Lichen sclerosus is a chronic skin disorder that causes itchy white patches to appear on the skin. This disorder can make sufferers feel uncomfortable and can relapse.
Lichen sclerosus can occur anywhere on the body, but most often occurs in the genital and anal areas. However, this disease is not contagious and cannot be spread through sexual contact.
Lichen sclerosus is suspected as an autoimmune reaction on the skin. Everyone can suffer from this condition, including children. However, lichen sclerosus is more common in women, especially postmenopausal women.
Causes of Lichen Sclerosus
The cause of lichen sclerosus is not certain, but this condition is thought to be an autoimmune reaction. In this condition, the immune system instead attacks healthy skin tissue.
Lichen sclerosus is also thought to occur due to hormonal imbalances. In women, LS generally appears when entering menopause . This condition is thought to be related to decreased levels of the hormone estrogen during menopause.
Meanwhile, the risk of LS appearing in men who are not circumcised is higher when compared to men who are circumcised. This is presumably because the head of the penis in uncircumcised men often experiences irritation due to residual urine that remains on the foreskin after urinating.
Symptoms of Lichen Sclerosus
Lichen sclerosus (LS) is characterized by thickened or wrinkled white patches on the skin. These patches tend to leave scars in the form of scar tissue.
Based on its location, LS is divided into three types, namely:
Lichen sclerosus (LS) vulva
In women, lichen sclerosus usually appears on the hairless parts of the vulva (the outer female sex organ). This condition can spread to the groin, urethra, vaginal opening, or anus. However, lichen sclerosus vulva never spreads to the inner wall of the vagina.
Other symptoms that accompany the white spots on the LS vulva are:
- Painful
- redness
- Itching in the genitals which can be very severe
- Tears of skin that bleed on the spots
- Blisters or open sores that bleed (in severe cases)
If this condition is not treated, the vulva can gradually become scarred and harden or wrinkle. This condition can cause complications that cause discomfort.
Lichen sclerosus (LS) extra genital
Spots that arise on extra-genital LS have a dry, thin, and wrinkled surface. Usually, one or more spots appear on the inner thighs, buttocks, lower back, stomach, under the breasts, neck, shoulders, or armpits.
Other symptoms that may appear are skin texture like chicken skin (spotted), bruises, abrasions, or blisters that were not preceded by an injury.
Lichen sclerosus (LS) penis
In men, lichen sclerosus tends to develop on the foreskin or tip of the penis and rarely affects the skin around the anus. Early symptoms include:
- A flat patch that is reddish or lighter in color than the surrounding area of skin
- Plaques are round with a purplish-white color
- Appearance of small blood vessels or bleeding spots on the foreskin of the penis
Lichen sclerosus in men is sometimes accompanied by annoying itching. However, the above symptoms are generally not recognized. Usually, LS in men is realized when the area affected by LS turns white and hardens into scar tissue.
Along with the above symptoms, complications such as difficulty urinating or pain during an erection can also occur.
When to see a doctor
Immediately consult a doctor if you find white spots that match the symptoms of LS, especially if the wound has hardened, shriveled or causes other complaints such as pain when urinating or having sex.
Diagnosis of Lichen Sclerosus
In determining the diagnosis of LS, the doctor will first ask about the history and complaints related to the patient's symptoms. After that, the doctor will perform a physical examination of the patient's skin.
To confirm the diagnosis, the doctor will carry out a supporting examination through the skin biopsy method , which is taking samples of the patient's skin tissue for examination using a microscope. This examination will also be carried out if the doctor suspects spots or sores on the skin are caused by other conditions.
Lichen Sclerosus Treatment
Lichen sclerosus treatment aims to relieve itching, improve skin condition, and reduce the risk of scarring. Medical treatment is carried out by doctors in the form of administering corticosteroid creams or ointments .
For mild LS, an ointment containing 0.1% mometasone furoate can be used. Meanwhile, for more severe cases, the doctor will prescribe an ointment containing 0.05% clobetasol propionate .
Corticosteroid ointment should generally be used once a day for 3–6 months. The way to use it is to apply the medicine thinly on the white spots and rub it gently.
After the symptoms have subsided, the use of the ointment should not be stopped, but reduced to 1-2 times a week. This is necessary to prevent LS from recurring. Patients are also encouraged to routinely see a doctor.
For cases of severe lichen sclerosus that cannot be treated with the above drugs, the doctor will prescribe methotrexate, ciclosporin , or retinoids (such as isotretinoin). In addition, sufferers can also be given immunosuppressive drugs, such as tacrolimus or pimecrolimus.
Apart from taking medication from a doctor, people with LS also need to make independent efforts to control symptoms, including:
- Gently wash the area affected by LS, 1–2 times a day. Patients can use mild soap (does not contain fragrances or detergents).
- Avoid scratching or rubbing the area affected by LS even if it feels itchy.
- Avoid wearing clothes or underwear that are tight and easily damp.
- Avoid doing activities such as horse riding or riding a bicycle when experiencing LS in the genital area, because it can exacerbate symptoms.
- Dry the genital area after urinating to avoid irritation by urine.
- Use a cream that contains petroleum jelly on areas affected by LS to reduce dryness and itching on the skin, and to avoid direct contact between skin affected by LS with urine or feces.
In male patients, doctors will recommend circumcision as an alternative treatment if the condition of the foreskin is getting worse.
Lichen Sclerosus Complications
Although lichen sclerosus is a skin disorder that is classified as harmless, this condition can be serious and interfere with the sufferer's quality of life. If treated too late, LS can develop into scar tissue.
Some of the complications that may occur due to LS are:
- Narrowing of the vaginal opening which causes pain during intercourse
- Changes in the shape of the sex organs, especially in women, due to the formation of scar tissue
- Narrowing of the urinary opening in women which causes pain when urinating
- Narrowing of the urinary opening in men, which causes the stream of urine when urinating to be crooked or weak
- Attachment of the foreskin to the head of the penis ( phimosis ) which can cause spontaneous pain or pain with an erection
- Infections in the genital area or urinary tract, such as Candida albicans yeast infections, Staphylococcus aureus bacterial infections , and herpes simplex virus infections
- Decreased sexual function due to lack of self-confidence due to changes in the shape of the sex organs
- Constipation or bleeding during bowel movements in children
In addition to the complications above, LS is also thought to increase the risk of developing skin cancer called squamous cell carcinoma . This cancer can occur in the vulva ( vulvar cancer ), penis ( penile cancer ), or anus.
Prevention of Lichen Sclerosus
There is no specific way to prevent the appearance of lichen sclerosus, because this disease is related to a person's immune system and hormones. However, the exacerbation of this disease can be prevented with proper treatment.
In order to avoid the occurrence of recurrence of LS and its worsening in the future, patients should continue to monitor the signs and symptoms of LS. Generally, doctors will recommend people with LS to routinely carry out follow-up examinations every 6-12 months