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Lichen sclerosus

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 3 minutes read
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Lichen sclerosus is a skin condition in which you might notice the area feels tight or itchy. It may be painful when passing urine, having sex, or – for men – getting an erection. If it's around the anus, you may find it sore when passing a stool.

Skin can become fragile and bleed if rubbed or scratched and then feel very sore if it breaks down. It may form blood blisters or thickened areas with constant scratching. At first, there may be nothing to see on the skin. Later in the process, you may notice shiny white patches where it feels sore or itchy.

Who gets lichen sclerosus?

It occurs in both men and women. Men are most commonly affected around the foreskin or tip of the penis. The labial folds (lips around the vagina) and perineum (the skin between the vagina and the anus) are most commonly affected in women. Occasionally, lichen sclerosus occurs in non-genital areas, where you will see ivory spots or slightly raised patches resembling white tissue paper. These patches are seen on the neck, armpits, around the breasts or upper trunk, or on the inside of the wrists.

It affects all ages and can start in childhood, although this may resolve by puberty. Women are more at risk of this after menopause.

For a minority, this can occur alongside autoimmune conditions such as autoimmune Type 1 diabetes or Grave's thyroid disease, but the link isn't very well understood.

What's the treatment?

Treatment is with a strong steroid cream (prescription) for several months to reduce inflammation and improve itching. There isn't necessarily a cure, but this helps to manage the flare-up, hopefully keeping any long-term scarring at bay. Circumcision is considered in some men if tightness persists.

An emollient cream will soften and protect the skin, making it feel less itchy - the greasier, the better, so ointments are often advised. Using an emollient in place of soap will be less irritating and more repairing to the area.

A lubricant may ease discomfort during sex.

Any cause of friction, such as wearing panty liners, incontinence pads, or urinary leakage, can cause the area to become irritated and sore, so it's worth addressing any other problems or irritants. You can use a barrier cream such as Vaseline to protect against urine.

This isn't contagious and can't be caught or passed on from intimate or sexual contact.

When should I see my doctor?

You should book a routine appointment with your doctor or sexual health clinic to confirm this condition and start treatment. This is likely to be a strong steroid cream for several months, which will relieve symptoms, help the skin repair and prevent long-term damage to the skin. They will also advise on the best emollient. Suppose there is doubt about the diagnosis or you are not improving after a couple of months of treatment. In that case, they may consider referring you to a skin specialist – a dermatologist.

A bacterial, fungal, or thrush infection can develop where the skin is cracked, so see a doctor for any increase in itchiness, discharge, or change to the look or feel of the area.

Are there risks?

Unfortunately, yes – small but serious risks. If left untreated, there is a risk that long-term inflammation will cause the tissue to change permanently, which can alter the anatomy. Additionally, there is a small increased risk of cancer in the area (vulval or penile cancer), so check yourself regularly and ensure you get any lumps, ulcers, or crusted lesions checked out.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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