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Sclerotic, vulvar, glans and prepuce sclerosis

Lichen sclerosus or scleroatrophic lichen is a disease that causes sclerotic fibrosis of total thickness and the mucosa becomes:

  • Irregular,
  • White,
  • Thinner than normal,
  • Less elastic

This disease can affect the skin anywhere in the body, but it often occurs:

  • In the mucosa of the vulva,
  • In the prepuce of the penis,
  • Around the anus.

Rarely does oral lichen sclerosus affect the mouth. 
It may develop after an injury to the affected area.


You can follow or coexist with another skin disease such as:


Who can suffer from lichen sclerosus?

  • Women (often after menopause);
  • Men;
  • Children (rare).


Causes and risk factors for lcleratrophic lichen

The causes of lichen sclerosus (LE) are unclear. 
The main factors can be:

  • Genetic factors: LE seems to be more common in some families. People genetically predisposed to LE may develop symptoms after suffering from trauma , injury , or sexual abuse.
  • Immune system disorders: Lichen sclerosus occurs when the immune system mistakenly attacks and destroys healthy tissues of the body. Doctors believe that the main cause of lichen sclerosus is a combination of hormonal changes and an excessive response of the immune system.
  • Infections: researchers have tried to identify the microorganism responsible for the LE, but no data has shown that clear lichen sclerosus is contagious.

Lichen sclerosus is not contagious, so there can be no transmission by contact or sexual intercourse.


Symptoms of lichen sclerosus

Vulvar sclerosis lyric

In women, lichen sclerosus manifests itself with:

  • Relining of the vaginal and vulvar mucosa,
  • White patches on the vulva.

May cause :

Sometimes bruises  and ulcers appear after scrubbing or spontaneously because the thin skin is:

  • More delicate,
  • Less elastic

The intercourse can:

  • Being very annoying,
  • Causes cracking of the skin (cracks).

Can be located in a small area or wrap:

  • The perineum,
  • The clitoris,
  • The big, small lips.

If lichen is not treated, severe anatomical changes of the external female genital organs may occur :

  • Sometimes the clitoris disappears,
  • Lips may shrink,
  • The vaginal opening tightens.

Lichen sclerosus does not occur inside the vagina.

Sclerotic lichen may increase the risk of vulvar cancer that presents as a slowly growing lump or a non-healing wound. 
It can affect up to 5% of patients with vulvar lichen sclerosus. 
In some cases lichen sclerosus causes the differentiated vulvar intraepithelial tumor.

Symptoms of perianal sclerosis lichen

The skin around the anus can be hit by lichen sclerosus that can cause:

  • Discomfort,
  • Bleeding during bowel movements.

This disease can aggravate constipation , especially in children.


Symptoms of lichen sclerosus on the foreskin and glans

  • In men, usually lichen sclerosus, it involves the foreskin that becomes hard and white (also known as balanitis xeroótica obliterante).
  • The urethral meatus (the final part of the urethra) may shrink and may make it difficult to pass urine, causing a fine flow. 
    Sometimes it is necessary to dilate the passage with a special operation.
  • The sexual life can be painful.
  • It may become difficult to retract the foreskin ( phimosis ). 
    white ring may form that blocks the slip of the foreskin . 
    In this case your doctor may recommend circumcision . However, some doctors believe that surgery could further traumatize the area. This could cause the disease to worsen.
  • The loss of elasticity of the tissue causes cracks (small cuts). The mucosa can not extend, so it breaks.
  • If lichen sclerosus affects the glans , white spots appear, rough and thick.
  • Male genital lichen sclerosus is rare in circumcised men at birth.
  • Rarely penile lichen sclerosus may predispose to penile intraepithelial neoplasia and cancer.
  • We therefore recommend examinations and long-term analyzes.


Lichen sclerosus underarm

Other Skin Areas
Lichen sclerosus may also affect non-genital areas. 
Six percent of men and women affected by lichen sclerosus in other areas do not have genital involvement. 
We can observe one or more white spots:

  • In the inner thigh,
  • Buttocks,
  • Beneath the breasts,
  • In the neck,
  • On the shoulders,
  • In the armpits.

They often look like cigarette paper with a surface:

  • Rugosa,
  • Soft,
  • Thick to the touch.

Less often stains:

  • They are scaly,
  • They present bruises,
  • They have bubbles
  • They are ulcerated.

In these sites, usually lichen sclerosus is not pruritic and does not appear to predispose to cancer.


Who has lichen sclerosus can have sex?

Women affected by severe lichen sclerosus on the genitals may not be able to have sexual intercourse. 
The disease can cause scars that shrink the vagina. In addition, intercourse can:

  • Hurt,
  • Causing bleeding from blemishes.

However, treatment with creams or ointments may help. 
In women with severe scarring on the external genitalia, surgery may be necessary, but only after having treated lichen sclerosus with medications.


