Download LICHEN SCLEROSIS Lichen sclerosis is a skin condition that can

LICHEN SCLEROSIS
WHAT IS LICHEN SCLEROSIS?
Lichen sclerosis is a skin condition that can occur in the vulvar and anal area of girls,
adolescents, and adults. The appearance of lichen sclerosis is a white, shiny, smooth area
around the vulva and anus. The skin surface can sometimes become fragile and thin, which
can result in tears and bleeding. In severe cases of untreated lichen sclerosis, scarring in the
genital area can lead to the inner lips of the labia to become smaller and the clitoris to become
covered with scar tissue.
WHAT ARE THE SYMPTOMS?
Symptoms differ from person to person, and can be mild to severe. Symptoms that may be
experienced are as follows:
• Mild to severe itching in the vulvar area
• Skin that appears pale or white and fragile
• Skin that is bruised or with broken blood vessels (blood blisters)
• Small tears in the vulvar skin
• Scar tissue covering the clitoris and/or labia
• Bleeding or tearing of the skin, especially with bowel movements
As untreated lichen sclerosis progresses, the vulvar architecture may be almost completely lost
due to scarring.
WHAT CAUSES LICHEN SCLEROSIS?
The exact cause of this disease is unknown. Possible causes include an overactive immune
system, a genetic component or predisposition, or changes in hormones. It is not caused by an
infection, and is not contagious nor an STD.
HOW IS IT DIAGNOSED?
Many experienced physicians can diagnose lichen sclerosis by physical examination of the
vulvar area alone. However, in some cases of atypical presentation of the disease or in very
early disease, a biopsy of the vulvar skin may be necessary to confirm the diagnosis. Biopsies
are rarely needed in children.
HOW IS IT TREATED? IS THERE A CURE?
Unfortunately, there is no “cure” for lichen sclerosis at this time. However, it is important to treat
lichen sclerosis aggressively early in the disease to prevent scarring and discomfort. There are
medication which can help control the symptoms and prevent severe damage to the vulvar area.
Typical treatment regimens are as follows:
•
Mild to Moderate Lichen Sclerosis: Important principles here are to eliminate any local
irritant to the vulvar area. This includes wearing cotton underwear and loose fitting
clothing, using mild soaps to prevent irritation (Unscented Dove is a good option), and
using good hygiene of the vulvar area (wiping front to back, and cleaning yourself
completely after bowel movements). Some find a pretective ointment such as A&D to be
helpful in preventing rubbing in the affected areas. If this is not sufficient to alleviate the
symptoms, a topical corticosteroid cream such as 1% or 2.5% hydrocortisone can be used
for several months until there are no more symptoms. However, whenever topical steroids
are used, it is important to follow up with your physician so they can watch for any side
effects from the treatment. Also, if a patient is asymptomatic for several months but then
has a flare-up, it is reasonable to restart the steroid cream until you can schedule an
appointment with your physician.
•
Severe Lichen Sclerosis: For more severe cases, your physician may choose to use a
stronger topical steroid cream such as Clobetasol for up to 2 weeks, and then to switch
over to the medium strength steroid cream once symptoms have lessened. However, it is
important to follow up with your physician after using this stronger medication so efficacy
and side effects can be assessed.
WILL I NEED SURGERY?
Surgery is rarely indicated for lichen sclerosis. One exception would be if there is such sever
scarring that it causes painful sexual intercourse or difficulty urinating or having a bowel
movement. Even then, it is only utilized in very severe cases when the conventional treatments
have failed.
CAN ADULTS WITH LICHEN SCLEROSIS HAVE SEX?
Lichen sclerosis is a skin disorder, and therefore it is not contagious nor is it a STD.
There is no risk in spreading lichen sclerosis to your partner during intercourse. However,
because of the nature and progression of the disease, some women may find it painful to have
intercourse either due to the fragility of the skin or due to scarring of the vaginal orifice which
makes it narrower. Proper early treatment of the disease can help prevent this scarring, and
many women with lichen sclerosis are able to have sex without pain. However, if scarring of the
vaginal opening should occur, it is possible to use dilators to help open the vagina and make
sex less painful.
IS IT CANCEROUS?
Lichen sclerosis itself is not cancer, nor can it become cancer. However, about 1 in 20
adult women with untreated lichen sclerosis do develop skin cancer, likely due to the chronic
damage to the skin in that area. For this reason, lichen sclerosis is treated aggressively in the
early stages, and skin biopsies are done when indicated.