What is lichen sclerosus?
Lichen sclerosus is a fairly rare skin condition whose cause is not entirely clear, though it is clear that the body’s own autoimmune system plays a central role. It occurs mainly on the skin of the genitals, but ordinary skin can also be affected. Genital lichen sclerosus often causes severe complaints. It occurs in women, men and children, though it is seen about 10 times more often in women. Lichen sclerosus is a strongly underestimated problem: patients often live with the complaints for a long time without consulting a doctor, frequently out of embarrassment.
Which men get it?
Lichen sclerosus can be seen in men of any age, but men of 45 and older are at greater risk than younger men.
What does it look like?
Usually an inflammation of the foreskin develops first. As a result the foreskin can narrow, so that it can no longer be pulled back properly over the glans — a phenomenon called phimosis. In a later stage (and sometimes at the same time) a thinning of the skin (atrophy) develops: the skin becomes white and looks paper-thin. Painful cracks in the foreskin can also develop, which can be particularly painful during sex. Lichen sclerosus can also initially arise only on the glans; particularly when the changes are located around the urethra, passing urine can be affected.
Non-genital lichen sclerosus. In rare cases it can also arise on “ordinary” skin, usually on the back or chest, as porcelain-white, paper-thin areas that generally cause few complaints.
What is the treatment and course?
Corticosteroid creams can slow the development of lichen sclerosus. Your dermatologist can agree a treatment schedule to combat the inflammation safely; results are often good, especially when treatment is started early. If complaints persist, or there is a strongly narrowed foreskin, removing the foreskin (circumcision) is often a good and usually definitive solution. For a narrowing of the urethra, surgery by the urologist may sometimes be needed.
Lichen sclerosus and cancer
In (usually long-standing) genital lichen sclerosus, a form of skin cancer can develop in some cases. This applies especially to women with vulval lichen sclerosus, who have an increased risk of vulval carcinoma. In men the relationship between lichen sclerosus and penile cancer is less clear; although cases are described, there is no certainty that lichen sclerosus increases the risk. It is usually advised to examine the affected area yourself regularly and have a check by the doctor or dermatologist once a year.
When to see a doctor
See a doctor for a tight, whitening or cracking foreskin, painful changes of the glans or foreskin, or difficulty retracting the foreskin, so lichen sclerosus can be treated early and monitored.