Lichen sclerosus is a rare, prolonged skin condition. This disease results in patchy, thin skin that may cause permanent scarring and which may affect any part of the body – however, it is most often found around the genitals or anus and is a known risk factor for both penile and vulva cancers. Most commonly seen in middle aged, post menopausal, women the condition is thought to affect around one in one thousand individuals.
Lichen sclerosus is the result of hormonal and immune system disorders and is also thought to have a genetic cause. The condition may appear on skin that has been previously damaged or scarred and, in addition to the patchy appearance may also produce itching and burning that in turn result in lesions or sore area.
Although Lichen sclerosus is most commonly seen in post-menopausal women it can affect women of any age. The symptoms of the disease may only affect a small localised area of the genitals or may be more widespread.
Typically small, itchy, white spots will appear on the vulva – there may not be any itching or discomfort in some patients, and the condition frequently goes unnoticed until a medical examination is carried out.
In around 35% of cases the skin around the anus is affected – and, occasionally, this is the only area affected.
The intense, persistence itching and irritation caused by lichen sclerosus may worsen at night causing disruption to sleeping patterns and may cause acute distress to the sufferer. The patient may feel the area is extremely sore – this disease does not affect the inside of the vagina or the anus, only the surrounding skin.
Left untreated the typical white spots associated with lichen sclerosus may increase in size and eventually join together causing the whitening and fragility of the skin associated with this condition. The fragile skin may become damaged and inflamed as it is prone to splitting and cracking, this in turn makes intercourse painful, and, if the anus is affected, passing stools may also be extremely painful.
Atrophy, or shrinkage, of the vulva may develop should the lichen sclerosus be left untreated and the entrance to the vagina may also narrow. Patients with this condition are also more prone to thrush and other infections due to the soreness and cracked appearance of the vulva.
Using moisturising creams containing vitamins C and E along with zinc may help prevent the development of lichen sclerosus and will soothe the condition should it arise. Some individuals report the use of anaesthetic creams or gels to be beneficial.
Once the rash has broken out it may be necessary to use topical steroid creams or ointment, any infection should be treated with antibiotics and if a yeast infection is present anti-fungal medication may also be necessary. The area should be gently cleansed with plain water – avoiding the use of soap – and gently patted dry. In extreme cases surgery to remove the entire vulva may be required.
When this skin disorder affects men circumcision is generally the preferred method of treatment.
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