Diagnosis of lichen sclerosus

The male patient who arrives in the office with this disease says he has:

  • Pain during sexual intercourse, because the foreskin has difficulty in flowing,
  • A change in the urine stream.

Generally, he has tried to treat lichen with antifungal or circumcision.

The woman with this disorder goes to the doctor and refers to pain and especially vulvar or vaginal dryness.

The doctor can identify lichen sclerosus immediately, but usually collects a little skin (biopsy) to examine it under a microscope. This allows the doctor to confirm the diagnosis.

Exclude other diseases: analysis may be made to rule out other diseases that may cause lichen sclerosus- like symptoms , for example:

1. Lichen planus is a skin disease that can also cause itching and melting of the genital skin. 
2. Low levels of estrogen : rarely the lack of the estrogen hormone can cause the fusion of the genital skin, but often is the cause of pain during intercourse . 
3. Vitiligo is a disease that can cause white patches on the skin similar to lichen sclerosus. 
4. Bullous pemphigoid is a skin disease that causes blisters and scarring of the vulva, is extremely rare. 
5. Hemorrhoids  and anal fissures that can cause cracks in the skin of the anus.


Which specialist treats lichen sclerosus?

  • Dermatologist – venereologist (skin specialist);
  • Gynecologist (specialist in the female reproductive system);
  • Andrologist (male reproductive system specialist);
  • Urologist (urinary or urogenital tract specialist);
  • Primary care physician.


Treatment for lichen sclerosus and medications

If there is no involvement of the genital area, therapy for scleroatrophic lichen may not be necessary, especially if the patient has no symptoms. 
Those who have this disease in the genital area, anus or in other parts of the body should carry out the treatment. 
Treatment helps to:

  • Reduce itching,
  • Improve the appearance of the skin,
  • Shorten the scar even further.

Usually corticosteroid creams or ointments are prescribed for lichen sclerosus. 
Initially, a cortisone ointment or lotions should be applied daily on the affected skin, for example Quadriderm (gentamicin and betamethasone). 
After several weeks, your doctor may recommend using these medicines only twice a week to prevent recurrences. 
Your doctor checks for side effects such as thinning of the skin caused by prolonged use of  topical corticosteroids .

Other treatment options
If cortisone treatment does not work or if it takes months for this treatment, your doctor may prescribe:

1. Immunomodulatory drugs, such as Protopic ( tacrolimus ) and Elidel (pimecrolimus). 
2. Treatment with ultraviolet light for non-genital areas. 
3. Topical sex hormone based creams to treat lichen sclerosus, for example, testosterone. 
4. Vitamin E ointment to reduce genital dryness.

Intralesional Infiltrations for Severe Lichen Sclerosus

These infiltrations are done directly on the affected areas. 
The dermatologist applies anesthetic creams prior to treatment. 
Micro infiltrations aim at:

  • Stop inflammation ,
  • Stimulate the production of new and healthy skin.

For men with scleroatrophic lichen on the prepuce, removal of the foreskin ( circumcision ) is frequent in severe cases and only resistant to other treatments. 
Generally, surgery on the genital or anal area is not recommended for women with lichen sclerosus because the results are weak and the disease may return.


Natural cure for lichen sclerosus

Among the natural remedies, some people have had some benefits by applying zinc oxide cream or aloe vera gel in the affected areas. 
In the case of vulvar lichen sclerosus, wheat germ oil compresses are useful. 
This oil is a natural emollient: it softens and moisturizes the skin without causing irritation.

Diet and feeding for lichen sclerosus

Feeding is important because it can affect:

  • The immune system,
  • The health of the skin and the mucosa.

Because it can coexist with candida , according to conventional medicine probiotics and yogurt can help maintain the balance of the intestinal flora that is essential to prevent the proliferation of certain fungi and bacteria.

According to natural medicine it is necessary to avoid or reduce :

  • Cereals, especially those with gluten (pasta, bread, pizza),
  • Milk and dairy products,
  • Sweets,
  • Stored, Processed and Industrialized Foods,
  • Spices
  • Fast food food,
  • Fried foods,
  • Cold.

A healthy diet includes:

  • Fruits, best of the season,
  • Vegetables, especially green leaves,
  • Nuts (hazelnuts, walnuts, almonds, etc.),
  • Potatoes,
  • Legumes,
  • Fish, eggs and meat (according to the diet of the blood group and the Paleo diet).


How long does it last? The prognosis of the patient with lichen sclerosus

The good news for patients diagnosed with lichen sclerosus (LS) is that the treatments currently available make it possible to treat the disease. 
In a study in which women and adolescents were treated, 96% of the patients showed an improvement in LE symptoms and 66% of the patients had relief of all symptoms of lichen sclerosus. 
Early treatment of LE with topical steroid creams can prevent scars. 
Medical checks are important throughout life. 
Scleroatrophic lichen:

  • It is a chronic disease
  • You have to go.