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 bright, itchy patches. Women are most often affected, but lichen sclerosus can also occur in children and men.
It is important to early treatment to prevent damage to the skin, as well as regular checkups. Because in patients with lichen sclerosus, the risk for a certain form of skin cancer is increased. While a cure by circumcision is possible in men, the disease is not curable in women so far.
What is lichen sclerosus?
Lichen sclerosus et atrophicus (LSA) - as the formerly common, full name - refers to a skin disease in which whitish spots occur 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 referred to as white spot disease. The disease usually runs chronically over years in spurts.
Most common form: Lichen sclerosus genitalis
In most cases it is a lichen sclerosus genital, in which the skin lesions affect the genital region. In about 15 to 20 percent of lichen sclerosus occurs in other parts of the body, for example, on the back, arms or thighs and rarely on the oral mucosa.
How is lichen sclerosus formed?
The cause of lichen sclerosus is unknown. An involvement of the immune system is discussed, especially since some patients additionally suffer from an autoimmune disease. Also genetic or hormonal influences are possible.
In addition, lichen sclerosus appears to be more common in areas of damaged skin, such as after surgery, injury or severe scratching. The disease is not contagious and therefore can not be transmitted during sexual intercourse.
What does Lichen sclerosus look like?
Lichen sclerosus causes bright spots on the skin, which are often raised and hardened and then feel like papules or nodules. The skin in this area is often vulnerable, which can lead to tears and bleeding, especially from scratching.
In women, lichen sclerosus usually occurs at the vulva (external genitalia with labia minora and vaginal entrance) as well as in the area of the anus. In man, the glans and foreskin are usually affected.
Other symptoms: itching and pain
The skin changes in lichen sclerosus often itch and tend to skin tears. This can lead to soreness and pain during intercourse, bowel movements and urination.
However, lichen sclerosus can also occur without additional symptoms: The skin symptoms are then usually discovered by accident, such as in a routine examination at the gynecologist.
Who treats Lichen sclerosus?
Lichen sclerosus is a multidisciplinary disease - mainly dermatologists, gynecologists and urologists. As a first point of contact, however, you can also contact your family doctor or pediatrician, who can refer you to a specialist.
Diagnosis: tissue sample in case of doubt
Lichen sclerosus is often due to the typical appearance. To ensure the diagnosis, a tissue sample (biopsy) of the skin can be taken under local anesthesia.
This can be useful to rule out a malignant skin change. Other possible diagnoses such as a lichen planus can also be differentiated. In children, however, this is usually dispensed with, as long as the diagnosis of lichen sclerosus is clear.
LSA: treatment with ointments
The treatment of lichen sclerosus is usually first locally by a strong cortisone ointment. If there is not enough improvement, the doctor may alternatively inject cortisone under the skin in the affected areas. Cortisone has an anti-inflammatory effect and can thus relieve the symptoms of lichen sclerosus.
Another alternative may be ointments with stronger immunosuppressive (immunosuppressive) agents such as tacrolimus. Tacrolimus is known by the trade name Protopic®).
In non-genital (extragenital) lichen sclerosus, vitamin D-containing creams and UV therapy may also be used.
Cure by circumcision possible
In men and boys Lichen sclerosus is curable by a circumcision. Therefore, this possibility should be considered in male patients when cortisone ointments do not show sufficient effect.
At an early stage and in mild cases of lichen sclerosus, incomplete circumcision with partial preservation of the foreskin may be considered, however, relapse may occur.
Foreskin narrowing as a possible complication
If a lichen sclerosus is not treated in time, the chronic inflammation can lead to various complications.
In men and boys it is not uncommon for a foreskin narrowing (phimosis), because of which often circumcision is necessary.
In women, shrinkage and adhesions of the labia may be the result of untreated lichen sclerosus.
In addition, the following complications are possible in both sexes:
- Infections with damaged skin
- Narrowing of the urethra due to adhesions
- Urinary retention in narrowing of the urethra
- Constipation due to suppression of painful bowel movements
- Impaired sexual function due to adhesions and pain
- Scars by injury to the skin
Surgery for complications
In some cases, complications of lichen sclerosus require surgery: narrowing the urethra may require surgery, such as when urination is difficult, painful or impossible.
In women with lichen sclerosus, surgery may be useful for labia clumping or narrowing of the vaginal entrance. In addition, suspected skin lesions should be surgically removed and examined microscopically.
Lichen sclerosus in children
Symptoms and therapy of lichen sclerosus in children are similar to those in adults. Boys as well as men benefit from circumcision in the course of treatment - a cure is then often possible.
In girls, there may be a spontaneous decline in symptoms during puberty.
However, a sexual abuse should be excluded for girls: Firstly, the skin lesions may look similar to the traces of sexual violence and secondly, the injuries in an abuse may favor the development of lichen sclerosus.
How dangerous is Lichen sclerosus?
Lichen sclerosus is a benign condition that is usually benign when treated early. In patients with genital lichen sclerosus, however, there is an increased risk of a specific form of skin cancer (squamous cell carcinoma) - especially in the area of the vulva (vulvar carcinoma). Therefore, regular checks should be made at the gynecologist.
In men with genital lichen sclerosus, however, the onset of cancer is very rare, in extragenital lichen sclerorus so far no case of skin cancer is known.
Lichen sclerosus: What you can do yourself
Since the affected skin is very sensitive to lichen sclerosus, you should pay attention to a protective skin care. We give you four tips for this:
- Use mild, ph-skin-neutral shower gels - for example special intimate wash lotions.
- Avoid tight, abrasive clothing and underwear.
- Maintain the skin with healing ointments, such as the active ingredient dexpanthenol.
- Use lubricants during sexual intercourse, if necessary.
Because the condition can be very distressing due to distressing symptoms and sexual intercourse, a self-help group or Lichen sclerosus forum can provide psychological support through sharing with other patients.
Naturopathy in lichen sclerosus
In some patients, naturopathic treatments such as homeopathy may help alleviate the symptoms.
Furthermore, it is speculated about an efficacy of preparations with colostrum in lichen sclerosus. It is the first milk of cows or other mammals that is supposed to positively influence the immune system. Naturopathic treatments should only be used as an adjunct but not as a substitute for the therapy prescribed by your doctor.