This is one of the most common diseases dermatologists and gynaecologists treat at the specialised vulval diseases clinics.'Sclerosus' means deep thickening within the skin. `Et atrophicus' means that there can also be thinning of the skin, or atrophy. The name tells us a lot about what the condition looks like. Because it is such a long name it is abbreviated to LS.
One of the earliest changes is that the oil glands on the labia minora start to fade and disappear and the labia minora seem to become attached to the inside surface of the labia majora. With time they may disappear completely. Whitening of the skin is very common and some areas become thick and firm. Very prominent blood vessels, called telangiectasia, can be present on the surface and sometimes these bleed. Blisters and ulcers can also occur.
In time the vulva may come to look abnormal-like a white sheet with an opening, much smaller than normal, in which you can see the entrances to the bladder and vagina. At this point other problems like splitting and tearing with intercourse and perhaps even problems urinating are likely. The main symptom of LS is itch. We do not know what exactly causes this itch. Some women with only very minor LS have quite intense itch, and others with more advanced changes have hardly any symptoms at all.
It was once thought that LS was mainly a problem of older women, but it is now realised that it can strike women in their 20s and 30s and even children. The youngest case reported so far has been a six-week-old girl. This raises another important issue. It is clearly important that doctors examining the vulva in young girls in whom the question of potential sexual abuse has been raised are aware of this condition as it is one that could be confused with child sexual abuse.
The cause of LS is not known but we do know that it tends to run in families. We also know that about 15-20 percent of women with the condition will get it on other parts of their skin. We also know that occasionally men get it on the foreskin and glans of the penis. The most plausible theory is that the body's immune system produces auto-anti-bodies against part of the skin and that these abnormal antibodies trigger the disease.
How is lichen sclerosus treated?
Strong cortisone creams used in short bursts under medical supervision not only take away the symptoms but can also improve the abnormal skin. The earlier the disease is treated the greater the improvement. Cortisone creams are safe provided your doctor supervises treatment and provided they are used for the right reason. You should be examined regularly by your doctor so that an experienced eye can be kept out for any early changes signalling the need to reduce the amount or change the type of cortisone cream.
Skin cancer is known to develop very occasionally on the vulvas of women with LS. This may be signalled by a persistent area of pain, itch or ulceration. This is another important reason why women with LS should have regular reviews by their treating doctor as, when detected early, this type of skin cancer can be cured.
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