Lichen Sclerosus

Lichen sclerosus is an inflammatory skin condition that can cause itching, soreness, white patches and fragile vulval skin.

Lichen sclerosus is an inflammatory skin condition, usually affecting the vulva and skin around the anus. It is not an infection and cannot be passed through sexual contact. The skin may become pale, thin and fragile, with changes that need ongoing care even when symptoms settle.

Vulval skin changes are a very common presentation of lichen sclerosus. Itching, white patches and vulval pain are common presentations too. Cracks, soreness, easy bruising and pain during sex can develop when skin becomes fragile or the vaginal opening narrows. Symptoms may be worse at night or after friction.

The precise cause is not known. The condition may involve an overactive immune response and inherited susceptibility. Hormonal changes and local irritation may influence symptoms, but lichen sclerosus is not caused by poor hygiene, sexual activity or a sexually transmitted infection.

Lichen sclerosus often follows a relapsing pattern, with quieter periods and flares. Without control, repeated inflammation can scar the skin, narrow the vaginal opening or fuse skin folds. Symptoms can improve with treatment, but the condition may still need long-term monitoring.

It can occur at any age, including after menopause and during childhood. A personal or family history of autoimmune conditions may be associated with it. These associations do not confirm a diagnosis, and symptoms should be assessed rather than self-labelled.

A clinician usually diagnoses lichen sclerosus by asking about itching and soreness and examining the affected skin. A small biopsy may be recommended when the appearance is unclear, symptoms do not respond as expected or a persistent thickened, ulcerated or changing area needs checking. Infection and other skin disorders can look similar.

The main treatment is a prescribed topical corticosteroid applied to affected skin in a planned schedule. Topical steroid treatment for vulval skin reduces inflammation, itching and the risk of further scarring when used correctly. A clinician will explain where to apply it, how to taper or maintain treatment and when to return. Severe scarring may require specialist discussion about surgery.

Wash gently with water or an unscented emollient and avoid fragranced products, tight clothing and scratching. Use a protective ointment if advised, and lubricant can reduce friction during sex. Learn the normal appearance of your skin so you can report a new lump, sore, ulcer or persistent thickened area promptly.

Scarring can alter the vulval shape, narrow the vaginal opening and make sex or urination uncomfortable. Cracked skin can be painful and may become irritated. Lichen sclerosus is also linked with a higher risk of vulval cancer, so new persistent or changing lesions need prompt review.

There is no known way to prevent lichen sclerosus. Avoiding irritants, treating flares early and following the prescribed skin-care plan can reduce inflammation and protect the skin. Regular follow-up remains useful even when itching has stopped.

A vulval-care gynaecologist, dermatologist or clinician experienced with inflammatory skin conditions can confirm the diagnosis and plan monitoring. Bring a list of products and treatments used, mention autoimmune conditions, and ask how to recognise a flare or a change needing biopsy.