upper back, wrists, and mouth.
It is essential to seek medical advice if symptoms persist, as they can mimic those of other conditions. Prompt consultation with a healthcare provider is crucial for an accurate diagnosis and appropriate treatment. Regular follow-ups, particularly after treatment, are advised for monitoring potential recurrence and for cancer screening, with check-ups recommended every 6 to 12 months. In situations where lichen sclerosus leads to complete urinary obstruction, immediate medical intervention is necessary.
Causes
Lichen sclerosus is not contagious and cannot be transmitted through sexual contact. It is believed to result from a mix of factors such as an overactive immune system, genetics, and past skin damage or irritation. However, the exact cause of lichen sclerosus is still unknown.
Risk factors
Several factors can contribute to one’s risk of developing lichen sclerosus and certain individuals may be more susceptible to it, such as:
- Children under the age of 10
- Postmenopausal women aged 40 to 60
- Individuals who have not undergone puberty
- Individuals with history of lichen sclerosus in the family
- People who have an autoimmune disease or allergies, such as hypothyroidism
- Men who retain their foreskin or uncircumcised
- Men with urinary incontinence
- People with diabetes and a body mass index (BMI) exceeding 30, indicating overweight or obesity
Diagnosis
Lichen sclerosus diagnosis often involves a healthcare provider examining the affected skin, with a biopsy sometimes necessary to exclude the possibility of cancer or if the skin does not improve with steroid cream treatment. This process entails removing a small section of the affected tissue for microscopic evaluation. Depending on the specific symptoms and areas affected, you may also be referred to specialists such as dermatologists (skin conditions), gynecologists (female reproductive system), urologists, and pain medicine experts for further management and treatment.
Treatment
Lichen sclerosus is a condition that, with appropriate treatment, can see a significant improvement or even resolution of symptoms. The treatment strategy is tailored to the severity of symptoms and the affected area on the body, aiming to alleviate itching, enhance the appearance of the skin, and reduce the risk of scarring. However, it’s important to note that even after successful treatment, symptoms may recur.
Medicated ointments:
- Clobe tasol ointment: This potent steroid ointment is frequently prescribed for lichen sclerosus. Initially, the treatment involves applying the ointment to the affected area twice daily. Over time, and upon improvement, the frequency is reduced to twice a week to keep symptoms at bay.
- Monitoring and side effects: Regular follow-ups with your healthcare provider are essential to monitor for side effects, especially with prolonged use of topical corticosteroids, which may include skin thinning.
- Calcineurin inhibitors: For additional treatment, healthcare providers may recommend a calcineurin inhibitor, such as tacrolimus ointment (Protopic), to further manage symptoms.
Follow-up and long-term management
Regular check-ups, likely once or twice a year, are crucial for monitoring the condition’s progress, managing itching and irritation, and preventing serious complications. Long-term treatment may be necessary to maintain control over the condition.
Surgical intervention:
In cases where lichen sclerosus has narrowed the urinary opening, circumcision may be recommended by your healthcare provider as a treatment option to address this specific issue.
