Lichen sclerosus – what’s behind it

Lichen sclerosus - what's behind it

Lichen sclerosus is a chronic inflammatory disease of the connective tissue of the skin, which usually occurs in the genital area and is characterized by light, itchy patches. Women are most commonly affected, but lichen sclerosus can also affect children and men.

Early therapy is important to prevent damage to the skin, as well as regular check-ups. This is because patients with lichen sclerosus have an increased risk of developing a certain form of  skin cancer  . While men can be cured by circumcision, there is currently no cure for the disease in women.

What is lichen sclerosus?

Lichen sclerosus et atrophicus (LSA) – the full name it used to be used in the past – refers to a  skin disease in which whitish patches appear in the affected area that can harden (sclerose) and thicken (lichenify).

Therefore, lichen sclerosus is also called  white spot disease  – not to be confused with the skin disease vitiligo, which is also known as white spot disease. The disease usually runs chronically over years in phases.

Most common form: genital lichen sclerosus

In most cases it is genital lichen sclerosus, in which the skin changes affect the genital region. In about 15 to 20 percent, lichen sclerosus occurs on other parts of the body, for example on the back, arms or thighs and rarely on the oral mucosa. 

How does lichen sclerosus develop?

The cause of lichen sclerosus is unknown. Participation of the immune system is discussed, especially since some patients also suffer from an autoimmune disease. Genetic or hormonal influences are also possible. 

In addition, lichen sclerosus seems to  occur more frequently in areas of damaged skin  , for example after  surgery , injuries or severe scratching. The disease is  not contagious  and therefore cannot be transmitted through sexual intercourse.

What does lichen sclerosus look like?

Lichen sclerosus causes light-colored patches on the skin that are often raised and hardened and then feel like papules or nodules. The skin in this area is often vulnerable, so it can crack and bleed, especially from scratching. 

In women  , lichen sclerosus usually occurs on the vulva (external genitalia with labia and vaginal entrance) and in the anus area.  In men  , the glans and foreskin are usually affected. 

Other symptoms: itching and pain

The skin changes in lichen sclerosus  are often very itchy  and tend to tear. It can cause soreness and pain during sexual intercourse, bowel movements and urination. 

However, lichen sclerosus can also occur without additional symptoms: The skin symptoms are then usually discovered by accident, for example during a routine examination by a  gynecologist

Who treats lichen sclerosus?

Lichen sclerosus is a multidisciplinary disease – mainly dermatologists, gynecologists and urologists are responsible. However, as a first point of contact, you can also turn to your family doctor or paediatrician, who can refer you to a specialist.

Diagnosis: Tissue sample in cases of doubt

Lichen sclerosus can often be identified based on its typical appearance. To confirm the diagnosis, a tissue sample (biopsy) can be taken from the skin under local anesthesia. 

This can be useful to rule out a malignant skin change. Other possible diagnoses such as  lichen ruber  planus  can also be differentiated in this way. In children, however, this is usually avoided if the diagnosis of lichen sclerosus is clear.

LSA: treatment with ointments

The treatment of lichen sclerosus is initially usually carried out locally using an ointment that contains a lot of cortisone. If there is no sufficient improvement, the doctor can alternatively  inject cortisone  under the skin in the affected areas. Cortisone has an anti-inflammatory effect and can thus alleviate the symptoms of lichen sclerosus. 

Another alternative can be  ointments  with stronger immunosuppressive (immune system suppressing) agents such as tacrolimus. Tacrolimus  is known by the trade name Protopic®).

In the case of non-genital (extragenital) lichen sclerosus, creams containing vitamin D and UV therapy can also be used.

Healing by circumcision possible

In men and boys, lichen sclerosus can be cured by circumcision. Therefore, this possibility should be considered in male patients if cortisone ointments do not show sufficient effect. 

In the early stages and in mild cases of lichen sclerosus, incomplete circumcision with partial preservation of the foreskin may be considered, but recurrence (recurrence) may then occur.

Foreskin constriction as a possible complication

If lichen sclerosus is not treated in time, the chronic  inflammation can lead to  various complications.

Men and boys  often experience narrowing of  the foreskin  (phimosis), which often necessitates circumcision. 

In women  , shrinkage and adhesions of the labia can be the result of untreated lichen sclerosus.

In addition, the following complications are possible in both sexes:

  • Infections in damaged skin
  • Narrowing of the urethra by adhesions
  • Urinary retention with narrowing of the urethra
  • Constipation  due to suppression of painful bowel movements
  • Impaired sexual function due to adhesions and pain
  • Scars from injury to the skin

Surgery for complications

In some cases, complications of lichen sclerosus require an operation: A narrowing of the urethra can make an operation necessary, for example if urination is difficult, painful or impossible. 

In women with lichen sclerosus, an operation can be useful if the labia has grown together or the vaginal entrance is narrowed. In addition, skin changes that are suspected of being cancerous should be surgically removed and examined under a microscope.

Lichen sclerosus in children

Symptoms and therapy for lichen sclerosus in children are similar to those in adults. Boys, like men, benefit from circumcision as part of the treatment – ​​healing is then often possible.

In girls, symptoms may spontaneously subside during puberty. 

However, sexual abuse should be ruled out in girls: on the one hand, the skin changes can look similar to the traces of sexual violence and, on the other hand, the injuries caused by abuse can promote the development of lichen sclerosus.

How dangerous is lichen sclerosus?

Lichen sclerosus is a benign disease that is usually harmless if treated early. In patients with genital lichen sclerosus, however, there is an increased risk of a certain form of skin cancer ( squamous cell carcinoma ) – especially in the area of ​​the vulva  (vulvar carcinoma)  . Therefore, regular check-ups by the gynecologist should be carried out.

In men with genital lichen sclerosus, on the other hand, the development of  cancer  is very rare, with extragenital lichen sclerosus no case of skin cancer has been reported to date.

Lichen sclerosus: what you can do yourself    

Since the skin affected by lichen sclerosus is very sensitive, you should pay attention to protective skin care. We give you four tips for this:

  1. Use mild, pH-neutral shower gels – for example special intimate wash lotions.
  2. Avoid tight, abrasive clothing and underwear.
  3. Care for the skin with wound healing ointments, for example with the  active ingredient  dexpanthenol. 
  4. Use lubricant during intercourse if necessary.

Since the disease can be very distressing due to distressing symptoms and restrictions on sexual intercourse, a  self-help group  or forum on the subject of lichen sclerosus can provide psychological support through exchange with other patients. 

Naturopathy for lichen sclerosus

In some patients, naturopathic treatments such as  homeopathy  can help relieve symptoms. 

Furthermore, there is speculation about the effectiveness of preparations with  colostrum  in lichen sclerosus. This is the first milk from cows or other mammals, which   is said to have a positive effect on the immune system . Naturopathic treatments should only be used in addition to, but not as a substitute for, the therapy prescribed by your doctor.

 

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