Lichen Sclerosus: Know what’s below

by Liz Giles, Clinical Herbalist

Are you or someone you know suffering from a painful, dry and severely itchy genital condition? Does it make sexual contact painful if not impossible? Are you noticing changes in the landscape “down there”? If so you may be one of the growing number of people being diagnosed with lichen sclerosus. Once considered a rare medical condition, lichen sclerosus is on the rise, affecting people of all genders, ages, races and economic status.

First written about in 1887 by Dr. Hallopeau and termed “lichen plan atrophique,” it has undergone many name changes, the most modern being lichen sclerosus. Many cases are asymptomatic … until they aren’t. Classic presentation of LS is characterized by patchy, white, thin skin (referred to as “cigarette paper” skin) with atrophic quality; plaques associated with pruritus (severe itching) and pain, resulting in genital lesions; and finally scarring and adhesion. Left untreated, complications can include disfigurement (fusions of labia, penile tissues, clitoral obliteration) resulting in a figure “8” or “hour glass” presentation of scarring in both women and men. There is concern for sealing off the urethra, the vaginal canal or anus. Untreated, there is increased risk of developing squamous cell cancer (<5% sans additional risk factors). Though not contagious, LS can have destructive emotional ripples that affect partner relationships.

This inflammatory skin disorder can present at any site on the body, but it usually appears in the anogenital area. It is most commonly found in women in their perimenopausal through menopausal years, young prepubescent girls, and males between the ages of puberty and 60 years. Oral presentations have been reported, although rarely, and other body parts can be affected, less commonly. Proper diagnosis is necessary to differentiate from other similarly presenting conditions such as lichen planus (LP), vitiligo, vulvar intraepithelial neoplasia, etc. (1)

While lichen sclerosus is still considered to be idiopathic (of unknown origin) by conventional medicine, scientific research has pointed to these potential causes: previous trauma to the same tissue, hormonal imbalances, genetic links, chronic infections (HPV, HCV, EBV and Borrelia) and autoimmune factors. Whether only one or multiple causes are needed to start the disease is not yet agreed upon; however, there seems to be a recent consensus in the medical research community that LS is an autoimmune disease (one of over 100 confirmed and 40 suspected autoimmune diseases that the National Institutes of Health has recognized thus far).

In my upcoming class, this potentially devastating sexual health issue will be discussed in depth, including how to get a proper diagnosis; the links to autoimmunity and what can be done to mitigate them; and how to help reverse and even avoid developing lichen sclerosus in the first place. Join us at CSCH, Tuesday, March 6th, from 6-7:30 pm.

Resources:

Murphy, Ruth. “Lichen Sclerosus.” Dermatologic Clinics, vol.28, no.4, 6 Oct. 2010, pp. 707-715., doi:10.1016/jdet.2010.07.006

Fistarol, Susanna K., and Peter H. Itin. “Diagnosis and Treatment of Lichen Sclerosus.” American Journal of Clinical Dermatology, vol. 14, no. 1, 14 Dec. 2012, pp. 27–47., doi:10.1007/s40257-012-0006-4