Chronic lichen sclerosis is a skin disease that mostly affects the genital and anal regions, causing skin loss, bleaching, and scarring. Although it can afflict both sexes, following menopause it is more frequent in women. In addition to raising the risk of infections and skin cancer, lichen sclerosis can cause itching, pain, and discomfort. Although the precise origin of lichen sclerosis is unknown, immune system issues, hormone fluctuations, or hereditary factors may be involved. Although lichen sclerosis cannot be cured, therapy can lessen symptoms and avoid consequences. We'll talk about lichen sclerosis's causes, symptoms, diagnosis, course of therapy, and prevention in this blog article.
The exact cause of lichen sclerosis is not known, but it may involve several factors, such as:
Immune system problems: Lichen sclerosis may be an autoimmune disorder, in which the immune system mistakenly attacks the healthy skin cells and causes inflammation and damage. Some people with lichen sclerosis may also have other autoimmune diseases, such as thyroid disease, vitiligo, or alopecia areata.
Hormonal changes: Lichen sclerosis may be influenced by the levels of estrogen and testosterone in the body. Women with lichen sclerosis often have low estrogen levels, especially after menopause. Men with lichen sclerosis often have low testosterone levels, especially if they have been treated for prostate cancer.
Genetic factors: Lichen sclerosis may run in families, suggesting that some people may inherit a tendency to develop the condition. Some studies have found mutations in certain genes that may be associated with lichen sclerosis, such as the ERAP1 gene.
Lichen sclerosis can affect any part of the skin, but it usually affects the genital and anal areas. The symptoms of lichen sclerosis may vary from person to person, but they may include:
White or pale patches of thin, wrinkled, or shiny skin that may itch, burn, or hurt.
Redness, swelling, or bleeding of the affected skin, especially after scratching, rubbing, or having sex.
Fissures, cracks, or ulcers on the affected skin that may become infected or bleed.
Scarring or narrowing of the opening of the vagina, anus, or foreskin, which may make it difficult or painful to urinate, defecate, or have sex.
Increased risk of developing skin cancer, such as squamous cell carcinoma, on the affected skin.
Lichen sclerosis can be diagnosed by a doctor who specializes in skin conditions (dermatologist) or the reproductive system (gynecologist or urologist). The diagnosis may involve:
Medical history and physical examination: The doctor will ask about the symptoms, the duration and frequency of the symptoms, the personal and family history of skin or autoimmune diseases, and the medications or treatments used. The doctor will also examine the affected skin and look for signs of lichen sclerosis, such as white patches, thinning, or scarring.
Skin biopsy: The doctor may take a small sample of the affected skin and send it to a laboratory for microscopic analysis. A skin biopsy can confirm the diagnosis of lichen sclerosis and rule out other conditions that may cause similar symptoms, such as eczema, psoriasis, or skin cancer.
Blood tests: The doctor may order blood tests to check for the levels of hormones, such as estrogen and testosterone, or the presence of antibodies, such as thyroid antibodies, that may be related to lichen sclerosis.
There is no cure for lichen sclerosis, but treatment can help relieve the symptoms and prevent complications. The treatment of lichen sclerosis may include:
Medication: To lessen the skin's irritation, itching, and discomfort, the doctor may recommend oral or topical drugs. Corticosteroids, such as betamethasone or clobetasol, are the most often prescribed drugs for lichen sclerosis. These drugs are given topically to the afflicted area once or twice a day for a few weeks or months. Other drugs that may be used to treat lichen sclerosis include retinoids (like acitretin or isotretinoin) that are taken orally once a day for several months or years, and calcineurin inhibitors (like tacrolimus or pimecrolimus) that are applied topically to the affected skin once or twice a day for weeks or months.
Surgery: The doctor may recommend surgery to remove the affected skin or to widen the opening of the vagina, anus, or foreskin, if the scarring or narrowing is severe and causes problems with urination, defecation, or sex. Surgery may also be needed to remove any skin cancer that may develop on the affected skin.
Phototherapy: The doctor may suggest phototherapy, which involves exposing the affected skin to ultraviolet (UV) light, to improve the appearance and function of the skin. Phototherapy may be done in a clinic or at home, using a special lamp or device that emits UV light. Phototherapy may be combined with medications, such as psoralen, which makes the skin more sensitive to UV light.
Laser therapy: To enhance the look and feel of the skin, the physician may employ laser therapy, which entails vaporizing or destroying the afflicted skin with a light beam. Using either local or general anesthesia, laser treatment can be performed in a clinic or an operating room. Laser treatment can be used in conjunction with drugs, such corticosteroids, to lessen skin discomfort and inflammation.
There is no way to prevent lichen sclerosis, but some steps that may help reduce the risk or severity of the condition are:
Avoiding or treating any infections, such as yeast infections, that may irritate or trigger the symptoms of lichen sclerosis.
Avoiding or minimizing any trauma, friction, or rubbing of the affected skin, such as by wearing loose-fitting and breathable clothing and underwear, using lubricants during sex, and gently cleaning and drying the affected skin after bathing or urinating.
Applying moisturizers or emollients, such as petroleum jelly or lanolin, to the affected skin to keep it hydrated and protected.
Quitting or avoiding smoking, which can damage the skin and increase the risk of skin cancer.
Getting regular check-ups and screenings for any signs of skin cancer, such as changes in the size, shape, or color of the affected skin, or the appearance of new growths or sores.
