Lichen Sclerosus - Causes, Symptoms and Treatment
Lichen sclerosus(LS), is a chronic inflammatory skin disorder that results in white atrophic papules that may contain a central depression or a black keratotic plug. In advanced cases, the papules tend to blend into large, white patches of thin, itchy skin. Lichen sclerosus also called Hallopeau's disease .
The lesion often occur on the torso and in the anogenital regions. In the latter case, the disease is called kraurosis vulvae. Lichen sclerosus (LS) is a skin condition that usually affects the vulva and the anal area. In women it falls under the general category of vulvodynia. Lichen sclerosus can affect men, women, or children, but is most common in women.
The disease makes the skin's surface thin and delicate so that it tears easily. This can cause bleeding under the skin. In severe cases of lichen sclerosis of the genital area, scarring can occur. Skin affected by lichen sclerosus is usually white and sometimes there is a fine, crinkling texture to it. If left untreated, lichen sclerosus can cause progressive scarring.
Causes of Lichen sclerosus:
The exact cause of lichen sclerosis is uncertain.But several observations suggest that following may be the cause of Lichen sclerosus:
- The main cause may be an overactive immune system.
- The extracellular matrix protein-1 as antibodies may also leads to the disease.This protein have been detected in 75-80% of women with vulval lichen sclerosus.
- The thyroid disease, pernicious anaemia, vitiligo and alopecia areata can lead to the condition of lichen sclerosus.
- Lichen sclerosus is not contagious.
- The other causes may include genetic, hormonal and infectious components.
- To some extant, the family history of lichen sclerosus is responsible of it.
Symptoms of Lichen sclerosus:
The most common symptoms of lichen sclerosus includes:-
- There may be chronic itching and soreness of the vulval area.
- The Bruised skin with small broken blood vessels.
- The inflammation and swelling of the affected skin may be seen in lichen sclerosis.
- The splitting and bleeding of the skin may occur around the anal opening when passing bowel motions, causing pain and discomfort
- The affected skin becomes fragile and pale and white in appearance and there is an increased susceptibility to infection and thrush
- The vaginal opening becomes narrow.
- The blisters and ulceration may also present.
- The penile cancer, especially in men, may occur in chronic condition.
- Skin tears or ulcers generally caused by scratching.
Treatments of Lichen sclerosus:
The most effective treatments for lichen sclerosus includes:-
- Do not use any douches, perfumes, feminine hygiene sprays, commercial lubricants, or other substances on the vulva other than those prescribed or suggested. These treatments try to reduce the inflammation in the affected areas of skin.
- Avoid any soap on your vulva and wash no more than once a day with clear water only using your fingers instead of a wash cloth.
- The circumcision is the most widely used therapy for lichen sclerosus. This procedure removes the affected skin, and the disease usually does not recur.
- Xylocaine jelly will often help to numb the area before intercourse and makes sexual activity more comfortable. This should be applied liberally 15-20 minutes before intercourse.
- Other treatments include calcipotriol cream , topical and systemic retinoids (acitretin).
- The new immune modulating creams tacrolimus and pimecrolimus look promising for treating lichen sclerosus.
- The use of ultrapotent topical corticosteroid creams and ointments are very suitable for the treatment of lichen sclerosus.