Lichen Sclerosus

ByShinjita Das, MD MPH, Massachusetts General Hospital
Reviewed/Revised Sept 2023
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Lichen sclerosus is a disorder that tends to cause itching and can cause scarring in the area around the anus and genitals.

The cause of lichen sclerosis is unknown, but it may involve the immune system attacking some of the body's own tissues (called an autoimmune disorder).

Lichen sclerosis typically affects the area around the anus and genitals, but it can rarely be found on other areas of the body.

Symptoms of Lichen Sclerosus

At first, the skin around the anus and genitals tends to bruise and may blister. Itching, sometimes severe, is typical. After some time, the skin can thin, lose its normal color, and develop cracks and scales. In some people, the disorder develops differently, causing skin thickening.

Severe and longstanding cases of lichen sclerosus cause scarring that distorts the normal structures of the area around the anus and genitals.

Sometimes the appearance of lichen sclerosus in a child can resemble the effects of sexual abuse.

Rarely, squamous cell carcinoma (a skin cancer) develops in areas that have been affected by lichen sclerosus for a long time.

Lichen Sclerosus
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The top photo shows thinning of the skin and areas with an increase or decrease in skin pigment on the female genitals. The bottom photo shows areas of thinning and loss of pigment on the head of the penis.
Photos courtesy of Joe Miller (top) and Brian Hill (bottom) via the Public Health Image Library of the Centers for Disease Control and Prevention.

Diagnosis of Lichen Sclerosus

  • A doctor's evaluation

  • Sometimes skin biopsy

Doctors typically base the diagnosis of lichen sclerosus on how the rash looks and where it appears on the body.

Occasionally, doctors do a biopsy (examination of a tissue sample under a microscope) of any thickened skin to rule out squamous cell carcinoma (a skin cancer).

Treatment of Lichen Sclerosus

  • Corticosteroid creams or ointments

Strong corticosteroid creams or ointments are applied to the skin.

Because this disorder is typically incurable and causes scarring, people are treated long-term and examined periodically for squamous cell carcinoma.

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