Diagnosis

Your doctor may diagnose lichen sclerosus based on:

  • A physical examination
  • Removal of a small piece of affected tissue (biopsy) for examination under a microscope

Your doctor may refer you to a specialist in skin conditions (dermatologist) or the female reproductive system.

Treatment

If you have lichen sclerosus on or around your genitals or anus, or have a more advanced case on other parts of your body, your doctor will recommend treatment. Treatment helps reduce itching, improve your skin's appearance and decrease further scarring. Recurrence is common. Rarely, lichen sclerosus gets better on its own.

Corticosteroids

Corticosteroid ointments or creams are commonly prescribed for lichen sclerosus. Initially, you'll generally have to use cortisone creams or ointments on the affected skin twice a day. After several weeks, your doctor will likely recommend that you only use these medications twice a week to prevent a recurrence.

Your doctor will monitor you for side effects associated with prolonged use of topical corticosteroids, such as further thinning of the skin.

Other treatment options

If corticosteroid treatment doesn't work or if months of corticosteroid therapy are needed, your doctor may prescribe an ointment such as tacrolimus (Protopic).

Removal of the foreskin (circumcision) in men is a common treatment in cases resistant to other therapies or more-advanced cases. Surgery in the genital or anal area generally isn't recommended for women with lichen sclerosus because the condition may just come back after surgery.

Ask your doctor how often you should return for follow-up exams. They are generally recommended every six to 12 months.

Lifestyle and home remedies

These self-care tips may help, whether you are undergoing treatment or not:

  • Apply lubricant (petroleum jelly, A and D ointment, Aquaphor) to the affected area.
  • Gently wash the affected area daily and pat dry. Avoid harsh soaps and bathing too much.
  • Ease burning and pain with oatmeal solutions, sitz baths, ice packs or cool compresses.
  • Take an oral antihistamine at bedtime to help control the itching as you try to sleep.

Preparing for your appointment

If you have signs and symptoms common to lichen sclerosus, make an appointment with your primary care doctor. Your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment make a list of:

  • Your symptoms and how long you've had them.
  • Your key medical information, such as other conditions with which you've been diagnosed and any prescription or over-the-counter medications you're using, including vitamins and supplements.
  • Questions to ask your doctor.

Some basic questions to ask your doctor about possible lichen sclerosus include:

  • What's the most likely cause of my symptoms?
  • What treatment approach do you recommend, if any?
  • If the first treatment doesn't work, what will you recommend next?
  • How much do you expect my symptoms will improve with treatment — and how soon?
  • Will I need treatment for this condition for the rest of my life?
  • What self-care steps can I follow to ease my symptoms?
  • What can I do to help prevent a recurrence?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • How severe is your discomfort?
  • Have you noticed any bleeding?
  • Do your symptoms include pain with urination or bowel movements?
  • Do your symptoms include pain with sexual intercourse?
  • Have you had any previous injuries to the affected area?
  • What steps have you taken to treat this condition yourself?
  • Have you had prescription treatments for this condition?
  • Have you been diagnosed with any other medical conditions?
Oct. 09, 2018
References
  1. Ferri FF, et al., eds. Diseases and disorders. In: Ferri's Fast Facts in Dermatology: A Practical Guide to Skin Diseases and Disorders. 2nd ed. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed Aug. 24, 2018.
  2. Fistarol SK, et al. Diagnosis and treatment of lichen sclerosus. American Journal of Clinical Dermatology. 2013;14:27.
  3. What is lichen sclerosus? National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/lichen-sclerosus. Accessed Aug. 24, 2018.
  4. Schlosser BJ, et al. Lichen sclerosus and lichen planus in women and girls. Clinical Obstetrics and Gynecology. 2015;58:125.
  5. AskMayoExpert. Lichen sclerosus (balanitis xerotica obliterans). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.