Lichen sclerosus is a condition that can cause great discomfort and cause limitations in leading a normal life. It is important to recognize the symptoms to start treatment early.
Lichen sclerosus is a chronic skin disease. It almost always affects the genital and anal area of the body, but it can also appear in the upper arms, breasts and, in general, in the upper body.
This disease can appear at any age and in both sexes, although it is more common in women older than 50 years. The main characteristic of lichen sclerosus is the appearance of patches on the skin that become colorless and thin.
There is no exact data in this regard; therefore, the number of cases of lichen sclerosus is believed to range from 1 in 300 women to 1 in 1,000. With proper treatment, this disease can be controlled.
Lichen sclerosus symptoms
The most characteristic symptom of lichen sclerosus is the presence of patches on the skin. They have a thin and wrinkled appearance, and are white in color. They usually appear on the external genitalia or around the anus.
In women it can appear on the oral mucosa, tongue, arms or legs. It may be accompanied by one or more of the following manifestations:
Itching and burning.
Recurring pain before, during or after intercourse. It is called dyspareunia.
Dryness in the vaginal mucosa.
Irritation in the area.
Fissures or cracks in the affected skin.
Deterioration or shrinkage of the labia minora.
The most common is that in the case of men the affected area is the penis. In addition to the characteristic spots, which can be white-brownish, there may be these symptoms:
Irritation in the area.
Itching and micro-injuries.
Pain or burning in the penis.
Pain during sexual intercourse.
Urethritis or urethral stricture.
In severe cases, the lesions bleed, even with a slight scratch. There may also be tearing of the skin and blistering. The resulting scars sometimes make it painful to urinate or defecate. They can also make clothing and physical activity uncomfortable.
What Causes Lichen Sclerosus?
Although not entirely clear, the available data indicate that lichen sclerosus is caused by a combination of immune system dysfunction and genetic factors. Most experts classify it as an autoimmune disease.
An autoimmune condition is one in which the body’s natural defenses attack healthy tissue. The reasons why this occurs are unknown.
On the other hand, a genetic predisposition has been detected in those affected; In other words, they are carriers of the disease gene, but this only becomes present under certain circumstances. Lichen sclerosus is estimated to be an autoimmune reaction in individuals who are genetically predisposed.
The most frequent complications of lichen sclerosus have to do with the formation of bruises, blisters or even ulcerated wounds; that is, open wounds. These can become infected, which is difficult to avoid because most of the time they are on the genitals or anus.
Sometimes the skin cracks and bleeds, while severe pain is experienced. Scars can lead to the vulva to tighten and shrink, to the point that sexual intercourse becomes very painful and sometimes impossible.
There is a moderate risk that lichen sclerosus will develop into a form of skin cancer called “squamous cell carcinoma.” In these cases, the lesions look like red bumps, ulcers, or scabbed areas.
How is it diagnosed?
Often a physical examination of the affected area is sufficient to make the diagnosis. However, the usual is that a skin biopsy is also ordered to corroborate this. In these cases, a tissue sample is taken and examined under a microscope.
Other tests may also be done to rule out some associated health conditions. A flat liquor, estrogen level, or vitiligo test may be done. Also, other tests may be necessary to detect, for example, an autoimmune thyroid.
It is very rare for lichen sclerosus to get better on its own. Consequently, the usual thing is that a treatment is advanced, in particular in the cases in which the disease is advanced. The goal is to relieve symptoms and prevent the condition from getting worse.
Treatment is usually started with an ointment that contains steroids. Most people find relief from their symptoms with this measure. You can also choose one of the following treatments:
Steroid injections. It is indicated when the ointment is not effective.
Tricyclic antidepressants. They are used in low doses to reduce pain in the vulva.
Other drugs. More aggressive medications may be used if none of the measures have been effective.
Ultraviolet light. It is used as a last option, in case the other measures do not work.
All of these treatments are usually ordered long term. Circumcision, or removal of the foreskin, is a very effective measure when lichen sclerosus affects males. If the disease is not treated, it tends to get worse over time.
Recommendations at home
There are lifestyles and home remedies that can also help relieve symptoms and prevent the disease from progressing. Most commonly, measures such as the following are suggested:
Apply mild lubricant to the affected area.
Wash the area every day, gently, and pat it dry.
A sitz bath, an ice pack, or a cold pack may be effective for pain.
Do not wear tight pants or pantyhose.
Wear cotton underwear.
Use neutral soaps, without applying them directly to the affected area.
Do not use douches or sprays.
Take an antihistamine at bedtime to avoid itching at night.
Lichen sclerosus has no cure
Currently, there is no cure for lichen sclerosus. It is best to consult the doctor promptly, if symptoms appear. Early diagnosis and treatment help avoid complications and make the disease more manageable.
Sometimes this condition does not cause symptoms. Although the risk of developing cancer is moderate, it is still essential to have regular check-ups to detect any abnormalities that may arise.