What is lichen sclerosus?
Lichen sclerosus is an inflammatory skin disease that ultimately causes scarring of the skin. In women the inflammation occurs mainly on the vulva and around the anus and often causes severe pain. Lichen sclerosus of the vulva is common, and many women live with complaints for a long time before the right diagnosis is made and adequate treatment prescribed. It is much more common (about 10 times) in women than in men, and usually arises around the menopause, though it is sometimes seen in young children before puberty — which suggests that sex-hormone levels may play a role.
What are the complaints of vulval lichen sclerosus?
The vulva (the area around the vaginal opening) often becomes red and swollen at first. In a later stage the skin can become very thin (atrophy) and parts of the vulva can change: the labia minora can slowly disappear, or the entrance to the vagina can narrow. It usually involves a lot of itch and pain, and sex becomes very painful. The skin in the affected area is partly red, partly porcelain-white, and sometimes blisters and wounds can develop; dark discolouration can also occur. In some cases the anal area is also involved, which can cause pain on passing stool.
Non-genital lichen sclerosus. In rare cases lichen sclerosus can also arise on “ordinary” skin, usually on the back or chest, as porcelain-white, paper-thin areas that generally cause few complaints.
Lichen sclerosus in children. A small proportion of patients are girls before puberty. In two-thirds of these children the complaints disappear spontaneously at the start of puberty; in the remaining third the changes persist. Good guidance by a dermatologist and/or paediatrician is important, and corticosteroid creams can be given if needed.
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, and itch also improves. Even so, the complaints often prove very persistent and hard to control. Oestrogen-containing creams are sometimes prescribed too, with variable results. After some years a spontaneous “burning out” of the disease is sometimes seen, though skin changes that have already developed do not recover.
Lichen sclerosus and cancer
In (usually long-standing) genital lichen sclerosus, a form of skin cancer can develop in some cases — especially in women with vulval lichen sclerosus, who have an increased risk of vulval carcinoma. It is important to detect this in time. It is therefore usually advised to examine the affected area yourself regularly (for example with a mirror) and to have a check by the doctor or dermatologist at least once a year. Discuss the wisest check-up frequency with your dermatologist.
When to see a doctor
See a doctor for persistent itch, pain, white or thinning skin changes of the vulva or anus, and follow the recommended regular check-ups, as early treatment helps and monitoring for cancer is important.