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Patient education: Lichen sclerosus (The Basics)

Patient education: Lichen sclerosus (The Basics)

What is lichen sclerosus? — This is a condition that often causes white or light-colored patches on the skin. It usually happens on the genitals, where it can also cause itching or pain. But it can also affect other parts of the body (picture 1). It is more common in females than in males.

Females are most likely to get lichen sclerosus before puberty (when monthly periods begin) or after menopause (when periods stop). But adults who still have periods can also get lichen sclerosus.

What are the symptoms of lichen sclerosus? — In females, symptoms can include:

Skin changes around the vulva or anus, such as:

White, wrinkled skin

Bruises

Cracked skin that sometimes bleeds

Itching of the vulva – This is the area around the opening of the vagina (figure 1).

Itching, bleeding, or pain around the anus – This is the opening where bowel movements come out.

Discomfort or dull pain in the vulva

Fluid that comes out of the vagina – Doctors call this "vaginal discharge."

Pain during sex or urination

In males, lichen sclerosus is most common in people who are not circumcised. People who are not circumcised have skin over the tip of their penis, called the "foreskin." Symptoms of lichen sclerosus can include:

A tight foreskin – It might be hard to pull back for cleaning.

Skin changes on the foreskin that look like scars

A penis that is less sensitive than usual

Painful erections

Trouble urinating

Lichen sclerosus can cause white patches in areas other than the genitals. These can happen in adult females and males, but children do not usually get them. The patches are most common on the upper body (picture 1). People with dark skin might have patches that are darker or lighter than their normal skin.

Should I see a doctor or nurse? — See your doctor or nurse if:

You or your child has itching, bleeding, or pain in the vulva or penis.

You have white, light, or dark patches on your skin.

Will I need tests? — Maybe. Your doctor or nurse will do an exam and learn about your symptoms.

Adults with lichen sclerosus often have a test called a "biopsy." In this test, a doctor takes a small sample of skin from the area with symptoms. Another doctor looks at the sample under a microscope. It can show if lichen sclerosus or a different condition is causing symptoms. Children do not usually need a biopsy.

How is lichen sclerosus treated? — Doctors cannot get rid of lichen sclerosus that affects the vulva, but they can treat it. It is important to get treatment for this condition as soon as possible. Lichen sclerosus that is not treated can make scars form in the vulva. The scars can cause permanent damage.

Lichen sclerosus treatments for females include:

Medicines to relieve symptoms and keep scars from forming – These can be an ointment you put on the skin, a shot, or pills you take by mouth.

Avoiding things that might make the symptoms worse (table 1)

Surgery to remove scar tissue, if scars have formed

Lichen sclerosus treatments for males include medicines and surgery. The most common surgery is circumcision. This involves removing the foreskin.

Lichen sclerosus that is not on the vulva or penis might not need treatment. If it bothers you, your doctor or nurse can suggest different treatments to relieve symptoms.

What will my life be like? — Lichen sclerosus is usually a lifelong condition. Most people with lichen sclerosus on the vulva need to use medicine for years. Follow your doctor's or nurse's instruction. Do not stop using your medicine unless your doctor or nurse tells you to.

Adults who get lichen sclerosus on the genitals have a higher risk of cancer in the genital area. They should see a doctor or nurse at least 1 or 2 times a year. The doctor will check for cancer and any other changes. People with lichen sclerosus on the genitals should check their genitals every month for any changes. A doctor or nurse can show you the right way to check.

Doctors do not think that children who get lichen sclerosus have the same cancer risk as adults who get it.

More on this topic

Patient education: Vulvar itching (The Basics)
Patient education: Vulvar pain (The Basics)

Patient education: Vulvar lichen sclerosus (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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