Lichen sclerosus

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). Non-itchy white patches can sometimes develop on the upper arms, back, breasts 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 but it is not contagious.

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 entrance 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.

The NHS will fund this operation if all other treatments have been tried and steroid cream has failed to control the symptoms.