GENITAL LICHEN SCLEROSIS in Females
Lichen sclerosis is a chronic inflammatory skin condition which can affects the skin of the vulva and the skin around the anus. It can start in childhood or adulthood (usually after themenopause) and affect girls and women of all ages.
It can be associated with other auto-immune diseases in which the body’s immune system attacks normal tissues such as the thyroid gland or the insulin producing cells in the pancreas but it has not been proven that lichen sclerosis is an auto-immune condition in itself. It is not contagious and cannot be spread through contact, including sexual intercourse. Friction or damage to the skin can exacerbate lichen sclerosis; a reaction known as a ‘Koebner response’. Irritation from urine leakage or wearing incontinence pads or panty liners can make the problem worse.
The most common symptoms of lichen sclerosis is itching and tightening of the skin which can interfere with urination, sexual intercourse and cause discomfort when passing bowel motions.
The skin has a white shiny appearance which is usually thinned but can sometimes become raised and thickened. When the peri-anal skin is affected it is described as ‘a figure of eight pattern’. Skin fragility may lead to breaking of some small blood vessels in the skin which appear as tiny blood blisters. Occasionally, blisters and small cracks (‘fissures’)can be seen. If not treated, there may be a change in the normal appearance of the vulva.
Lichen sclerosis is diagnosis by clinical examination. If there is any doubt, a skin biopsy under local anaesthetic mat be performed.
There is no permanent cure for lichen sclerosis but the symptoms and signs of the disease can be well controlled. Strong steroid ointments (most commonly clobetasolpropionate 0.05%) are used to stop the inflammation. Steroids and emollients also soften and protect the affected skin. Secondary skin infection (impetigo and thrush) skin cracks may also require treatment. Rarely, a small operation may be needed to divide adhesions if the skin sticks together.
Individuals should avoid soap and shower gels and instead use an emollient soap substitute such as Emulsifying Ointment BP. To protect the genital skin from urine, careful drying after passing urine and the application of a moisturiser or yellow soft paraffin (such as Vaseline) as a barrier cream is recommended. Discomfort with sexual intercourse may require the use of lubricants and, on occasions, vaginal dilators.
There is a small risk of developing vulval cancer (less than 5%) in lichen sclerosis but with good control of the symptoms and signs this risk is reduced further. Regular self-examination is very important and any skin changes that do not respond to steroid creams, in particular any skin thickening, soreness or ulceration lasting more than two weeks, should be reported to a clinician. You may need a biopsy to test for skin cancer. Do not smoke; to reduce the risk of cancer.
CAUTION: This leaflet mentions ‘emollients’ (moisturisers). Patients using paraffin-containing skincare are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly