Lichen Sclerosus
Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, wrinkled, and can cause itching and pain. LS usually occurs in postmenopausal women and prepubertal young girls, however it can be seen at any age. In women it most commonly occurs near the clitoris, on the labia (the inner and outer genital lips), and around the anus.
Prevalence - It is not clear exactly how many people have LS. Estimates for LS involving the female genitals vary from 1 in 30 elderly women seen in general gynecology offices to 1 in 300 to 1000 patients referred to dermatologists.
Causes - The cause of lichen sclerosus (LS) is not clear; healthcare providers suspect that a number of factors may be involved.
Genetics - LS seems to be more common in some families. People who are genetically predisposed to LS may develop symptoms after experiencing trauma, injury, or sexual abuse.
Disorders of the immune system - LS is probably an autoimmune disease. People with LS are at greater risk of developing autoimmune disorders, which develop when the body's immune system mistakenly attacks and injures normal body tissues. These may include some types of thyroid disease, anemia, diabetes, alopecia areata, and vitiligo.
Infections - Researchers have tried to identify an infectious organism as a cause of LS, but no clear data have shown that there is an infectious source. LS is not contagious.
Features of genital LS in women — Some women with LS feel dull, painful discomfort in the vulva, while other women with LS have no symptoms. The most common symptoms include:
Untreated, LS may progress and change the appearance of the genital area as the outer and inner lips of the vulva fuse (stick together) and bury the clitoris. The opening of the vagina can narrow, and cracks, fissures, and thickened, scarred skin in the genital and anal area can make sexual intercourse or pelvicl examination painful. LS does not affect the inner reproductive organs, such as the vagina and uterus.
Increased cancer risk? - Women with LS affecting the vulva are at a slightly increased risk for developing squamous cell skin cancer. However, it is not clear if women who are treated for LS are at the same risk as women who are not treated.
Diagnosing LS early, treating it effectively, and biopsying any abnormal areas may help to reduce the risk of developing or missing a diagnosis of skin cancer. Regular exams of the skin of the vulva is recommended, and women should check for new lesions or sores that do not heal. A biopsy should be performed if there are areas that do not improve with treatment.
Painful sexual intercourse - Lichen sclerosus often leads to constriction of the vaginal opening making sexual intercourse/penetration uncomfortable.treatment to suppress any active disease. Once the disease is controlled, some clinicians may recommend an estrogen cream to help to soften the skin around the vaginal opening. Devices called vaginal dilators, which patients can use at home, also may be used to slowly stretch the skin. These dilators can be ordered from vaginismus.com with instruction booklet.
Treatment - The goals of treatment of lichen sclerosus are to relieve bothersome symptoms and to prevent the condition from worsening.
All patients with LS, even those without noticeable symptoms, need to use medication on a regular and ongoing basis. Patients also should see a healthcare provider for reevaluation of the disease several times per year, until well controlled, then once or twice yearly.
Patients who are diagnosed with LS should discuss with their gynecologist:
●The lifelong and potentially progressive nature of LS; appropriate treatment can stop the condition from worsening
●Ways to manage the condition
●The slightly increased risk of vulvar cancer and the need for ongoing monitoring
●How to keep the genital area healthy and avoid scratching
●Persistent pain with intercourse
The good news - for patients who have been diagnosed with LS is that treatments such as high potency topical steroid ointments are very effective. In one study of women and girls who were treated, 96% of patients showed improvement in their LS symptoms, and 66% of patients had relief of all LS symptoms. Thus, early treatment of LS with topical steroids can prevent scarring. Follow-up and maintenance treatment is important throughout your lifetime.
Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, wrinkled, and can cause itching and pain. LS usually occurs in postmenopausal women and prepubertal young girls, however it can be seen at any age. In women it most commonly occurs near the clitoris, on the labia (the inner and outer genital lips), and around the anus.
Prevalence - It is not clear exactly how many people have LS. Estimates for LS involving the female genitals vary from 1 in 30 elderly women seen in general gynecology offices to 1 in 300 to 1000 patients referred to dermatologists.
