Lichen Sclerosus: Symptoms, Causes, Treatment
الحزاز المتصلب
Lichen sclerosus is chronic skin inflammation causing pale patches and fragile or altered skin, particularly around the genitals. It differs from vitiligo and needs diagnosis, treatment and follow-up to control symptoms and limit scarring.
What is Lichen Sclerosus?
It affects women, men and children and sometimes non-genital skin. It is not sexually transmitted or evidence of poor hygiene. Vitiligo mainly changes color without the tightening, cracking and scarring that can occur in lichen sclerosus.
Related reading: Drug eruptions.
Symptoms
Features include itching or burning, thin or crinkled white patches, fissures, minor bleeding and painful sex. Skin or foreskin may tighten, or the urine stream may change. Some people have little noticeable itching.
Causes
The exact cause is unknown; immune, genetic and local factors may contribute. Autoimmune conditions may coexist, and friction or irritation can worsen symptoms. The condition does not indicate infection acquired from a partner.
Risk factors
The condition can occur at any age and is more common in postmenopausal women. An autoimmune history is relevant in some patients. Risk factors or white patches alone do not establish diagnosis or justify assuming a sexually transmitted infection.
Diagnosis
A specialist assesses skin location, texture and changes. Biopsy may be needed for uncertainty, a thickened area or persistent sore, or poor treatment response. Color change alone cannot establish the diagnosis.
Treatment
Prescribed potent topical steroid ointment is a main treatment, with a clear regimen and follow-up, alongside moisturizers and skin protection. The clinician specifies site, amount and maintenance. Narrowing or treatment-resistant disease may need specialist intervention; surgery and alternative medicines are not suitable for everyone.
Complications
Scarring, narrowing, pain and effects on relationships or quality of life may occur. There is a small increase in some genital skin cancers, but most cases do not become cancer. Surveillance helps identify concerning changes early.
Prevention
Onset cannot reliably be prevented. Gentle washing, avoiding scented soap, friction and scratching, and reducing persistent urine contact can help. Continue follow-up despite improved itching; avoid irritant remedies or repeatedly treating patches as presumed fungal infection.
When to see a doctor
Seek review for persistent genital patches, pain or fissures. A new lump, non-healing ulcer or focal change despite treatment needs prompt examination. Inability to pass urine requires urgent care.