Ask a gynaecologist: What is lichen sclerosus?

Lichen sclerosus is a little-known condition of the genitals that affects men, women, and even children.

Here to provide an expert insight into lichen sclerosus in women, including symptoms, complications and treatment, is Mr Mahantesh Karoshi, renowned London-based women’s health expert and consultant gynaecologist.

What is lichen sclerosus?

Lichen sclerosus is a chronic inflammatory condition that causes dry, white plaques of crinkly skin. These plaques can develop anywhere on the body, but commonly affect the vulva (the non-hair bearing area around the vaginal opening) and the anus.

The cause of lichen sclerosus is unknown. While people of all ages can be affected, the condition is more frequent in women over 50.

What problems can lichen sclerosus lead to?

In some cases, the skin affected by lichen sclerosus can become scarred and tight over time.

When this occurs, lichen sclerosus can lead to:

• The resorption (disappearance) of the labia minora, which are the two inner lips around the vaginal opening.
• Clitoral phimosis, which is when the clitoral hood (the skin fold that covers the clitoris) becomes thick and adheres to the clitoris.
• Scarring and ‘fissuring’ of the skin around and near the opening of the vagina.
• An increased risk for squamous cell carcinoma of the skin.

Troubled patients may experience one, or a combination, of symptoms.

These symptoms may include:

• A severe itch
• A burning sensation
• Pain or a burning sensation during urination
• Pain during sex

Once lichen sclerosus develops, it can remain in one area or it can spread to other parts of the body, such as the clitoris.

How is lichen sclerosus treated and managed?

Treatment for lichen sclerosus depends on the severity of symptoms. Hence, early diagnosis of the condition is vital to ensure that the appropriate medication is prescribed.

First-line-treatment for lichen sclerosis is usually prescription steroid creams (topic corticosteroids) of various concentrations.

If steroid creams fail to control symptoms, some studies have shown that laser is a safe and effective treatment option for lichen sclerosus. Laser can temporarily help to improve symptoms and manage any associated hyperkeratosis, which is the thickness of the outer skin layer.

However, there is no evidence that laser can change long-term outcomes of lichen sclerosus, especially in terms of malignancy risk.

If you require expert treatment and management for lichen sclerosus, do not hesitate to visit Mr Mahantesh Karoshi’s Top Doctors profile today.