Lichen sclerosus is a chronic inflammatory skin disease commonly found in the ano-genital area (anus and genitalia); however, lichen sclerosus can affect the skin anywhere, including the mouth. It is more common in postmenopausal women, but can also be found in children and men. The majority of patients present with itching, though children can present with constipation. The cause of lichen sclerosus has yet to be determined but is associated with auto-antibodies, infection and certain genetic characteristics. Treatment is often with topical corticosteroids, which reduces symptoms and can prevent disease progression.
Lichen sclerosus found in the genital area has been shown to have an increased risk of developing squamous cell carcinoma. A study in 2000 and published in the “British Journal of Dermatology” showed that women with lichen sclerosus had a 5 percent lifetime risk of vulvar cancer. However, a study in 1995 published in the “Journal of the American Academy of Dermatology", showed that the risk for men with lichen sclerosus developing cancer was lower.
Lichen sclerosus as it progresses can alter the architecture of the tissue. Lichen sclerosus causes scarring, which can result in painful sexual intercourse in women. In men, lichen sclerosus can result in scarring and contraction of the foreskin leading to painful erections and urinary obstruction. Surgery may be required to release the contractures.
Lichen sclerosus around the anal area can cause fissures due to tightening and scarring of the skin. Patients can suffer from pain, bleeding and cracks in the skin. A study, published in 2005 in "Pediatrics" and conducted by Maronn and Esterly, showed that 67 percent of girls with lichen sclerosus suffered severe constipation while 89 percent had some form of gastrointestinal problems such as bleeding with bowel movements, fissuring, constipation and soiling.
Improvement of clinical symptoms of lichen sclerosus can still leave the patient with pain or a burning sensation. Treatment can be with local anaesthetic ointments, or a low-dose antidepressant medications such as amitriptyline.