Lichen sclerosus

For both men and women, other areas of the body are also occasionally affected, including the upper arms, back, breasts and shoulders.

Lichen sclerosus

Lichen sclerosus is a long-term skin condition that mainly affects the skin of the genitals. It usually causes itching and white patches. It’s most common in women who’ve been through menopause but men and children can be affected. There’s currently no cure, but symptoms can normally be controlled with medication.

Causes of lichen sclerosus

It’s not clear what causes lichen sclerosus. It’s thought to be related to overactivity of the immune system.

It’s not an infection and can’t be spread to your partner or other people.

Lichen sclerosus can be uncomfortable and distressing, but it’s usually possible to control the symptoms with simple treatments.

Symptoms in women and girls

In women and girls, lichen sclerosus tends to affect the vulva (the skin around the entrance to the vagina) and the skin around the anus (back passage).

• small white areas that may increase in size and join together to form larger patches – these patches may become cracked and sore
• itchiness , which tends to be worse at night and may disturb sleep
• the skin becoming fragile and thin, or wrinkly and thickened
• red or purple blood blisters
• pain when having sex and/or passing stools

Without treatment, the vulva may gradually scar and shrink. This can make the entrance to the vagina narrower, which makes sex even more difficult and painful.

Symptoms in men and boys

In men and boys, lichen sclerosus tends to develop on the foreskin and end of the penis. The skin around the anus is rarely affected.

Symptoms can include:

• sore or sometimes itchy white patches on the penis, particularly around the tip, but sometimes on the shaft
• the skin at the tip of the penis becoming firm and white
• difficulty pulling the foreskin back, which can make peeing difficult and lead to painful erections if left untreated

For both men and women, other areas of the body are also occasionally affected, including the upper arms, back, breasts and shoulders.

It’s often easy for a doctor to diagnose lichen sclerosus by asking about your symptoms and examining your skin.

In some cases, a procedure known as a biopsy , where a skin sample is taken for analysis, may be needed to help make the diagnosis.

How long lichen sclerosus lasts

For most people, lichen sclerosus is a long-term condition that lasts many years and may flare up and down over time.

There’s currently no cure, but symptoms can normally be controlled with steroid medication applied directly to the affected skin.

Occasionally, lichen sclerosus goes away on its own and doesn’t come back. This usually only occurs when children with the condition reach puberty.

Treatments for lichen sclerosus

The main treatment for lichen sclerosus is steroid ointment or cream , which helps to control symptoms. It should be applied regularly, but quite sparingly, to the affected areas of skin. Your doctor will advise you on how much to use, how often and for how long.

Symptoms tend to ease after a few weeks of treatment, but it may be a few months before your symptoms are fully under control.

After three or four months of regular treatment, you might only need to use the cream once or twice a week, or sometimes even less, to stop symptoms returning.

Steroid creams and ointments are very effective in most cases. However, if they don’t help, other treatments may be suggested by a specialist.

In a few cases, surgery may be needed to treat problems caused by lichen sclerosus. Your doctor will advise if they think surgery is necessary for you.

Self-help for lichen sclerosus

The following measures, along with the above treatments, can often help keep your symptoms under control:

• avoid washing with soap or bubble bath – use plain water or an emollient wash instead, such as aqueous cream (but avoid leaving aqueous cream on the skin after washing)
• avoid rubbing or scratching the area
• gently dab your genitals dry after peeing, to stop your urine irritating the skin
• apply a barrier cream or ointment, such as petroleum jelly, to affected areas after washing and before and after urinating
• avoid wearing tight or restrictive clothes and wear underwear made from natural materials such as cotton or silk – women may find it helps to wear stockings rather than tights

For women who find sex painful, it may help to use a lubricant or a vaginal dilator.

Cancer risk

Women with lichen sclerosus have a slightly increased risk of developing cancer of the vulva .

It’s therefore important to check your vulva regularly for any symptoms of vulval cancer , as the earlier any cancer is detected, the easier it is to treat.

• thickening of the skin
• any lumps, blisters or sores

Use a mirror and feel the area with your fingers.

Men with lichen sclerosus may have a slightly higher risk of developing cancer of the penis , so it’s also important for them to keep an eye out for any unusual changes, such as growths or sores.

If you have lichen sclerosus, you should report any changes like these to your doctor.

More useful links

The information on this page has been adapted from original content from the NHS website.

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Lichen sclerosus

Lichen sclerosus affects people of all ages, including children. But it’s much more common in women over 50.

People with white, brown or black skin can get lichen sclerosus.

It causes patches on the skin that are usually:

• itchy
• white
• smooth or crinkled
• easily damaged – they may bleed or hurt if rubbed or scratched

The patches can appear anywhere, but most often are on the:

• area around the opening to the vagina (vulva) and anus
• foreskin and end of the penis

Lichen sclerosus patch on the vulva.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/152743/view

A white patch (lichen sclerosus) on the foreskin.
A large white patch around the anus.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/429743/view

Things you can do to help with lichen sclerosus

To help stop your skin becoming irritated or damaged:

Don’t

Non-urgent advice: See a GP if you have:

• an itchy white patch on your genitals or skin
• been diagnosed with lichen sclerosus and treatment is not helping
• been diagnosed with lichen sclerosus and have pain when going to the toilet or having sex

A GP may refer you to a specialist for tests and treatment.

Treatment for lichen sclerosus

Lichen sclerosus cannot be cured, but prescription steroid cream usually helps relieve the symptoms.

Unless your doctor tells you otherwise, follow the directions on the patient information leaflet that comes with the medicine.

You may need to use the cream regularly for a few months to get your symptoms under control.

If your symptoms keep coming back, you may have to keep using it every now and again.

You can get more cream from a GP if you need it.

Problems caused by lichen sclerosus

Although treatment can help, skin affected by lichen sclerosus can sometimes become scarred and tight over time.

The vulva may shrink, with the clitoris and small inner lips (labia minora) around the opening of the vagina often affected.

The scarring and tightness can cause discomfort when peeing, pooing and during sex. Having an erection can be painful.

If lichen sclerosus is severe, you might need a small operation, such as surgery to widen your vagina or remove your foreskin (circumcision).

Important: Cancer and lichen sclerosus

Lichen sclerosus increases your risk of getting cancer on your vulva, penis or anus.

The risk is low, but it’s a good idea to check yourself regularly and see a GP if you’re worried.

Symptoms to look for include a lump, a change in skin texture, such as thickening, or an ulcer that does not go away.

Causes of lichen sclerosus

The cause of lichen sclerosus is unknown.

It might be caused by your immune system, the body’s defence against infection, mistakenly attacking and damaging your skin.

Lichen sclerosus is not:

• contagious – you cannot spread it to other people
• caused by poor personal hygiene

Page last reviewed: 08 October 2021
Next review due: 08 October 2024

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