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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:
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
- 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.
- Steroid ointment
- Steroid injections
- Oral medications to address itch or pain
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