DEAR DR. GOTT: Please provide any information you have concerning lichen sclerosus. I was diagnosed eight years ago and have visited three doctors, who all agree I have it, but I have not had much help from the medications they have prescribed. Evidently not much is known about the cause of the problem or a cure. Mine is definitely getting worse, and I’m searching for help. I read your column and enjoy your helpful comments. Thank you for any assistance you can provide — even hints about where I could research further on my own would be welcome.
DEAR READER: Lichen sclerosus is an uncommon skin condition. It primarily affects the skin of the genitals or anus, but it can occur anywhere on the body and in anyone of any age. It is most prevalent in postmenopausal women.
Symptoms include itching (sometimes severe), smooth white spots that may become blotchy and wrinkled, easy bruising or tearing, tenderness of the affected areas, discomfort, bleeding and, in severe cases, blistering or ulcerated lesions.
The cause of lichen sclerosus is unknown, but it is thought to be related to either a lack of sex hormones or an overactive immune system. Areas of skin that had previous damage are more likely to be affected if you develop lichen sclerosus. The condition is not contagious, and it cannot be spread to others through sexual contact. Persistent cases may carry an increased risk of skin cancer, but this has not been definitively proved; however, it is still important to have follow-up examinations at least every year. More severe cases may require an exam every six months.
Untreated cases are at increased risk for complications. In women with genital involvement, scratching can lead to scarring, which may narrow the vaginal opening, thus affecting the ability and/or desire to have intercourse. In those with blistering, it may become so severe that any pressure on the area becomes unbearable. In men with foreskin involvement, it can lead to tightening and thinning of the area, causing problems urinating and during erections.
Treatment depends on location. Many mild cases without involvement of the genitals or anus will disappear on their own. Other areas that require therapy may respond to corticosteroid ointments or creams typically used daily for several weeks with a reduction to a maintenance level of just once or twice in a like period to prevent recurrence. It is important to have regular monitoring because prolonged use of steroids can cause side effects.
If this approach fails to work, other options include prescription sex hormones, ultraviolet-light treatment (only for nongenital areas) and immune-modulating medications. Men with lichen sclerosus of the foreskin may benefit from circumcision.
If you would like to read more about the condition, visit www.MayoClinic.com/health/lichen-sclerosus/DS00725. The Mayo Clinic does an excellent job of providing easy-to-understand yet in-depth information about a vast array of medical conditions.
Readers who are interested in learning more about skin disorders can order my Health Report “Dermatitis, Eczema and Psoriasis” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
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