Medical Dermatology

Lichen Sclerosus

Lichen sclerosus (also known as lichen sclerosus et atrophicus, LS&A or white spot disease) is an uncommon disease of unknown cause that results in white and red patches on the skin, which may be associated with ulceration, erosions and scarring.

  • Lichen sclerosus can affect any area of the skin, but it is most common on the female genital skin or the male foreskin and penile skin. In men, this has traditionally been known as balanitis xerotica obliterans (BXO).
  • There may be marked itching or the condition may be without any symptoms. There may also be thinning and shrinkage of the genital area that can make sexual intercourse painful or difficult. Thinning of the skin may also occur.
  • The disease can last for a long time. Occasionally, spontaneous cure may ensue, particularly in young girls.
  • Lichen sclerosus is usually treated with application of potent steroids, which may cause relief and prevent scarring.
  • In severe cases or those with significant pain or rapid progression, oral immunosuppressant medication are necessary to control the disease (hydroxychloroquine, methotrexate, dapsone and mycophenolate mofetil are a few options).
  • Narrowed vaginal tissues can be expanded with vaginal expanders or surgery.
  • Occasionally, squamous cell cancer may develop in areas of chronic lichen sclerosus.
  • Periodic consultation and follow up with a physician experienced in the treatment of lichen sclerosus is important to treat this condition effectively, avoid complications and prevent secondary skin cancers.