What is LS?
Lichen sclerosus (aka lichen sclerosis
or lichen sclerosis et atrophicus) is a painful skin
condition that typically affects the vulva (or penis)
and anus.
In women, LS falls under the general category
of vulvodynia
(chronic vulvar pain). It is not a contagious
condition.
Lichen sclerosis is a chronic inflammatory
skin disease that causes substantial discomfort and
morbidity, most commonly in adult women, but also in
men and children.
Any skin site may be affected (and,
rarely, the oral mucosa) but lichen sclerosus is most
common in the anogenital area, where it causes intractable
itching and soreness.
In children, the disorder may be confused
with changes seen in sexual abuse. Progression to destructive
scarring is common. There is increased risk of developing
vulval cancer, and there are links with penile cancer.
Patients should be kept under long-term review. Lichen
sclerosus can occur without symptoms, and the exact
prevalence is uncertain. It occurs most commonly in
women at times of low sex hormone output. The underlying
cause is unknown, but there seems to be a genetic susceptibility
and a link with autoimmune mechanisms.
The wart virus and the spirochaete borrelia
have been suggested but not substantiated as infective
triggers. The Koebner phenomenon is known to occur (lichen
sclerosus occurs in skin already scarred or damaged),
so trauma, injury, and sexual abuse have been suggested
as possible triggers of symptoms in genetically predisposed
people. The treatment of choice for anogenital lichen
sclerosus is potent topical corticosteroid ointment
for a limited time.
Circumcision may be indicated in men,
and surgery may be considered in women, to relieve effects
of scarring or to treat coexisting carcinoma. Current
research aims to identify a treatable cause of lichen
sclerosus, to identify patients at risk of scarring
and of malignant disorders, and to find target pathways
for therapeutic intervention.
What are the symptoms of LS?
The symptoms of LS are thinning skin, white patches
of skin, itching and/or burning, painful sexual intercourse,
and sores or lesions resulting from scratching.
If left untreated, LS can result in fusing of the skin,
atrophy, and narrowing of the vagina. A more detailed
description is provided here.
Please note that all of these symptoms may not be present.
Some women do not experience itching, for example --
only pain.
Who can get LS?
The most common sufferers of LS are post-menopausal
women, although the disease can strike women of any
age -- including young girls. In addition, there
are many known cases of men and boys diagnosed with
LS.
Common Misdiagnoses
The most common misdiagnosis for lichen sclerosus is
a yeast infection. Other misdiagnoses include
herpes or a bacteria infection. In children, the
symptoms of LS are sometimes mistakenly
identified as signs of sexual abuse.
Generally, a biopsy from the affected area can help
determine whether your condition is indeed LS.
Unfortunately, some sufferers have gone as long as twenty
years without proper diagnosis.
Overviews
- What
Is Lichen Sclerosus? National Institute of
Arthritis and Musculoskeletal and Skin Diseases
- Lichen Sclerosus
- Lichen
sclerosus 1989 Review.
- Non-neoplastic epithelial disorders of the vulva
Organizations
Worldwide Lichen Sclerosus Support
Living with LS – Online Community
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