Lichen sclerosus (like-en scluh-ro-sus) is an uncommon skin
condition that causes a distinctive rash, and usually affects the genital skin
around the vulva (external female genital area) and anus. It most often looks
like white patches on the skin. It can last for years and in some cases, cause
permanent scarring of the affected area.
While lichen sclerosus can affect females and males of any age, it is
most common in females, and it usually occurs before puberty or around
menopause.
If your child has lichen sclerosus, they should avoid using soap, talcum
powder, antiseptics and non-prescription creams. The most effective treatment is
strong steroid ointment.
Signs and symptoms of lichen sclerosus
Lichen sclerosus can occur anywhere on the body, but it usually affects the genital skin around the vulva and anus. It does not affect the inside of
the vagina. The general health of a person with lichen sclerosus remains
normal.
The most common symptoms include:
- itchiness
- constipation (due to painful cracks in the skin around the anus)
- pain when urinating
- small tears in the skin, which may bleed
- red and inflamed skin at the beginning, that later looks like white, shiny, wrinkled or thickened patches.
In males, lichen sclerosus can cause the foreskin of the penis to become tight and difficult to draw back. In some cases, a circumcision is required.
What causes lichen sclerosus?
The cause of lichen sclerosus is thought to be an autoimmune disease, although the trigger is unknown. It is not an infection, and it is not contagious (cannot be spread from one person to another).
There may be a family history of lichen sclerosus or other types of autoimmune disease (where the immune system mistakenly attacks part of its own body), for example, vitiligo (loss of skin pigment), alopecia (loss of scalp or body hair), diabetes, psoriasis or pernicious anaemia.
In adult women, lichen sclerosus may be associated with thyroid gland problems and other autoimmune conditions.
When to see a doctor
If your child shows signs of lichen sclerosus, see your GP. Lichen sclerosus in children can usually be diagnosed by inspection
alone. Sometimes a biopsy (small sample of the affected skin) may be taken to
confirm the diagnosis.
Left unrtreated, lichen sclerosus found on or near the vulva may cause the labia to shrink and the opening to the vagina may become narrow and tight.
Treatment for lichen sclerosus
Your doctor may prescribe steroid ointment, which is the most effective treatment for lichen sclerosus. The
ointment should be used once a day initially, usually at night and should
only be applied to the affected area. Over time it may be used less
often, depending on symptoms. Continued use once or twice per week may be
needed for the long term.
If the lichen sclerosus causes scarring, surgery may be required.
Photographs can help in monitoring activity and treatment.
Care at home
Because genital skin is very delicate, it is important to protect it, especially when lichen sclerosus is present. If your child has lichen sclerosus, they
should stop using the following items, if they cause irritation:
- soaps and bubble baths
- vaginal wash products
- talcum powder
- antiseptics or non-prescription creams from the chemist or supermarket
Alternatives for washing include:
- soap free wash products
- salt-water baths (add two teaspoons of salt per one litre of water).
If certain activities or clothing worsen your child’s symptoms, they
should be avoided. Examples include tight clothing, and activities such
as bike riding and horse riding. It is also recommended to apply moisturiser to
relieve any dryness or itchiness that your child may experience.
Current research suggests
that lichen sclerosus around the anal and genital area can get better naturally, before or around the time your child starts having periods. However, the condition can
continue past this time in some cases, or it can also be latent (sleeping)
and start again at an older age.
Follow-up
Once the condition is controlled, either by the use of steroid ointment
or naturally, it is important to have an annual check-up with your GP, dermatologist
or gynaecologist who has experience with this condition. Changes in the
vulva architecture, such as shrinking of the labia and narrowing of the vaginal
opening can happen without other symptoms. Furthermore, very rarely, a skin
cancer can develop when there has been long-standing chronic inflammation of
the skin.
Key points to remember
- Lichen sclerosus is an uncommon skin condition. It is not contagious and usually affects females.
- Lichen sclerosus usually affects genital skin around the vulva and anus.
- Avoid soaps, talcum powder, antiseptics and non-prescription creams.
- The most successful treatment is steroid ointment, and current research also suggests it usually gets better naturally.
- An annual check-up is important once the condition has cleared.
For more information
Common questions our doctors are asked
What can I do to relieve the itch in the genital area caused
by lichen sclerosus?
Steroid ointments are the most common treatment for lichen sclerosus and
treating the lesions will reduce the itch. Symptom relief can also be achieved
with salt-water baths and barrier creams/ointments.
How high is the risk of skin cancer after having lichen
sclerosus?
Studies have shown
that skin that has been affected by lichen sclerosus is slightly more likely to
develop skin cancer, later in life. That is why it is important to have a checkup each year, so the doctor can monitor any changes to the skin. The risk of
cancer is higher in adults with lichen sclerosus, compared to children with the
condition.
Developed by The Royal Children's Hospital Dermatology department. We acknowledge the input of RCH consumers and carers.
Reviewed February 2023.