Lichen Sclerosus (LS)

What Is Lichen Sclerosus?

Lichen sclerosus (LS) is a chronic inflammatory, vulvar skin condition affecting young girls prior to puberty, as well as older, menopausal women. It is not clear how many patients experience LS or what causes it, but it may be an autoimmune condition. In girls, LS is most commonly diagnosed around age 4-6 years and often associated with constipation.

What Are the Signs and Symptoms of Lichen Sclerosus?

The most common symptoms of lichen sclerosus are vulvar irritation, pain and bleeding. Patients may also experience pain when they urinate without signs of a urinary tract infection. Symptoms often “wax and wane” with episodic flares.

Lichen Sclerosus is typically diagnosed by examination of the perineum. Rarely, a physician may need to do a small skin biopsy to confirm LS or rule out other skin conditions. The skin of the vulva, clitoris, perineal body and anus can be impacted with very specific changes including thinning, color change, bruising, cracks or erosions. The vagina and urethra are typically normal looking.

What Causes Lichen Sclerosus?

The cause of LS is unknown. LS may be associated with autoimmune conditions. Irritants to the skin may cause a flare of symptoms.

How Is Lichen Sclerosus Treated?

Treatment of LS has two goals:

  1. Improvement of symptoms
  2. Prevention of permanent damage to the skin with scarring or erosions.

The first line of therapy is topical corticosteroid ointments, sitz baths and removal of skin irritants. Patients need follow up to make sure they respond to therapy, symptoms improve, and the skin remains healthy without any permanent scars or erosions.