Lichen sclerosus is a chronic skin disorder that causes white, itchy patches to appear on the skin. This disorder can make sufferers feel uncomfortable and can recur.
Lichen sclerosus can occur anywhere on the body, but mostly occurs in the genitals and anus. However, this disease is not contagious and cannot be spread through sexual intercourse.
Lichen sclerosus is thought to be an autoimmune reaction in the skin. Everyone can suffer from this condition, including children. However, lichen sclerosus is more common in women, especially postmenopausal women.
Causes of Lichen Sclerosus
The cause of lichen sclerosus is not known, but this condition is thought to be an autoimmune reaction. In this condition, the immune system attacks healthy skin tissue instead.
Lichen sclerosus is also thought to occur due to hormonal imbalance. In women, LS generally appears when entering menopause. This condition is thought to be related to decreased levels of the hormone estrogen during menopause.
Meanwhile, the risk of developing LS in uncircumcised men was higher than in circumcised men. This is presumably because the head of the penis in uncircumcised men often experiences irritation due to residual urine left in the foreskin after urinating.
Symptoms of Lichen Sclerosus
Lichen sclerosus (LS) is characterized by thickened or puckered white patches on the skin. These patches tend to leave scars in the form of scar tissue.
Based on their location, LS are divided into three types, namely:
Lichen sclerosus (LS) vulva
In women, lichen sclerosus generally appears on the vulva (the outer female sex organ) which is hairless. This condition can spread to the groin, urethra, mouth, vagina, or anus. However, vulvar lichen sclerosus never spreads to the inner wall of the vagina.
Other symptoms that accompany white patches on vulvar LS are:
- Itching in the genitals which can be very heavy
- Tear of skin that bleeds at the spot
- Bleeding blisters or open sores (in severe cases)
If this condition is not treated, the vulva can gradually become scarred and harden or shrivel up. This condition can cause complications that cause discomfort.
Lichen sclerosus (LS) extra genital
Spots that arise in extra-genital LS have a dry, thin, and wrinkled surface. Usually, one or more patches appear on the inner thighs, buttocks, lower back, abdomen, under the breasts, neck, shoulders, or armpits.
Other symptoms that may appear are chicken skin-like texture (spots), bruises, abrasions, or blisters that are not preceded by an injury.
Lichen sclerosus (LS) penis
In men, lichen sclerosus tends to develop on the foreskin or the tip of the penis and rarely affects the skin around the anus. Initial symptoms include:
- Flat patches that are reddish or lighter in color than the surrounding skin area
- Plaque is round with a purplish white color
- Appearance of small blood vessels or bleeding spots on the foreskin of the penis
Lichen sclerosus in men is sometimes accompanied by annoying itching. However, the above symptoms generally go unnoticed. Usually, LS in men is only noticed when the area affected by LS turns white and hardens into scar tissue.
Along with the above symptoms, complications such as not urinating smoothly or pain during an erection can also occur.
When to go to the doctor
Immediately consult a doctor if you find white patches that match the symptoms of LS, especially if the wound has hardened, shriveled or causes other complaints such as pain when urinating or having sex.
Diagnosis of Lichen Sclerosus
In determining the diagnosis of LS, the doctor will first ask about the history and complaints related to the symptoms felt by the patient. After that, the doctor will perform a physical examination of the patient's skin.
To confirm the diagnosis, the doctor will carry out a supporting examination through the skin biopsy method, which is taking a sample of the patient's skin tissue to be studied using a microscope. This examination will also be done if the doctor suspects that the patches or sores on the skin are caused by other conditions.
Lichen Sclerosus Treatment
Lichen sclerosus treatment aims to relieve itching, improve skin condition, and reduce the risk of scar tissue forming. Medical treatment is carried out by doctors in the form of giving corticosteroid creams or ointments.
For mild LS, an ointment containing mometasone furoate 0.1% can be used. Meanwhile, for more severe cases, the doctor will prescribe an ointment containing clobetasol propionate 0,05 %.
Corticosteroid ointment should generally be used once a day for 3–6 months. How to use it is to apply the drug thinly on the white patches and rub gently.
After the symptoms subside, the use of the ointment should not be stopped, but reduced to 1-2 times a week. This is necessary to prevent LS recurrence. Patients are also advised to regularly check with the doctor.
For severe cases of lichen sclerosus that cannot be treated with the above medicines, your doctor may prescribe methotrexate, ciclosporin, or retinoids (such as isotretinoin). In addition, patients can also be given immunosuppressive drugs, such as tacrolimus or pimecrolimus.
In addition to taking medication from a doctor, LS sufferers also need to make independent efforts to control symptoms, including:
- Gently wash the affected area of LS, 1-2 times a day. Patients can use a mild soap (no fragrance or detergent).
- Avoid scratching or rubbing the affected area even if it itches.
- Avoid wearing clothes or underwear that are tight and easily get damp.
- Avoid doing activities such as riding or riding a bicycle when experiencing LS in the genital area, because it can make symptoms worse.
- Dry the genital area after urinating to avoid irritation by urine.
- Use a cream that contains petroleum jelly on the area affected by LS to reduce dryness and itching of the skin, and to avoid direct contact between the skin affected by LS with urine or feces.
In male patients, doctors will recommend circumcision (circumcision) as an alternative treatment if the foreskin condition is getting worse.
Complications of Lichen Sclerosus
Although lichen sclerosus is a skin disorder that is classified as harmless, this condition can be serious and interfere with the sufferer's quality of life. If treated too late, LS can develop into scar tissue.
Some of the complications that may occur as a result of LS are:
- Narrowing of the vaginal opening that causes pain during intercourse
- Changes in the shape of the intimate organs, especially in women, due to the formation of scar tissue
- Narrowing of the urinary opening in women that causes pain when urinating
- Narrowing of the urinary opening in men, which causes the flow of urine when urinating to become crooked or weak
- Attachment of the foreskin to the head of the penis (phimosis) which can cause spontaneous pain or pain during erection
- Infections of the genital area or urinary tract, such as yeast infections Candida albicans, bacterial infection Staphylococcus aureus, and herpes simplex virus infection
- Decreased sexual function due to lack of confidence due to changes in the shape of the intimate organs
- Constipation or bleeding during bowel movements in children
In addition to the above complications, LS is also thought to increase the risk of developing a skin cancer called squamous cell carcinoma. This cancer can occur in the vulva (vulvar cancer), penis (penile cancer), or anus.
Lichen Sclerosus Prevention
There is no specific way to prevent the appearance of lichen sclerosus, because this disease is related to a person's immune system and hormones. However, the worsening of this disease can be prevented with proper treatment.
To avoid recurrence of LS and its worsening in the future, patients should continue to monitor signs and symptoms of LS. Generally, doctors will recommend LS sufferers to routinely carry out follow-up examinations every 6-12 months