8 Common Symptoms of Lichen Sclerosus You Should Know

Lichen sclerosus is a chronic inflammatory skin condition that primarily affects the genital and anal areas, though it can occur on other parts of the body. This condition is most commonly seen in postmenopausal women, but it can affect people of any age and gender, including children and men. The vulva is the most frequently affected area in women, while men may experience symptoms on the foreskin and glans of the penis.

Understanding the symptoms of lichen sclerosus is crucial for early detection and proper management of the condition. While it’s not contagious or caused by poor hygiene, lichen sclerosus can significantly impact quality of life if left untreated. The condition causes patches of white, thin skin that can lead to scarring and permanent changes to the affected tissues. Recognizing the early warning signs can help you seek appropriate medical care and prevent complications.

In this comprehensive guide, we’ll explore the most common symptoms of lichen sclerosus, helping you identify potential signs of this condition and understand when to consult a healthcare provider.

1. White Patches on the Skin

One of the most distinctive and noticeable symptoms of lichen sclerosus is the appearance of white patches on the affected skin. These patches typically have a smooth, shiny appearance and are often described as resembling white tissue paper or porcelain. The skin in these areas becomes noticeably paler than the surrounding tissue.

In vulvar lichen sclerosus, these white patches commonly appear on the labia, around the clitoral hood, and extending to the perineum, sometimes forming a figure-eight pattern around the vulva and anus. The affected skin often loses its normal texture and appearance, becoming thin and fragile. These patches may start small but can gradually expand over time if the condition remains untreated.

The white discoloration occurs due to the chronic inflammation affecting the deeper layers of the skin, which disrupts normal pigmentation and skin structure. This symptom is often one of the first signs that prompts people to seek medical attention, as the visual change can be quite striking and concerning.

2. Intense Itching (Pruritus)

Severe itching, medically known as pruritus, is one of the most distressing symptoms of lichen sclerosus and is often the primary complaint that brings patients to their doctor. This itching can be relentless and may be worse at night, significantly disrupting sleep and daily activities. The intensity of the itching varies from person to person, but many describe it as unbearable at times.

The itching associated with lichen sclerosus et atrophicus is different from ordinary itching—it tends to be persistent, intense, and localized to the affected areas. Scratching provides only temporary relief and can actually worsen the condition by causing further skin damage, creating small tears, and increasing the risk of secondary infections.

Many people find that the itching intensifies with heat, sweating, tight clothing, or after urination. The constant urge to scratch can become overwhelming and may lead to psychological distress, anxiety, and embarrassment. This symptom alone can significantly impact quality of life, affecting work performance, social activities, and intimate relationships.

3. Skin Thinning and Fragility

Lichen sclerosus causes progressive thinning of the skin, medically referred to as atrophy. The affected skin becomes noticeably thinner than normal tissue, almost transparent in appearance, and extremely delicate. This thinning makes the skin exceptionally vulnerable to injury, even from minor friction or pressure.

The fragile skin tears easily, sometimes even during routine activities such as wiping after using the bathroom, during sexual activity, or from simple scratching. These tears, called fissures, can be painful and may bleed. The skin’s reduced thickness also means it has less ability to protect the underlying tissues, making the area more sensitive to irritation from clothing, soaps, and other substances.

In cases of lichen sclerosus genitalis, this skin thinning can lead to structural changes in the genital anatomy. The normal skin elasticity is lost, which can result in functional problems over time. The thin, fragile nature of the affected skin is a hallmark feature of the condition and distinguishes it from other skin disorders.

4. Pain and Discomfort

Pain is a common and significant symptom of lichen sclerosus that can manifest in various ways. The affected areas may feel tender, sore, or experience a burning sensation, even without any obvious cause. This discomfort can be constant or intermittent, and its intensity may fluctuate throughout the day.

For women with vulvar lichen sclerosus, pain may occur during urination (dysuria) as urine comes into contact with the inflamed, fragile skin. This can make routine bathroom visits uncomfortable or even dreaded experiences. Sexual activity often becomes painful (dyspareunia) due to the skin’s fragility and loss of elasticity, which can lead to tears and fissures during intercourse.

The pain can also be triggered by friction from clothing, especially tight underwear or pants. Some people describe a raw, stinging sensation that persists throughout the day. In more advanced cases, even sitting for extended periods can become uncomfortable. This chronic pain can have significant emotional and psychological impacts, affecting relationships, self-esteem, and overall mental health.

5. Cracking and Fissuring of the Skin

As lichen sclerosus progresses, the affected skin becomes prone to developing cracks and fissures. These are painful splits or tears in the skin that occur because the tissue loses its normal elasticity and becomes brittle. Unlike healthy skin that can stretch and flex, skin affected by lichen sclerosus is stiff and easily damaged.

