Lichen sclerosus

Read NHS Choices information on lichen sclerosus, which is a skin disorder that affects the area around the genitals.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you have this condition you should see a doctor within two weeks.

How is it diagnosed?

Your doctor can usually diagnose lichen sclerosus based on a physical examination. As lichen sclerosus can look like other conditions, a skin sample (biopsy) may be taken and examined under a microscope to confirm the diagnosis.

What is the treatment?

There is currently no cure for lichen sclerosis.

The main treatment is steroid creams; these can help to control the symptoms.

When to worry?

If you have any of the following symptoms then you should see a doctor within 48 hours:

  • persistent itch in the vulva
  • pain or soreness in the vulva
  • thickened patches of skin
  • lump, blister, wart or sore on the vulva
  • blood-stained vaginal discharge between periods
  • growth or sore in the penis
  • bleeding from the penis
  • foul smelling discharge from the penis
  • rash on the penis
  • change in colour of the skin of the penis
  • thickened skin of the penis or foreskin.

Introduction

Lichen sclerosus is a long-term skin disorder that most commonly affects the skin around the genitals. The skin develops severely itchy or sore white spots.

Itchy spots can sometimes also develop on the skin around the anus (bottom) and, occasionally, non-itchy white patches develop on the back and shoulders.

Lichen sclerosus is an uncommon disease that can affect men or women, but most often affects women aged over 50. The cause is unknown.

It usually lasts for years and can be very distressing. There is no cure, but symptoms can be controlled with steroid creams, which may also prevent the condition getting worse.

Occasionally, the condition clears on its own without treatment, and doesn't come back.

This page gives information and advice for:

Lichen sclerosus in women

Lichen sclerosus affects about 1 in 1,000 women, although this may be an underestimate as mild cases may go unreported. Some women may mistake the symptoms for those of vaginal thrush, meaning they are not diagnosed immediately.

Symptoms in women

Women with lichen sclerosus usually develop small white spots on their vulva (the skin outside the entrance to the vagina). These are usually itchy or sore. This itchiness tends to be worse at night and may disturb sleep.

There may also be itchy spots on the skin around the anus.

Over time, the spots can become larger and join together to form large white plaques.

The skin of the vulva or anus may eventually turn white and become fragile, thin and wrinkly or thickened. Some patches of skin may become inflamed and raw, and may eventually split or crack. Sore or cracked vulval skin is more prone to a vaginal thrush infection. Sex can be very painful and, if the anus is affected, it may be painful to pass stools.

Without treatment, the skin of the vulva or anus may scar and shrink over the following months or years. This can make the entrance to the vagina narrower, which makes sex even more difficult.

Steroid cream

Steroid ointment or cream is the main treatment for lichen sclerosus. It helps to reduce the inflammation and keep symptoms under control.

It should be applied regularly but sparingly to the affected areas. Your doctor will advise you on how much to use, how frequently and for how long. Generally, a 30g tube should last two to three months.

Symptoms tend to ease after two weeks, but it may take three months before the area feels normal and symptoms are fully under control.

After three months of using the cream, you may only need to use it once or twice every few weeks to prevent symptoms returning.

Lifestyle advice

Women may find the following advice helpful:

  • avoid washing with soap or bubble bath - use plain warm water or a soap substitute instead, such as aqueous cream
  • avoid perfumed bubble baths and biological washing powder
  • don't rub or scratch the area
  • try using an emollient, such as petroleum jelly, before and after urinating
  • wear stockings instead of tights
  • if sex is painful, try using lubricant
  • a vaginal dilator may help if your vaginal opening has become smaller (if this doesn't work, you may need to consider surgery to widen the entry to the vagina - speak to your doctor about this)

Lichen sclerosus in men and boys

In men and boys, white spots develop on the foreskin and end of the penis. These may be itchy or sore. The skin on the tip of the penis becomes firm and white.

Eventually, it may become hard to pull the foreskin back and it may be difficult to urinate.

Steroid cream

Steroid ointment or cream is the main treatment for lichen sclerosus. It helps to reduce the inflammation and keep symptoms under control.

It should be applied regularly but sparingly to the affected area of the penis. Your doctor will advise you on how much to use, how frequently and for how long. Generally, a 30g tube should last two to three months.

Symptoms tend to ease after two weeks, but it may take three months before the area feels normal and symptoms are fully under control.

After three months of using the cream, you may only need to use it once or twice every few weeks to prevent symptoms returning.

Circumcision

Men or boys may need a circumcision if their foreskin has become severely damaged. Circumcision is an operation to have the foreskin removed.

Content supplied by NHS Choices