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

Treatment

If your genital area isn't affected, you may not need treatment for lichen sclerosus, especially if you're not having symptoms. Lichen sclerosus may get better on its own.

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. Treatments help reduce itching, improve your skin's appearance and decrease further scarring.

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 daily. 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, other treatments your doctor may prescribe include:

  • Immune-modulating medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel)
  • Ultraviolet light treatment, for nongenital areas

Topical sex hormones have been used in the past to treat lichen sclerosus, but recent research suggests that these medications aren't effective.

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.

Be sure to ask your doctor how often he or she recommends follow-up visits to look for changes in the skin. Follow-up exams are generally recommended every six to 12 months.

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?
Sept. 03, 2015
References
  1. Ferri FF. Lichen sclerosus. In: Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed Aug. 12, 2015.
  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. http://www.niams.nih.gov/health_info/Lichen_Sclerosus/default.asp. Accessed Aug. 12, 2015.
  4. Schlosser BJ, et al. Lichen sclerosus and lichen planus in women and girls. Clinical Obstetrics and Gynecology. 2015;58:125.
  5. Ofori AO, et al. What's new in dermatology? http://www.uptodate.com/home. Accessed Aug. 6, 2015.
  6. Murphy R. Lichen sclerosus. Dermatology Clinics. 2010;28:707.
  7. Chi CC, et al. Topical interventions for genital lichen sclerosus. Cochrane Database Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008240.pub2/abstract. Accessed Aug. 7, 2015.
  8. Funaro D, et al. A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. Journal of the American Academy of Dermatology. 2014;71:84.