Fissures typically develop in areas subject to movement or friction, such as the posterior fourchette (the area between the vaginal opening and the anus) in women, or the foreskin in men. These cracks can be superficial or deep, and they often cause sharp, stinging pain, especially when stretched or exposed to urine or other irritants.

The fissures may bleed, particularly after activities that put stress on the affected area, such as bowel movements, sexual activity, or even normal walking. These breaks in the skin also create entry points for bacteria, increasing the risk of secondary infections. Healing can be slow because the underlying skin condition persists, and the same activities that caused the initial fissure continue to stress the area. Recurrent fissuring in the same location can lead to scarring and further structural changes.

6. Bleeding and Bruising

The thin, fragile skin characteristic of lichen sclerosus is highly susceptible to bleeding and bruising, even from minimal trauma. Small blood vessels beneath the thinned skin are less protected and more easily damaged, leading to spontaneous bruising or bleeding with very little provocation.

Bleeding may occur from fissures or tears in the skin, or it may happen when the fragile surface layer is accidentally scraped or rubbed. Some people notice small spots of blood on their underwear or when wiping after using the bathroom. The bleeding is typically light but can be alarming, especially when it occurs without any obvious cause or injury.

Bruising (purpura or ecchymosis) appears as purple or dark red discoloration beneath the skin. These bruises may develop from minor bumps or pressure that wouldn’t normally cause bruising on healthy skin. The combination of easy bruising and bleeding is a direct result of the compromised skin structure and serves as an indicator of how fragile the affected tissue has become. While the bleeding and bruising are usually not dangerous, they can be distressing and may cause concern about more serious underlying conditions.

7. Structural Changes and Scarring

Over time, untreated or poorly controlled lichen sclerosus can lead to permanent structural changes in the affected area due to progressive scarring (fibrosis). This is one of the most serious long-term consequences of the condition and can significantly impact function and quality of life.

In women with vulvar lichen sclerosus, scarring can cause the labia minora to shrink and eventually fuse together or adhere to the labia majora. The clitoral hood may become fused, covering or burying the clitoris. The vaginal opening (introitus) may become narrowed, a condition called stenosis, which can make sexual intercourse difficult or impossible and may even affect gynecological examinations.

These architectural changes alter the normal anatomy of the genital area, potentially affecting urinary flow patterns and making hygiene more challenging. In men, lichen sclerosus can cause scarring of the foreskin, leading to phimosis (inability to retract the foreskin) or narrowing of the urethral opening (meatal stenosis), which can interfere with urination.

The scarring process is often gradual and may not be immediately noticeable, but once structural changes occur, they are typically irreversible. This is why early diagnosis and management of lichen sclerosus are so important—to prevent these permanent alterations to the genital anatomy.

8. Changes in Skin Texture

Lichen sclerosus causes distinctive changes in the texture of the affected skin beyond just thinning and whitening. The skin may develop a wrinkled, crinkled appearance, often compared to tissue paper or parchment. This wrinkling is particularly noticeable when the skin is gently stretched.

Some areas may feel thickened or hardened (lichenification), especially if there has been chronic scratching or rubbing in response to itching. This creates a leathery texture that contrasts with the paper-thin quality of other affected areas. The skin may also lose its normal suppleness and elasticity, feeling tight and inelastic rather than soft and flexible.

In some cases, small firm bumps or raised areas may develop within the affected skin. The surface texture becomes uneven, losing the smooth, consistent feel of healthy tissue. These textural changes are often accompanied by loss of the normal skin markings and patterns. The altered texture contributes to the overall fragility of the skin and the ease with which it tears or becomes damaged. Recognizing these textural changes can help in early identification of the condition, as they represent visible and palpable evidence of the underlying inflammatory process affecting the skin.

What Causes Lichen Sclerosus?

The exact cause of lichen sclerosus remains unknown, but research suggests it likely results from a combination of factors rather than a single cause. Understanding potential contributing factors can help patients better comprehend their condition, though it’s important to note that having these risk factors doesn’t mean someone will definitely develop lichen sclerosus.

Autoimmune factors: The most widely accepted theory is that lichen sclerosus is an autoimmune condition, where the body’s immune system mistakenly attacks healthy skin tissue. This is supported by the fact that lichen sclerosus often occurs alongside other autoimmune disorders such as thyroid disease, vitiligo, pernicious anemia, and alopecia areata. People with a family history of autoimmune diseases appear to be at higher risk.

Genetic predisposition: There appears to be a hereditary component to lichen sclerosus, as it sometimes runs in families. Certain genetic factors may make some individuals more susceptible to developing the condition, though the specific genes involved are still being researched.

