You ignored some white spots on your genitals a few months ago, and now you noticed a bigger patch that gave you a doubt of cancer when you experienced slight bleeding. You have been very anxious as intercourse has also been a discomfort, but you thought it was all due to menopause. You may be mistaken. This may be lichen sclerosus. You should learn more about this condition.
About lichen sclerosus
Lichen sclerosus is a rare inflammatory skin disorder that results in a white patchy skin which is thinner than the normal skin. This happens due to atrophy of the most superficial layer of skin called the epidermis. Lichen sclerosus commonly affects the external genitalia in women and men. It involves the foreskin of penis in men. It can also occur around the anus and can affect any part of the body.
Lichen sclerosus commonly affects postmenopausal women though it can affect of all age groups. It is uncommon in men and rare in children though anybody can be affected. It has been reported in babies from age of six months and in all age groups including adults.
The exact cause for lichen sclerosus is not known. It is believed to be an autoimmune disorder, where the defense system called the immune system of the body, which recognizes and attacks external invaders, erroneously mounts an attack against the components of the skin and triggers an inflammation. Sometimes a deficiency or underactivity of sex hormones locally in the affected skin is believed to be causative. Lichen sclerosus does not spread from person to person via sexual intercourse.
Symptoms
Lichen sclerosus may not always be symptomatic. It may present with smooth white or pale discolored spots that may enlarge to form blotchy patches. These may itch and cause discomfort, especially if the patches appear around the genital and anal areas. The area may be painful to touch, may bruise easily, and develop tears. In severe cases, there may be bleeding or ulceration. Intercourse may become painful and affect sexual life. Scars may form in the affected skin.
Diagnosis
Lichen sclerosus is diagnosed by a physical examination and biopsy. In this, the doctor snips a small piece of skin from the affected area and examines it under a microscope to study the change sin structure of the skin.
Treatment
An asymptomatic patient may need no treatment for lichen sclerosus. Many lesions that are not in the genitalia may heal without treatment. Medicines may be needed for more severe cases or in lesions around the anus or genitalia. The most commonly prescribed medicine is corticosteroid ointment or cream that can be applied locally on the affected areas. These may be applied daily and can be tapered to lower frequency after few weeks. The itching and discomfort resolve with these medicines. Other treatment options are medicines like tacrolimus and pimecrolimus that help to modulate the overactive immune system. Sex hormones and ultraviolet light also have been used. In men, when the foreskin is involved, it may be removed by surgically cutting the foreskin. This is called circumcision and is done in the very severe and advanced cases that so not respond well to medical treatment. Surgery is not a good option for lichen sclerosus in women, as the condition may recur after it is surgically removed. However, surgery may be done for scar treatment if the scars cause distressing symptoms.
Tips to relieve discomfort
Lichen sclerosus causes discomfort. Some precautions can help to address the discomfort. Any irritants like soaps, bubble baths, tight clothing, long bike, and horseback rides should be avoided. Any injury or friction should be prevented as lesions of lichen sclerosus are more likely to occur if the skin has been previously damaged by any other skin conditions. Though diet does not influence the lesions, spices and flavorings are known to precipitate the symptoms. Although intercourse may be painful and uncomfortable, no restriction for intercourse is required in intercourse if there are no symptoms. A healthy diet rich in vitamins and essential nutrients may be helpful.
Women who have lichen sclerosus may have the vaginal opening narrowed by scarring. This can be dilated by using vaginal dilators or by vaginal surgery. Most women may be able to have comfortable sex after treatment.
Prevention
Lichen sclerosus cannot be prevented from occurring. However discomfort and further lesions can be prevented by observing some precautions. Irritants and injuries in the affected areas should be avoided. Physical activity such as biking, uncomfortable postures, and tight clothing should be avoided.
Outlook
Lichen sclerosus does not cause skin cancer though the scarred skin may be more prone to develop cancer. Any skin changes in the affected regions should be reported to the health care provider for review and examination. Depending upon the severity of the condition, the doctor may be seen once or twice in a year. It is certainly relieving to know that lichen sclerosus is not a cancer of skin. Regular examination and timely treatment can prevent discomfort.
