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Lichen sclerosus (LS) is a chronic skin disorder that usually affects the skin around your vulva and anus. It causes the skin to appear white, thick and wrinkly. Learn more about this condition, the symptoms, causes and treatment options.

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What is lichen sclerosus?

Lichen sclerosus (LS) is a chronic skin disorder that usually affects the skin around your vulva and anus. This lifelong condition is more common in women, particularly postmenopausal women. It is not contagious and can’t be spread through sex. Lichen sclerosus and lichen planus (LP) can occur together.

Symptoms

Symptoms can range from mild to severe. People with a mild condition may not have any symptoms. LS can be in one small area or it can affect many areas, including the skin between your vagina and anus (perineum), inner lips and clitoral hood.

Common symptoms include:

  • itchiness around your vulva or anal areas
  • bruised or torn skin, blisters and ulcers (caused by itching)
  • cracked and bleeding skin
  • pain or bleeding when doing a poo (caused by skin cracking or splitting)
  • stinging when weeing
  • painful sex (dyspareunia) due to skin splits at the vaginal opening.

Causes

We don’t know the exact cause of LS, but it’s thought to be an autoimmune disorder. About 15% of people with the condition have a family history of the disorder, so there may be a genetic link.

LS is associated with other autoimmune diseases such as thyroid disease, pernicious anaemia, type 1 diabetes and coeliac disease. It can also co-exist with other skin conditions.

Other factors associated with LS include:

  • hormonal imbalances (usually postmenopause)
  • previous damage to skin related to other skin conditions.

Diagnosis

LS is usually diagnosed via a clinical examination. Your doctor will ask about your symptoms and medical history. They should examine your vulva and affected areas. They may also take a small sample (biopsy) of vulval or perianal skin and send it to a laboratory for testing.

It’s important for your doctor to examine the affected areas to ensure an accurate diagnosis.

Treatment and management

There is no cure for LS – and you won’t be able to get rid of it completely – but treatment should reduce symptoms and stop the condition from getting worse.

The main treatment for LS is corticosteroid ointment. The ointment is applied to affected areas to reduce pain, itching and inflammation and to stop the condition from getting worse.

Ointments are recommended instead of creams, as ointments are less likely to sting or cause contact dermatitis.

While the ointment will relieve itching within a few days, it will take some time for the skin to improve. After a few months, you may be able to reduce the frequency of treatment, but don’t stop unless your doctor tells you to.

This treatment is usually effective, but you will need regular check-ups with your doctor to monitor the condition.

Surgery may be required to remove scar tissue or adhesions that narrow the entrance to your vagina.

What you can do

It’s important to take extra care of your vulva and other affected areas when managing this condition. For example, use a soap-free wash, avoid tight-fitting clothes and Lycra, and try not to rub or scratch affected areas.

Learn more about vulval care.

Risks and complications

LS can lead to changes in your vulva and other affected areas, including:

  • small white spots that grow into larger white areas and may become wrinkled
  • thickened patches of white skin with splits or fissures
  • smooth white patches on your skin
  • a buried clitoris due to your clitoris hood sticking together
  • shrinkage of your inner lips
  • tightening of your vaginal entrance.

LS doesn’t cause cancer, but it is associated with an increased risk of vulval cancer – especially if the condition is left untreated.

When to see your doctor

See your doctor if you notice any symptoms. Sometimes LS can be mistaken for other skin conditions, including lichen planus, so it’s important to get the right diagnosis and treatment. If you are diagnosed with LS, you will need to have regular, ongoing check-ups with your doctor to monitor your condition.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2023.

This con­tent has been reviewed by a group of med­ical sub­ject mat­ter experts, in accor­dance with Jean Hailes pol­i­cy.

1
F. R. Pérez-López & P. Vieira-Baptista (2017) Lichen sclerosus in women: a review,Climacteric, 20:4, 339-347, Doi: 10.1080/13697137.2017.1343295
2
Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14(1):27-47. doi:10.1007/s40257-012-0006-4
3
Singh N, Ghatage P. Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review. Obstet Gynecol Int. 2020;2020:7480754. Published 2020 Apr 21.
4
Jaden R. Kohn, Trissa M. Connors, Warren Chan, Cynthia S. Liang, Harry Dao, Anuja Vyas, Clinical outcomes and adherence to topical corticosteroid therapy in women with vulvar lichen sclerosus: A retrospective cohort study, Journal of the American Academy of Dermatology, Volume 83, Issue 4, 2020, Pages 1104-1109, ISSN 0190-9622
5
Vieira-Baptista P, Pérez-López FR, López-Baena MT, Stockdale CK, Preti M, Bornstein J. Risk of Development of Vulvar Cancer in Women With Lichen Sclerosus or Lichen Planus: A Systematic Review. J Low Genit Tract Dis. 2022 Jul 1;26(3):250-257. doi: 10.1097/LGT.0000000000000673. Epub 2022 Mar 11. PMID: 35285455.
Last updated: 
07 December 2023
 | 
Last reviewed: 
26 April 2023

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