Hormonal influences: The condition is most common in postmenopausal women, suggesting that hormonal changes, particularly low estrogen levels, may play a role. However, since lichen sclerosus also affects children and men, hormones are likely not the sole cause but may be a contributing factor in some cases.

Previous skin damage: Some evidence suggests that previous injury or trauma to the skin, including scarring from injury, radiation therapy, or chronic irritation, may trigger lichen sclerosus in genetically susceptible individuals. This is sometimes called the Koebner phenomenon.

Infection: While lichen sclerosus itself is not caused by an infection and is not contagious, some researchers have investigated whether previous infections might trigger the condition in susceptible people. However, no specific infectious agent has been definitively linked to lichen sclerosus.

It’s important to emphasize what does not cause lichen sclerosus: it is not caused by poor hygiene, is not sexually transmitted, and is not the result of any personal behavior or lifestyle choice. No one is at fault for developing this condition.

Frequently Asked Questions

Can lichen sclerosus go away on its own?

Lichen sclerosus rarely resolves without treatment, especially in adults. In children, the condition sometimes improves spontaneously after puberty, but this is not guaranteed. For adults, particularly postmenopausal women, the condition is typically chronic and requires ongoing management to control symptoms and prevent complications. Early medical intervention is recommended to minimize scarring and structural changes.

Is lichen sclerosus contagious or sexually transmitted?

No, lichen sclerosus is not contagious and cannot be transmitted through sexual contact or any other form of contact. It is not a sexually transmitted infection. You cannot catch it from someone else, nor can you pass it to others. The condition is believed to be related to immune system factors and genetic predisposition rather than any infectious agent.

Does lichen sclerosus increase cancer risk?

There is a small increased risk of squamous cell carcinoma (a type of skin cancer) developing in areas affected by lichen sclerosus, particularly vulvar lichen sclerosus. The risk is estimated at 3-5% over a lifetime. This is why regular monitoring by a healthcare provider is important. Any suspicious changes in the affected area, such as new growths, ulcers that don’t heal, or unusual bleeding, should be evaluated promptly. Proper management of the condition may help reduce this risk.

Can men get lichen sclerosus?

Yes, men can develop lichen sclerosus, though it is less common than in women. In men, it typically affects the foreskin and head (glans) of the penis, a condition sometimes called balanitis xerotica obliterans (BXO). Symptoms include white patches, tightening of the foreskin, difficulty with retraction, and sometimes narrowing of the urethral opening. Men with persistent genital symptoms should seek medical evaluation.

Can I still have sexual intercourse if I have lichen sclerosus?

Sexual activity may be possible with lichen sclerosus, but it can be painful due to skin fragility, fissures, and loss of elasticity. With proper management and treatment to control inflammation, many people can maintain sexual activity. Using adequate lubrication, gentle techniques, and open communication with partners is important. If scarring has narrowed the vaginal opening, sexual intercourse may become more difficult. Discuss concerns about sexual function with your healthcare provider, as they can offer strategies to help.

How is lichen sclerosus diagnosed?

Lichen sclerosus is typically diagnosed through physical examination by a healthcare provider, usually a dermatologist or gynecologist. The characteristic appearance of white, thin patches in the genital area is often distinctive enough for diagnosis. However, a skin biopsy may be performed to confirm the diagnosis, rule out other conditions, or check for precancerous changes. The biopsy involves removing a small sample of affected skin for laboratory examination.

Will the white patches and scarring go away with treatment?

While treatment can effectively control symptoms and prevent progression of lichen sclerosus, it typically cannot reverse structural changes or scarring that has already occurred. White discoloration may improve somewhat with treatment, but the skin often retains some degree of altered appearance. This is why early diagnosis and treatment are so important—to prevent permanent changes before they occur. Any scarring or anatomical changes that have already developed are usually permanent.

Should I avoid certain products if I have lichen sclerosus?

Yes, it’s generally recommended to avoid potential irritants that can worsen symptoms. These include perfumed soaps, bubble baths, feminine hygiene products, douches, and products containing alcohol or other harsh chemicals. Avoid tight-fitting clothing and synthetic underwear that doesn’t breathe well. Use gentle, fragrance-free cleansers and mild, hypoallergenic moisturizers if recommended by your healthcare provider. Pat the area dry gently rather than rubbing after bathing.

References:

• Mayo Clinic – Lichen Sclerosus
• American Academy of Dermatology – Lichen Sclerosus
• NHS – Lichen Sclerosus
• National Institute of Child Health and Human Development – Lichen Sclerosus
• DermNet NZ – Lichen Sclerosus