What is lichen sclerosus?

One common cause of non-fungal itchy genitalia is lichen sclerosis (LS). This condition is not an infection or a sexually transmitted disease, but an inflammation of the skin causing an itching so severe that some women literally scratch until they bleed. One of my patients hadn't had a decent night's sleep for months -- every time she would drift off she would awaken to find herself scratching furiously. Another patient even confessed to using her hairbrush on her vaginal area in a desperate attempt to get some relief.

Lichen sclerosus is a skin problem that causes thin, wrinkled white patches that are itchy and painful. If the skin tears, bright red or purple spots may appear.

Doctors don't know the exact cause of this problem. But genetics, autoimmune diseases, and changes in hormone levels may be part of the reason. It is not caused by an infection and is not contagious.

Anyone can get lichen sclerosus, but women who have gone through menopause are more likely to get it.

This skin problem can affect any part of the body. But in most cases, it occurs on the skin of the anus (the opening where stool leaves the body), the vulva (the area around the vagina), and the tip of the penis in men who haven't been circumcised.

If these skin patches are on the anus, vulva, or penis, they may need to be treated. If these areas are not treated, the skin can thicken and scar. This can cause the openings to the vagina and anus to become narrow and the foreskin over the penis to tighten and shrink. If this happens, going to the bathroom and having sex can be painful. In most cases, skin patches on any other part of the body go away on their own without treatment.

Lichen sclerosus can be treated with strong, medicated creams or with a prescription medicine. In most cases, surgery to remove the foreskin is the recommended treatment for men who have this condition on the tip of the penis.

Lichen sclerosis of the genitals is what seems to be an autoimmune skin condition, especially common in women; I often identify this in premenopausal women before they have symptoms, but more significantly it affects women with declining estrogen levels in menopause. There seems to be some relationship with thyroid issues as well.

The Lichen sclerosis tissue can already be low in estrogen, but more pale-even white, often thinning, sometimes itchy, features of the folds of skin can be flattening out, and the opening to the vagina can feel very tight or narrowed. This skin condition really disrupts comfort in many ways, and often women delay seeking help for this often-treatable condition. What is important is there are options to help! I love the reference "The V-Book" by Dr. Stewart, from Boston area. There are few vulva-vaginal dermatological specialists, but hopefully an army of Nurse Practitioners can learn the skills to help in this important area of women's health!

We discuss Lichen Sclerosis (LS) further in great detail on a page I have written about other causes of vaginal dryness here:

http://www.womentowomen.com/menopause/atrophicvaginitislichensclerosisvulvodynia.aspx

 

A rare, progressive skin disorder, lichen sclerosus occurs most often in postmenopausal women in the anogenital region. Although no one knows what causes lichen sclerosus, some experts believe a bacterium kicks off immune changes that trigger the development of the condition.

Lichen sclerosus usually appears first on the vulva (the outer tissue surrounding the vagina and urethra) as shiny white spots, which may itch or hurt. These may develop into larger white patches, extending over the entire vulva. If left untreated, the skin becomes wrinkled, thin, and so fragile it may tear, bruise, or bleed with relatively minor rubbing, or during activities such as bicycle riding or sex. With time, underlying tissues fuse to form scars, which, in severe cases, may cover the clitoris, shrink the inner lips of the vulva, narrow the opening of the vagina, and interfere with urination.

Some women with chronic, intense vulvar itching have a skin condition affecting the vulva that can affect other areas of the body as well. Lichen sclerosus is not necessarily related to low estrogen levels, but is more frequently seen in postmenopausal women or in young girls who have not yet gone through puberty than in reproductive-age women. The condition affects between 1 in 300 and 1 in 1,000 people in the population. It may be hereditary and may increase the risk of cancer of the vulva.

While the cause of lichen sclerosus is still not known, it may be an autoimmune condition. Autoimmune skin conditions result when the body's natural defences launch an attack against the skin, much as they would toward an infection or foreign substance. The result may be white, parchment like skin patches that itch or hurt. The resemblance between the white skin patches and lichen gives the condition its name.

At first, many women who have this condition believe they have a simple yeast infection and use an over-the-counter remedy or get a prescription for a yeast infection medication from a health care provider. This may provide temporary relief because of the cream's soothing effect, but the symptoms come back. Often, the woman comes to think she has recurrent or chronic yeast infections and treats herself repeatedly. By the time it is correctly diagnosed, the condition has often been present for a long time and may actually have altered the appearance of the vulva.