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Lichen sclerosus

What is lichen sclerosus?

Lichen sclerosus (LIKE-in skler-O-sus) is a skin disorder that most commonly affects older women. It can happen at any age, and sometimes runs in the family. It usually occurs on the vulva (the outer genitalia) in women, but can occur on the upper body, breasts, and upper arms of women and on the head of the penis of men.

What are the symtoms?

Sometimes there are no symptoms, but usually, there is itching or irritation of the vulva. Sometimes there can be small breaks or “cuts” in the skin that are painful. When the doctor looks at the area, there are larger patches of thin whitish appearing skin that may look “crinkly.”

Often, the affected area looks like a hourglass around the vulva and anus. Because the skin is thin, it tears easily, causing pain and bleeding. Bleeding under the skin can cause bright red or purple discoloration or “blood blisters.” Women may choose to avoid sexual intercourse, tight clothing, tampons, riding bikes or horses, and other common activities that involve pressure or friction. Urination can be accompanied by burning or pain.

Persistent untreated lichen sclerosus can result in scarring. The result may be that the inner lips of the vulva shrink and disappear, the clitoris becomes covered with scar tissue, and/or the opening of the vagina may narrow.

What causes lichen sclerosus?

The cause of lichen sclerosus is not known, but an overactive immune system may play a role. There may be a genetic tendency toward the disease but it is not due to an infection or trauma.

How is lichen sclerosus diagnosed?

Lichen sclerosus can be diagnosed in the office by looking at the skin. While some offices do biopsies of the skin, a biopsy is usually not necessary.

Genital area of a young girl

How is lichen sclerosus treated?

Lichen sclerosus is a chronic condition that needs ongoing treatment – even if there are no symptoms. Continuing treatment will help prevent symptoms and scarring.

Prescription medicines are required to treat vulvar lichen sclerosus. The first treatment of choice is a very strong steroid ointment (Clobetasol). After initial short treatment (two to four weeks) with the very strong steroids, the strength of the steroid cream or ointment will be reduced to medium or lower strength steroids (Triamcinalone or Hydrocortisone). The strength of the steroid and how often it needs to be used will depend on how the skin responds.

Use of these creams or oinments can stop the symptoms (itching and bleeding), help the skin to heal and prevent scarring. Even after the symptoms are gone, the medicine needs to continue to prevent scarring and the symptoms from returning. 

Some girls may require lifelong treatment. Lichen sclerosus symptoms may or may not disappear at puberty. Scarring and changes in skin color may remain even after the symptoms have disappeared.

Vulvar care

  1. Teach good hygiene
  • Wash hands before and after toileting.
  • Wipe from front to back after urinating. Consider using toilet paper wipes or damp gauze.
  • Urinate with knees spread apart and stay seated on the toilet until finished urinating to allow all the urine to come out.
  • Take a bath (not a shower) every day. Soak in a frog-leg position in a bathtub of plain water for 10 to 15 minutes daily.
  1. Avoid irritation
  • Wear white cotton underwear and avoid wearing underwear at night.
  • Avoid harsh laundry detergents and bleach, and make sure underwear is rinsed thoroughly. Avoid fabric softeners and dryer sheets.
  • Do not use bubble bath or add anything else to bath water unless prescribed by your health care provider.
  • Use a mild, hypoallergenic bar soap, such as Dove®. Avoid deodorant soaps.
  • Make sure all soap is washed off after bathing, and do not allow a bar of soap to float around in the bathtub.
  • Avoid tight jeans or pants and tights.
  • Avoid sitting in a wet bathing suit after swimming – rinse off after swimming and change as soon as possible into
    dry clothing.

Questions?

This is not specific to your child but provides general information. If you have any questions, please call the clinic.

Reviewesd by GYN 1/2018

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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