Lichen Sclerosis

 

What is Lichen Sclerosis?

Lichen sclerosus is a chronic inflammatory skin condition which can affect any part of the skin, but it most often affects the genital skin (vulva) and the skin around the anus. It can start in childhood - or adulthood (usually after the menopause) and affect girls or women of any age.

 

What causes lichen sclerosus?

The cause of lichen sclerosus is not fully understood. It can be associated with other diseases in which the body’s immune system attacks normal tissues such as the thyroid gland (causing an overactive - or underactive thyroid gland) or the insulinproducing cells in the pancreas (causing diabetes), but it has not been proven that it is an auto-immune condition in itself. Lichen sclerosus is not due to an infection – the disease is not contagious and cannot be spread through contact, including sexual intercourse. Friction or damage to the skin triggers lichen sclerosus and make it worse. This reaction is called a ‘Koebner response’. Irritation from urine leakage or wearing incontinence pads or panty liners can make the problem worse.

 

What are the symptoms of lichen sclerosus?

The most common symptom of vulval lichen sclerosus is itching, which may be severe and be very sore if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin which can interfere with urination and sexual intercourse. Tightening of the skin around the anus may cause discomfort when passing bowel motions and aggravate any tendency to constipation, especially in children. The patches on the non-genital skin rarely cause any symptoms at all

 

How will lichen sclerosus be diagnosed? 

The diagnosis can usually be made from the typical appearance of the condition. If there is any doubt, a small skin sample may be taken and examined under a microscope to confirm the diagnosis, especially if there is an open sore or a thickened area of skin. This is known as a skin biopsy and requires a local anaesthetic injection and possibly stitches to close the wound, leading to a small scar.

 

Can lichen sclerosus be cured?

There is no permanent cure for lichen sclerosus, but the symptoms and signs of the disease can be well controlled with the application of creams to the affected skin. If it starts in childhood, it usually goes away around the time of puberty

 

How can lichen sclerosus be treated? 

A variety of treatments are available for lichen sclerosus: • Strong steroid ointments (most commonly clobetasol propionate 0.05%) are used to stop the inflammation and also soften the affected skin. Please do not worry about the warning inside the pack, where it might say ‘not to use these ointments on genital skin’ as these are very safe for this condition and your dermatologist will advise you how and when to apply the steroid ointments safely. • Moisturisers help to soften and protect the skin. • It is possible to develop thrush or other infection is the skin cracks and your doctor will treat these problems if they arise. • Rarely, a small operation may be needed to divide adhesions if the skin sticks together

 

What is the role of PRP in Lichen Sclerosus? 

PRP is used in skin rejuvenation for many years. The role of PRP in Lichen Sclerosus is not known. There are very few studies published including some case reports on the usage of PRP for Lichen Sclerosus in anecdotal cases.Currently there is a trial registered on clinical trials.gov on the usage of PRP in Lichen Sclerosus.

 

Is it safe to Use PRP in Lichen Sclerosis? 

Though PRP is contraindicated in skin abnormal multiplication disorders, there is no evidence to suggest that Lichen Sclerosus is one of them. Though the risk of cancer is slightly elevated with Lichen Sclerosus if good symptom control is achieved the risk of cancer is 0. The role of PRP in this is unknown.*