What are the first signs of lichen sclerosus?

Lichen sclerosus commonly affects the skin around the vulva and anus. It may cause itching that is worse at night, soreness after rubbing, small splits, or pain during sex. The skin can change in colour and texture, and scratching may create bruising or tiny areas of bleeding.

Not every itchy or pale patch is lichen sclerosus. Thrush, contact irritation, eczema, and other skin conditions can look similar. An examination is needed to identify the cause; symptoms are not a diagnosis. Read about [Vulval Skin Changes](/symptoms/vulval-skin-changes/) and [White Patches On Skin](/symptoms/white-patches-on-skin/).

Book an appointment if itching or skin changes persist, recur, or cause cracks. Until then, wash gently with water or an unperfumed emollient, pat dry, and choose loose cotton underwear. Avoid scratching and fragranced products. A clinician may recommend [Topical Steroid Treatment for Vulval Skin](/treatments/medical-gynaecology/topical-steroid-treatment-for-vulval-skin/) and arrange follow-up to check the skin.

Seek prompt assessment for a sore that does not heal, a lump, thickened area, persistent bleeding, or a new change that is getting larger. Seek urgent help for severe pain, spreading redness, fever, or difficulty passing urine. Early review can reduce irritation and protect the skin's structure.

Could this be lichen sclerosus or another skin condition? Do I need a biopsy or follow-up examination? How should I apply the prescribed [Topical Corticosteroids](/treatments/medical-dermatology/topical-corticosteroids/), and which changes should I report?