LICHEN SCLEROSUS

What is Lichen Sclerosus et Atrophicus?

Lichen sclerosus is a poorly recognised skin condition which mainly affects the vulval and perianal area. Although it is considered a condition which mainly affects mature women, there are women of all ages with LS. Men can have the disease and this affects the penis. Children can also suffer from LS and it can sometimes affect other areas of the body. It is not known what causes LS but it has been found that there is a connection between LS and thyroid disease, vitiligo and other auto-immune diseases.

It is not possible to get LS through sexual intercourse and it is not infectious.

What are the symptoms?

• chronic itching and soreness of the vulval area and pain
• splitting of the vulval skin, causing stinging and pain
• splitting and bleeding of the skin around the anal opening when passing bowel motions, causing pain and discomfort
• the skin becomes fragile and pale and white in appearance and there is an increased susceptibility to infection and thrush
• "shrinking" (atrophy) of the vulva area, change in shape and size of the area, sometimes causing urination difficulties and sexual problems
• pain and difficulties with sexual intercourse possibly leading to total sexual abstinence (enforced celibacy) for long periods of time
• narrowing of the vaginal opening
• fusion of the labia, clitoris and urethra
• in men the foreskin becomes "fused"
• there is a small risk, about 5%, of cancer

It is important to say that not everyone will experience all of the above symptoms.

Diagnosis

Diagnosis can be difficult. Many GPs are unable to recognise the symptoms and patients are sometimes misdiagnosed and treated for "thrush". Referral to a specialist is usually necessary and a skin biopsy is taken (under anaesthetic) to establish the presence of LS. It is recommended that if vulval itching has been persistent for up to a year, that the advice of a dermatologist or gynaecologist is sought. LS is sometimes only discovered when examination takes place for other disorders.

What about treatment?

There is no cure for lichen sclerosus.

Symptoms may be alleviated by use of steroid creams. Usually a three-month course of Dermovate (or similar) used twice daily is beneficial and then it can be used as maintenance treatment twice a week. In some cases, though, soreness can still persist with no apparent remedy. Although quite long remissions can be experienced, the symptoms often return.