Lichen Sclerosus

Lichen sclerosus is a skin disorder causing itching, pain and bleeding – usually in the genital area.

It can happen at any age but often affects young girls before they go into puberty. It usually occurs on the vulva (the area around the opening of the vagina) in women, but can occur on the butt, upper body, breasts and upper arms of women and on the head of the penis of men. Lichen sclerosus is not contagious.

The cause of lichen sclerosus is not known. Sometimes there is a family history although how it is passed is unknown. There is some thought that a weak immune system, bacteria, or local irritation (often from increased warmth, moisture, tight clothing or trauma) may also cause lichen sclerosus. Lastly it is suggested that hormone levels may play a part. The cause usually does not effect the treatment.

The main symptom of lichen sclerosus are small breaks or “cuts” in the skin that are painful. There may be large patches of thin whitish appearing skin that may look “crinkly”. Because the skin is thin, it tears easily, causing pain and bleeding. Bleeding under the skin can cause bright red or purple discoloration or “blood blisters”. Sometimes girls will have a bloody discharge in their underwear usually from the small tears in the skin in there vulva.

Girls with these symptoms feel better if they wear loose-fitting clothing, avoid bike riding, horse-back riding and other activities that may put pressure on the vaginal area.

Persistent untreated lichen sclerosus can cause scarring. The result may be that the inner lips of the vulva shrink and disappear, the clitoris becomes covered with scar tissue and/or the opening of the vagina may narrow.

Prescription medications are required to treat vulvar lichen sclerosus. The first treatment of choice is a very high potency steroid cream or ointment (Clobetasol). After initial short term treatment (2-4 weeks) with the very high potency steroids, the potency of the steroid cream or ointment will be reduced to medium or low potency (Triamcinalone or Hydrocortisone). The potency of the steroid used and how often it needs to be used will depend on how the skin responds. Your healthcare provider will help to determine appropriate duration of treatment.

Lichen sclerosus may disappear permanently at puberty, but some girls require life-long treatment. Scarring and changes in skin color may remain even after the symptoms have disappeared.