Lichen sclerosus is caused by chronic inflammation of the skin and/or mucous membranes. Mucosal involvement is most common, occurring on the glans penis and/or foreskin in males, and in the vulva, vaginal opening, perineum, and around the anal opening in females. The vagina is not affected.
The condition is approximately six to ten times more common in women than in men. It usually starts in adulthood, typically in the 40-60 age range, and is more common after menopause in women. In rare cases, it can also occur in children.
The condition typically starts with diffuse, patchy, and reddish changes that spread and progress over time to atrophic plaques (thin, whitish, tight, and scar-like changes). The condition causes mild to intense itch, burning, and discomfort in the affected areas. The skin/mucous membranes are often fragile, and small, easily bleeding sores and cracks can develop. Skin affected by lichen sclerosus, often on the back and shoulders, may sometimes resemble cigarette paper.
One-third of patients with lichen sclerosus have no symptoms. The scar-like changes caused by lichen sclerosus in men can lead to problems with tight foreskin (phimosis), while in women, it can result in adhesions and altered anatomy in the genital area.
Although lichen sclerosus itself is a benign condition, in rare cases, it can lead to cancerous changes. Approximately 3-5% of patients develop cancer, likely due to long-standing inflammation in the skin or mucous membranes.
The diagnosis of lichen sclerosus is usually based on its characteristic appearance. In some cases, a biopsy may be necessary. Blood tests for autoimmune diseases can provide additional information.
The exact causes of lichen sclerosus are not known. There appears to be a genetic component, and it is associated with certain autoimmune diseases.
Lichen sclerosus is treated with potent corticosteroid creams that are gradually tapered over time. Maintenance treatment over several weeks or months is often necessary. In some cases, non-steroidal anti-inflammatory creams/ointments may be used as maintenance therapy. Moisturizing creams/barrier creams are usually recommended.
For individuals experiencing pain, discomfort, and functional problems (such as during urination, bowel movements, or sexual intercourse) due to skin and mucous membrane changes, surgical correction maybe considered.
In cases of acute and severe symptoms, immunosuppressive tablets (such as methotrexate) may be used, although this is rarely indicated, and the effectiveness is debatable. Experimental treatments such as laser therapy, fat injection, and stem cells are currently being explored. In children, the condition may resolve spontaneously, often during puberty, so a watchful waiting approach may be considered.
Genital lichen planus and psoriasis can partially resemble lichen sclerosus. To differentiate between these conditions, a biopsy may sometimes be necessary. If there are areas that differ from the rest, change rapidly, or exhibit chronic ulceration, a biopsy should also be performed to rule out cancer development. This is a general recommendation in dermatology.
It is advisable to prevent external factors that can irritate the affected skin/mucous membrane areas, such as friction.
