Lichen Sclerosus

This leaflet has been written to help you understand more about lichen sclerosus. It tells you what it is, what causes it, what can be done about it and where you can find out more about the condition.

What is lichen sclerosus?
Lichen sclerosus is a chronic inflammatory skin condition which can affect any part of the skin. In women it most often affects the vulval skin which is the part of your body surrounding the vagina and the skin around the anus, the opening of your bottom. It can start in childhood or adulthood and affects girls or women of any age. The most common site of involvement is the vulval skin.

What causes lichen sclerosus?
The cause of lichen sclerosus is not fully understood. It is thought to be a type of autoimmune condition in which the person’s immune system becomes overactive in one area. Previous skin damage at a particular site on your skin may increase the likelihood of lichen sclerosus at that location. Lichen sclerosus is not contagious and cannot be spread through sexual intercourse.

What are the symptoms of lichen sclerosus?
Many patients have none, but the most common symptom of lichen sclerosus is itching. As a rule the patches on the general skin surface seldom itch much, but those in the genital area do, and can also become sore if the skin breaks down or cracks. In the genital area, a scar-like process can tighten the skin. This can interfere with urination and with sexual intercourse. Tightening of the skin around the anus can lead to problems with constipation

What does lichen sclerosus look like?
The skin has a white shiny appearance which can sometimes become raised and thickened. When there is also involvement of the anus it is described as a figure of eight pattern. Skin fragility may lead to easy bruising, blisters and erosions. There is a small risk of developing a skin cancer in affected areas in the vulva. These can look like lumps, ulcers or crusted areas. In areas away from the genital skin, lichen sclerosus can look like small ivory-coloured slightly raised areas, which can join up to form white patches. After a while the surface of the spots can look like white wrinkled tissue paper. The most common sites are the bends of the wrists, the upper trunk, around the breasts, the neck and armpits.

How will lichen sclerosus be diagnosed?
The diagnosis of lichen sclerosus can usually be made from the typical appearance of the condition. Sometimes a small skin sample may be taken and checked under the microscope to confirm the diagnosis, especially if there is an open sore or a thickened area of skin. This is known as a skin biopsy and requires a local anaesthetic injection and possibly stitches to close the wound, leading to a small scar.

Can lichen sclerosus be cured?
No treatment is likely to reverse the changes of lichen sclerosus completely, but the symptoms and signs of the disease can usually be well controlled with the application of creams to the affected skin.

How can lichen sclerosus be treated?

A variety of treatments are available for lichen sclerosus:

• Strong steroid ointments are used to stop the inflammation and also soften the affected skin. Please discuss the warning leaflet inside the pack with your gynaecologist as it might say not to use these ointments on genital skin. They will advise you how and when to apply the steroid ointments safely.
• Moisturisers help to soften and protect the skin.
• The fragile skin of lichen sclerosus may be more susceptible than normal skin to infection with thrush or bacteria, and may split or even bleed. Your doctor will treat these problems if they arise.
• Rarely, a small operation may be needed to divide adhesions if the skin sticks together.

What can I do?

• Avoid washing the vulval area with soap and instead use the emollient soap substitute/cream such as Cetraben/Hydromol that you have been prescribed.
• Carefully dry yourself after passing urine to reduce the contact of urine with your skin.
• Using your moisturiser Cetraben/Hydromol on your vulval skin several times a day as a barrier cream cannot protect your skin from exposure to urine.
• If sexual intercourse is painful because of tightening at the entrance to the vagina, the use of lubricants and on occasions, vaginal dilators, will help.
• Keep an eye on your skin. Cancer of the vulva may be more likely to occur in lichen sclerosus that has been present for many years than in normal skin. Lifelong regular self-examination by feeling the skin as you apply your creams rather than trying to look at the vulva is very important for all females who have or have had genital lichen sclerosus. If any skin change develops which does not respond to steroid creams, in particular any skin thickening, soreness or ulceration lasting more than two weeks, you need to tell your doctor without delay. You may need a biopsy to test for skin cancer.

You can I get more information about Lichen Sclerosus from:-
https://www.lichensclerosusguide.org.uk/

Treatment (to be completed by your gynaecologist)
Moisturiser/soap substitute ……………………………………………………………………………………………………………………………..
Steroid preparation …………………………………………………………………………………………………………………………………………..

• Use one fingertip unit once a day, in the morning, for 2 weeks. We will demonstrate this in clinic.
• After using for 2 weeks, use on alternate days for a further 2 weeks.
• If your symptoms improve then reduce to using twice a week until you are seen for review.
• If your symptoms flare up, go back to using every morning again for a week or two before dropping back down to twice a week.

Should you have any concerns once you have returned home, please do not hesitate to contact the Oscopy administration team on 01274 364542 and they will direct you to the appropriate health care professional.