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Lichen Sclerosus - Symptoms & Treatment

Lichen sclerosus (LIKE-in skler-O-sus) is a chronic inflammatory skin disorder that can affect men, women, or children, but is most common in women. It usually affects the vulva (the outer genitalia or sex organ) and the anal area. Lichen sclerosus (aka lichen sclerosis or lichen sclerosis et atrophicus) is a painful skin condition that typically affects the vulva (or penis) and anus. In women, LS falls under the general category of vulvodynia (chronic vulvar pain).  It is not a contagious condition. It's estimated to affect up to one in 300 people around the world, the majority of these people being women over 50. They can come up anywhere, but cause most trouble in the genital areas.

Symptoms of Lichen Sclerosus

Symptoms vary depending on the area affected. The Symptoms of Lichen Sclerosus are covered the following points .

  • chronic itching and soreness of the vulval area and pain
  • splitting of the vulval skin, causing stinging and pain
  • inflammation and sometimes swelling
  • splitting and bleeding of the skin around the anal opening when passing bowel motions, causing pain and discomfort
  • the skin becomes fragile and pale and white in appearance and there is an increased susceptibility to infection and thrush
  • "shrinking" (atrophy) of the vulva area, change in shape and size of the area, sometimes causing urination difficulties and sexual problems
  • loss of vulval features, labia, clitoris
  • pain and difficulties with sexual intercourse possibly leading to total sexual abstinence (enforced celibacy) for long periods of time
  • narrowing of the vaginal opening
  • fusion of the labia, clitoral hood and urethra
  • blisters and ulceration (considered to be uncommon)
  • LS does not extend into the vagina
  • in men the foreskin becomes "fused" or tight making retraction of the foreskin painful and urination may become difficult
  • there is a small risk, estimated at between 3% and 5%, of cancer of the vulva in adult women
  • for men there may also be a small risk of penile cancer

Causes of Lichen Sclerosus

The medical community does not yet understand the exact nature or cause of lichen sclerosus (LS). but there also appears to be a link with other auto-immune conditions.Lichen sclerosus has also been shown to appear at sites of previous injury or trauma where the skin has already experienced scarring or damage. Lichen Sclerosus is not associated with any other disease except for rarely skin cancer as noted above. Lichen sclerosus is not contagious. The cause Lichen Sclerosus is unknown, although an overactive immune system may play a role. Some people may have a genetic tendency toward the disease, and studies suggest that abnormal hormone levels may also play a role. Lichen sclerosus has also been shown to appear at sites of previous injury or trauma where the skin has already experienced scarring or damage.

Treatment of Lichen Sclerosus

A variety of treatments is available for lichen sclerosus :

  • Your symptoms can be relieved by the use of steroid creams or ointments. It is usual to treat symptomatic skin with quite strong steroids regularly for two to three months, and then to keep things under control with only occasional applications. This may be more effective than continuing with milder creams, and is safe for this period of time.  
  • Bland moisturisers help to soften and protect the skin.
  • In men, tightening of the foreskin will often respond to steroid ointments. If not, a circumcision may be worth considering.
  • The fragile skin of lichen sclerosus may be more susceptible than normal skin to infection with candida yeasts (thrush) or bacteria; and may split or even bleed.  Your doctor will treat all of these problems on their merits.  
  • Wear loose fitting clothes and consider wearing thigh high hose instead of panty hose.  Wear cotton underwear that "breathes." 
  • Do not use any soap on your vulva and wash no more than once a day with clear water only using your fingers instead of a wash cloth.  Pat the area gently to dry
  •  Do not use any douches, perfumes, feminine hygiene sprays, commercial lubricants, or other substances on the vulva other than those prescribed or suggested.
  • Use lubrication if needed with intercourse, most women with chronic vulvar symptoms do not find intercourse pleasurable and therefore do not lubricate naturally.  Vegetable oil is a good lubricant to use because it has no alcohol or preservatives in it.
  • Xylocaine jelly will often help to numb the area before intercourse and make sexual activity more comfortable.  This should be applied liberally 15-20 minutes before intercourse.  This medication can also be used at other times when irritation or pain is at its worst.
  • Panty liners and pads irritate some people.  Allergies to chemicals in the pads can occur and may not show up until several days aft er use.
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