Causes - The cause of lichen sclerosus (LS) is not clear; healthcare providers suspect that a number of factors may be involved.
Genetics - LS seems to be more common in some families. People who are genetically predisposed to LS may develop symptoms after experiencing trauma, injury, or sexual abuse.
Disorders of the immune system - LS is probably an autoimmune disease. People with LS are at greater risk of developing autoimmune disorders, which develop when the body's immune system mistakenly attacks and injures normal body tissues. These may include some types of thyroid disease, anemia, diabetes, alopecia areata, and vitiligo.
Infections - Researchers have tried to identify an infectious organism as a cause of LS, but no clear data have shown that there is an infectious source. LS is not contagious.
Features of genital LS in women — Some women with LS feel dull, painful discomfort in the vulva, while other women with LS have no symptoms. The most common symptoms include:
- Vulvar itching – The most common symptom of LS is itching. It may interfere with sleep.
- Anal itching, fissures, bleeding, and pain.
- Painful sexual intercourse (dyspareunia) – This can occur as a result of repeated cracking of the skin (fissuring) or from narrowing of the vaginal opening due to scarring.
- Labial skin can be thin, white and wrinkled, often extending down and around the anus in a figure of 8 configuration. Purple-colored areas of bruising may be seen. Cracks (fissures) may form in the skin in the area around the anus, the labia, and the clitoris. Relatively minor rubbing or sex may lead to bleeding due to the fragility of the involved skin.
Untreated, LS may progress and change the appearance of the genital area as the outer and inner lips of the vulva fuse (stick together) and bury the clitoris. The opening of the vagina can narrow, and cracks, fissures, and thickened, scarred skin in the genital and anal area can make sexual intercourse or pelvicl examination painful. LS does not affect the inner reproductive organs, such as the vagina and uterus.
Increased cancer risk? - Women with LS affecting the vulva are at a slightly increased risk for developing squamous cell skin cancer. However, it is not clear if women who are treated for LS are at the same risk as women who are not treated.
Diagnosing LS early, treating it effectively, and biopsying any abnormal areas may help to reduce the risk of developing or missing a diagnosis of skin cancer. Regular exams of the skin of the vulva is recommended, and women should check for new lesions or sores that do not heal. A biopsy should be performed if there are areas that do not improve with treatment.
Painful sexual intercourse - Lichen sclerosus often leads to constriction of the vaginal opening making sexual intercourse/penetration uncomfortable.treatment to suppress any active disease. Once the disease is controlled, some clinicians may recommend an estrogen cream to help to soften the skin around the vaginal opening. Devices called vaginal dilators, which patients can use at home, also may be used to slowly stretch the skin. These dilators can be ordered from vaginismus.com with instruction booklet.
Treatment - The goals of treatment of lichen sclerosus are to relieve bothersome symptoms and to prevent the condition from worsening.
All patients with LS, even those without noticeable symptoms, need to use medication on a regular and ongoing basis. Patients also should see a healthcare provider for reevaluation of the disease several times per year, until well controlled, then once or twice yearly.
Patients who are diagnosed with LS should discuss with their gynecologist:
●The lifelong and potentially progressive nature of LS; appropriate treatment can stop the condition from worsening
●Ways to manage the condition
●The slightly increased risk of vulvar cancer and the need for ongoing monitoring
●How to keep the genital area healthy and avoid scratching
●Persistent pain with intercourse
The good news - for patients who have been diagnosed with LS is that treatments such as high potency topical steroid ointments are very effective. In one study of women and girls who were treated, 96% of patients showed improvement in their LS symptoms, and 66% of patients had relief of all LS symptoms. Thus, early treatment of LS with topical steroids can prevent scarring. Follow-up and maintenance treatment is important throughout your lifetime.
|
Susan Malley, MD
Pediatric, Adolescent & Adult Gynecology |
Summit Health
3030 Westchester Avenue Purchase, NY 914.848.8800 |
Summit Health
1 Theall Road Rye, NY 914.848.8800 |
"Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow." MA Radmacher