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Lichen sclerosis

What is Lichen Sclerosis et Atrophicus?

Lichen Sclerosis (LS) is a skin condition that mainly affects the vulval and perianal area. The affected skin resembles the appearance of lichens hence its name the unusual name! It is more common in women and, although it can occur at any age it tends to affect older women. Men can have the disease and it may affect the penis. Children can also suffer LS. The cause of lichen sclerosis is unknown. There may be a genetic link (runs in families). A link between LS and auto-immune disease such as thyroid disease and vitiligo seems to exist. It is not an infection that you catch from anyone, and you cannot transmit it to others.

There is a small risk of cancer developing in skin affected by lichen sclerosis (this happens in 3-7% of cases). You will need to be followed closely and have the vulva examined at regular intervals. In some cases, a biopsy may be needed. You should examine the vulva as you would examine any other part of your skin. You should see your GP if you have a sore or ulcer that doesn’t heal in a few weeks, areas that bleed easily, or bumps or raised areas that are becoming larger.

What are the symptoms and signs?

  • itching
  • soreness
  • splitting of the vulva skin
  • ‘shrinking’ (atrophy) of the vulval area
  • pain and difficulties with sexual intercourse
  • narrowing of the vaginal opening
  • fusion of the labia, clitoris and urethra
  • in men the foreskin becomes ‘fused’

Not every one will experience all of the above symptoms

Diagnosis

Diagnosis can be difficult. Patients are sometimes misdiagnosed and treated for thrush. Referral to a specialist is usually necessary and a skin biopsy may be taken (under anaesthetic). LS is sometimes only discovered when examination takes place for other disorders.

What about treatment?

There is no cure for lichen sclerosis. Treatment aims to control the itching and protect the skin from damage. Try to avoid wearing tight clothing. Gentle cleansing with water and non-irritating soaps is also important. Powerful steroid creams are usually effective at controlling the irritation. A three-month course of graduated steroids brings symptoms under control. After this you may find that you are symptom free for quite some time. Some women find that the symptoms return when they stop the creams and may need to use a maintenance dose of steroid cream from time to time. Several follow-up appointments will be needed to see the response to treatment.

Other useful resources

The vulval pain society:

http://www.vul-pain.dircon.co.uk

national lichen sclerosis support group

http://www.hiway.co.uk/lichensclerosis/

Interstitial cystitis support group of the UK

http://www.interstitialcystitis.co.uk/

National vulvodynia association

http://www.nva.org/

Vulvar pain foundation:

http://vulvarpainfoundation.org/

Vulvodynia.com:

http://vulvodynia.com/

Interstitial cystitis association:

http://www.ichelp.com/

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