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What is lichen sclerosis? How is it diagnosed? Lichen Sclerosus (LS) is an uncommon disease of the skin, which causes loss of colour (whitening) and gradual thinning. In women, there is often itching, soreness and discomfort. Men most commonly notice tightening of the foreskin (if uncircumcised) or whitening at the end of the penis (glans) and sometimes problems passing urine and/or frequent urine infections. In many cases, the rash is typical and a doctor can diagnose the condition by the look of the rash. If there is doubt, then a small sample of affected skin is taken (a biopsy) under local anaesthetic - injected into the skin. The biopsy is about the size of the end of a biro. It is not usually necessary to put a stitch in afterwards and although the injection stings, many people cope with this very well. Sometimes, in men, the term balanitis xerotica obliterans is used. In both sexes, the term lichen sclerosus et atrophicus was used, but now for both sexes it is simply called lichen sclerosus. Who gets lichen sclerosis? LS can affect men and women of any age, and can sometimes develop in childhood. We do not understand why some people develop it and not others, but there may be an inherited risk. Where does the disease occur? LS tends to occur most commonly in the genital area, although in rare cases it can affect the skin elsewhere. What is the cause? We do not know what the cause is, but we know it is not infectious. Your sexual partners cannot catch it from you. It will not affect your fertility, and for women it will not affect pregnancy or childbirth. How is it treated? There is a variety of treatments available for LS but no treatment can completely cure the condition. The main treatment is an antiinflammatory cream (steroid) applied to the affected area once daily for between 6 weeks and 3 months. It is often helpful to use a bland moisturising cream such as E45 or Aqueous cream, which you can buy from your local chemist. Side effects of steroid creams are rare if you do not use more than one 30g tube over 3 months. It can cause thinning of the skin, so it is important not to apply it to other areas or use too much. Rarely, some people become allergic to the cream but other treatments are available. Women who find sexual intercourse painful because of tightening of the entrance to the vagina, may find lubricants such as KY jelly help and on occasions, a vaginal dilator. Men who find intercourse a problem because of tightening and splitting of the foreskin, may find bland creams and lubricators help while you are waiting for the specific treatment your doctor has prescribed. Sometimes if the skin problem has been present for a long time, it may not get better with creams alone. Your doctor may recommend a circumcision and will arrange for you to see a surgeon. Is it serious? For most patients, this condition is a nuisance, and treatment can help control it. However, there is a very small risk of developing a skin cancer in the abnormal skin. For this reason, we ask you to keep a check on the skin and if you find it splits and does not heal properly, or if you develop an unusual swelling or ulcer, you should make an appointment to be checked by your doctor. Please remember the risk is very small and the sooner it is diagnosed the easier it is to treat. If you would like advice or information, please contact: National Lichen Sclerosus Support Group (UK) 3 Wantage Road Great Shefford Berkshire RG17 7DA If you have access to the internet, you can access information at this address: www.hiway.co.uk/lichensclerosus Lichen Sclerosis GU Medicine PIL11570/M Fitzgerald /May13/review May15