Understanding and treating lichen sclerosus

When white patches and intense itching affect your vulvar health, specialist care can provide effective management and prevent complications

Lichen sclerosus is a chronic inflammatory skin condition that most often affects the vulva and anal area, causing intense itching, pain, and skin changes.

If you’ve noticed white patches on your vulvar skin, experienced persistent itching that’s worse at night, or have fragile skin that tears easily, you may have lichen sclerosus. This condition requires specialist diagnosis and treatment to manage symptoms and prevent long-term complications.

At The Women’s Health Vulvo-Vaginal & Genitourinary Clinic, we specialise in diagnosing and treating lichen sclerosus. With proper treatment, most women experience significant symptom relief and can prevent disease progression.

Lichen sclerosus is manageable with the right treatment. Let us help you find relief.

Do you have lichen sclerosus?

You may have lichen sclerosus if you experience:

White, patchy skin on the vulva or around the anus
Intense itching, especially at night
Skin that tears or bruises easily
Pain or discomfort in the vulvar area
Painful intercourse due to skin fragility or scarring
Skin that appears thin, wrinkled, or crinkled
Bleeding or blood blisters from minor trauma

If this sounds familiar, it’s important to seek specialist assessment.

Common causes and risk factors

1. Autoimmune Response

Lichen sclerosus is believed to be an autoimmune condition where the body’s immune system mistakenly attacks the skin. It’s more common in women with other autoimmune conditions.

2. Hormonal Factors

The condition is most common in post-menopausal women, suggesting that low oestrogen levels may play a role. However, it can affect women of any age, including children.

3. Genetic Predisposition

There appears to be a genetic component, as lichen sclerosus sometimes runs in families.

4. Previous Skin Damage

Scarring or damage to the vulvar skin may trigger lichen sclerosus in some women, though this is not always the case.

5. Age-Related Changes

Whilst it can occur at any age, lichen sclerosus is most commonly diagnosed in post-menopausal women and prepubertal girls.

How we diagnose and treat lichen sclerosus

Comprehensive history

We’ll discuss:

When you first noticed symptoms and how they’ve progressed
The severity and frequency of itching
Any skin changes you’ve observed
Impact on sexual function and daily activities
Previous treatments and their effectiveness
Family history of autoimmune conditions

Thorough examination

A careful examination will reveal:

Characteristic white patches or plaques
Skin texture changes (thinning, wrinkling, or thickening)
Areas of scarring or architectural changes
Signs of scratching or secondary infection
Extent of the affected area

Skin biopsy (if needed)

In some cases, a small skin biopsy may be performed to confirm the diagnosis and rule out other conditions.

Treatment approach

Treatment for lichen sclerosus may include:

Topical corticosteroids
Symptom management
Lifestyle modifications
Ongoing monitoring

Frequently asked questions

Q: Is lichen sclerosus curable?

A: Lichen sclerosus is a chronic condition without a cure, but it is highly manageable with proper treatment. Most women experience significant symptom relief and can prevent disease progression with regular use of topical steroids.

Q: Will I need to use steroid cream forever?

A: After initial intensive treatment, most women transition to maintenance therapy, using the steroid cream 1-2 times per week. The goal is to use the lowest effective dose to keep symptoms controlled.

Q: Can lichen sclerosus lead to cancer?

A: There is a small increased risk of vulvar cancer in women with lichen sclerosus (approximately 4-5% over a lifetime). Regular monitoring and proper treatment can help detect any changes early.

Q: Is lichen sclerosus contagious or sexually transmitted?

A: No, lichen sclerosus is not contagious and cannot be transmitted through sexual contact. It is an autoimmune condition.

Q: Can I still have sex with lichen sclerosus?

A: With proper treatment, many women can return to comfortable sexual activity. Using lubricants and ensuring the condition is well-controlled can help reduce discomfort.

View all FAQ

Take the first step towards effective management

Lichen sclerosus requires specialist care, but with proper treatment, you can control your symptoms and prevent complications. Don't wait—early treatment leads to better outcomes.