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Lichen sclerosus: Treatment, symptoms, advice & help

About lichen sclerosus

Lichen sclerosus is a longstanding skin problem, which mostly affects the genital and anal areas of the body. It has also been known to affect extra genital sites like arms and chest occasionally. This skin disease is not infectious in nature. The skin eruptions appear characteristically as white plaques or marks on the affected area of the skin.

Lichen sclerosus: Incidence, age and sex

The incidence rate of lichen planus is not very clear; however it is six times more common in women as compared to men. Uncircumcised men are more susceptible to this skin condition than circumcised men. It mainly affects women after menopause, although it may occur in any age group. It is rarely seen in children. There seems to be no racial or genetic predilection.

Signs and symptoms of lichen sclerosus: Diagnosis

The skin lesions of lichen sclerosus typically occur on the vulvar and the penile region and characterised by appearance of white spots on the skin. These white spots may coalesce to form large white plaques and cause itching. The surrounding skin may become fragile and crinkled, leading to easy rupture of superficial small veins just under the skin. Other associated features include genital bleeding, painful sexual intercourse or pain on micturition. Extra-genital lesions are uncommon but may affect upper back, chest and arms in some individuals. The appearance of skin lesions is same as that of genital lesions but itching may be less pronounced.

The condition can be diagnosed on physical examination by a skin specialist. It is advisable to get biopsy of the skin lesion done, wherein the small skin tissue can be taken and studied under a microscope. This helps in establishing the diagnosis.

Causes and prevention of lichen sclerosus

The exact cause of lichen sclerosus is not clear. Several hypotheses have been put forward to explain the causation of lichen sclerosus. It may occur as an autoimmune reaction after an infection. Hormonal factors may also play a role in causing lichen sclerosus since its incidence is higher in women who have taken oral contraceptives. Local irritation or damage to the skin may also increase its chances of development. It is possible that genetic factors or inheritance may also lead to its development. No specific preventive measures are applicable for lichen sclerosus, since the exact cause has not been found out.

Lichen sclerosus: Complications

Lichen sclerosus is a longstanding skin disorder, which may lead to sexual problems in affected individuals. Scarring of the skin in cases of persistent skin eruptions of lichen sclerosus may lead to cancerous changes and present as squamous cell carcinoma in occasional individuals.

Lichen sclerosus: Treatment

The treatment of lichen sclerosus may need a multi-disciplinary approach involving a dermatologist, a gynaecologist and possibly an urologist. The extra-genital lesions usually do not need any treatment since they are self-limiting and may disappear on their own within a few weeks. However genital lesions need proper management which may include both medical and surgical treatment. Local application of corticosteroid cream or ointment may be prescribed for several weeks which help in controlling the itching and also in preventing the scarring of skin. However, the skin which is already scarred, may not heal with corticosteroid application and may require surgical intervention. Surgical removal of foreskin on penis in men is usually very helpful in managing the condition and preventing its future recurrence. But surgical intervention in women for removing scarred patches is not very fruitful. Other medications like retinoids or tacrolimus ointments may also be prescribed if the patient is not benefiting from corticosteroids. It is always advisable to continue follow up with the doctor since lichen sclerosus is a longstanding problem and may also show recurrence.