Genital lichen sclerosus is a chronic inflammatory skincondition most often seen on the foreskin and tip of the penis. The cause is not fully understood.

It is not caused by an infection and cannot be passed to a sexual partner. It may affect some men with auto-immune diseases, such as thyroid disease or diabetes, and atopic conditions, such as eczema, asthma and hayfever. Friction or damage to the skin can aggravate lichen sclerosus, a phenomenon known at a ‘Koebner response’. The dribbling ofa small amount of urine that traps under the foreskin may cause male lichen sclerosus. It almost never occurs in men who have been circumcised early in life.

The affected skin may feel uncomfortable, sometimes itchy, burning and sore, especially during or after sex. The foreskin may tighten and become more difficult to retract causing painful erections. The skin may tear and bleed during sexual intercourse. When the opening in the tip of the penis is affected, the urine may spray.

The affected skin can look red, with little cracks, sores, bleeding points or small blood-blisters. Scarring may change the appearance of the foreskin or tip of the penis. When the tightened foreskin is retracted, it may draw in around the shaft of the penis like a tight band (‘waisting’). The foreskin may be so tight it is impossible to retract it and clean the tip of penis.

The diagnosis is usually made by clinical examination although sometimes a skin biopsy under local anaesthetic may be required for confirmation.

There is a link in some men between lichen sclerosus and penis cancer but it is rare. Although circumcision can cure lichen sclerosus in some men, in others it does not and although circumcision may reduce the risk of penile cancer, it does not absolutely prevent it.

Lichen sclerosus is treated with strong steroid ointments such as clobetasol propionate and diflucortolone valerate to stop the inflammation and soften the skin.  After the initial treatment period, a period of maintenance treatment plan with the regular use of moisturisers and intermittent use of steroid ointments (often less strong) is needed.

If the foreskin becomes too tight to function properly and is not softened by creams, circumcision or other surgery may be necessary.

Patients should observe the following skin care advice. Avoid washing with soap and instead use an emollient soap substitute such as Emulsifying Ointment BP. Protect the skin from urine by carefully drying the tip of the penis after passing urine and by applying a moisturiser or yellow soft paraffin (such as Vaseline). Keep pubic hair short so it doesnot get trapped between the foreskin and the penis. Use lubricant for sex to reduce friction. Stop smoking, if a smoker,to reduce the risk of penis cancer. Regular self-examination and report any skin changes that do not respond to steroids.

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

Links:

http://dermnetnz.org/immune/lichen-sclerosus.

http://www.patient.co.uk/health/Lichen-Sclerosus.htm