Lichen sclerosus

Overview

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