Lichen Sclerosus

New Patient Appointment or 214-645-8300

UT Southwestern Medical Center provides skilled treatment for skin conditions such as lichen sclerosus, a rare, chronic disorder that results in patches of thin white skin that can be itchy or painful.

Dermatology and gynecology experts at UT Southwestern combine compassionate care with the latest medical resources for accurate diagnostic services and effective treatments that make a difference in patients’ lives.

Specialized Lichen Sclerosus Treatment

Developing most often in the genital or anal regions, lichen sclerosus is a skin condition most common among postmenopausal women – though it can occur in anyone. Treatment is important to control symptoms and disease activity, as well as decreasing the risk of scarring and skin cancer.

UT Southwestern’s Gynecologic Dermatology Clinic specializes in treating vulvovaginal conditions such as lichen sclerosus, lichen planus, and lichen simplex chronicus. Providers from throughout the state refer tough-to-treat cases to us.

Lichen Sclerosus Causes

Although the cause of lichen sclerosus has not been determined, research suggests it results from an autoimmune reaction in people who are genetically predisposed to the condition. Hormonal imbalance and previous skin damage might also be contributing factors.

People with autoimmune diseases may be at greater risk. These include:

Vitiligo
Autoimmune-related anemia
Type 1 diabetes
Alopecia areata
Autoimmune-related thyroid disease

Other factors that might increase risk include having a family history of the condition.

Symptoms of Lichen Sclerosus

Although lichen sclerosus most commonly affects the genital and anal regions, it can also develop in the skin of the upper body, breasts, thighs, and mouth.

And while the condition is most common among women older than age 50, it can affect anyone – up to 20% of women are diagnosed between the ages of 18-45. In men, it is most common among those who are uncircumcised.

Some people with the condition experience no symptoms whatsoever.

Symptoms may include:

Pain or discomfort
Itching (especially in the vulva)
Skin redness
Skin patches that are either smooth and white or blotchy and wrinkled
Skin tearing, bruising, or bleeding
Pain during sex
Constipation
Pain or bleeding during a bowel movement
Urinary retention or pain during urination
Fusing of the outer and inner lips of the vulva
Narrowing of the vaginal opening
Painful erections
Inability to retract the foreskin in uncircumcised men

In extreme cases, a person may develop blistering, bleeding, or ulcerated sores.

Women with lichen sclerosus have a slightly higher risk of developing vulvar cancer or squamous cell carcinoma, a type of skin cancer, in the affected areas. Men with lichen sclerosis on the penis also have a slightly elevated risk of developing squamous cell carcinoma.

Diagnosing Lichen Sclerosus

To determine whether you have lichen sclerosus, we will:

Ask you about your symptoms
Discuss your health history
Perform a physical exam

Frequently, we can diagnose the condition simply by examining the affected areas, but in some cases a skin biopsy, in which we remove a small tissue sample to exam in a laboratory, may be recommended.

We may need to rule out similar conditions, such as lichen planus and morphea, both of which cause skin irritation and discolored skin patches.

Lichen Sclerosus Treatment

There is no known cure for lichen sclerosus, but several treatments can help reduce symptoms, minimize scarring, and prevent the condition from worsening. Affected areas in the genital and anal regions always require intervention. Additionally, patients may have more than one contributing factor, including urinary incontinence, irritant contact dermatitis, allergic contact dermatitis, or candidiasis. It is important to address each condition.

Treatments include:

Steroid ointment
Steroid injections
Oral medications to address itch or pain
Circumcision

The following practices can help reduce symptoms of lichen sclerosus in women:

Wearing loose-fitting clothing and cotton underwear
Avoiding douches, feminine sprays, lotions, and scented detergents and soaps
Not washing your genitals with soap
Not washing the vulva with a washcloth
Patting (not rubbing) the vulva dry after washing
Abstaining from moist wipes
Treating urinary or fecal incontinence

Lichen sclerosus is a chronic condition that can have periodic flares. Working with providers experienced in treating patients with lichen sclerosus is important to get this disorder under control. Once the condition is in remission, follow-up appointments with us or the referring provider are recommended