Lichen Sclerosus and Lichen Planus, what are they?
Dermatology defines both lichen sclerosus (LS) and lichen planus (LP) as chronic skin conditions that can cause pruritus (intense itching) and discomfort, particularly in affected areas like the genitals, though other body parts can be affected.
While these two conditions share similarities and form part of the lichenoid group of skin diseases, LS and LP are distinct conditions with different causes and treatments.
What is lichen sclerosus?
LS is a chronic skin condition that is more common in women, especially after menopause. However, it can also affect men and children. LS causes white, shiny patches of skin or papules that may feel itchy, painful, or uncomfortable.
In women, it often affects the vulva and can lead to scarring or narrowing of the vaginal opening, which may make sexual intercourse painful (known as dyspareunia).
In men, it can cause tightening of the foreskin, making it difficult to retract.
What causes lichen sclerosus?
The exact cause of LS isn’t fully understood, but it is thought to involve some autoimmune diseases that mistakenly cause the patient’s body’s immune system to attack the skin.
Hormonal changes, genetics, or skin trauma may also play a role.
LS is associated with conditions like thyroid disease, vitiligo, or alopecia areata.
How do we diagnose lichen sclerosus?
Diagnosis is usually based on the appearance of the skin, but sometimes, a small skin biopsy is needed to confirm it. Treatment options typically involve high-potency topical steroid creams to reduce inflammation and itching, along with regular monitoring to prevent complications like scarring or, in rare cases, skin cancer.
What is lichen planus?
Although the prevalence of LP is noticeably higher in women, it can affect both genders, usually between the ages of 30 and 60. LP papules often present as purple, itchy bumps on the skin, commonly on the wrists, ankles, or lower back.
It can also affect the mucous membranes, such as the inside of the mouth (known as oral lichen planus) or the genital area, causing white, lacy patches or painful sores. LP can sometimes affect the nails or scalp, leading to thinning or hair loss.
What causes lichen planus?
Like LS, the exact cause of LP isn’t clear, but it’s also thought to involve an autoimmune response. Triggers can include:
- Stress
- Viral infections like hepatitis C
- Certain medications, such as beta blockers or NSAIDs.
- LP is also associated with other autoimmune conditions, such as lupus or alopecia areata.
However, suppose a patient presents with chronic symptoms, such as ulcers and disabling pain. In that case, it is essential to rule out erosive lichen planus, a rare variant of LP that requires diagnosis, treatment, and ongoing management in more persistent cases.
How do we diagnose lichen planus?
The appearance of the lesions usually determines the diagnosis, but a biopsy may sometimes be necessary to confirm it.
Do lichen sclerosus and lichen planus look the same?
No, LS and LP have distinct visual characteristics:
What does lichen sclerosus look like?
- LS starts as small, shiny, smooth white patches.
- The patches grow larger and merge into plaques.
- The skin becomes thin, wrinkled, and parchment-like.
- A characteristic figure of 8 pattern forms around the genitals and anus.
- The skin can develop tears, cracks, and bruising in affected areas.
What does lichen planus look like?
- LP presents as small, flat-topped, purple to reddish bumps.
- Distinctive gray to white streaks (Wickham’s striae) can be seen on the surface.
- In the mouth, it appears as white streaks or patches in a network pattern.
- LP leaves behind dark patches when healing.
- LP can affect nails, causing thickening, ridges, or splitting.
What are the key visual differences between lichen sclerosus and lichen planus?
- LS primarily appears as white, thin, wrinkled patches.
- LP appears as purple-brown, flat-topped bumps with scaling.
- LS rarely affects the mouth, while LP commonly does.
- LP tends to leave darker post-inflammatory pigmentation.
- LS typically affects the genital and perianal areas, while LP can be more widespread.
How do we treat lichen sclerosus and lichen planus?
Treatment for lichen sclerosis and lichen planus often involves steroid creams or ointments, oral medications for severe cases, and light therapy for widespread skin involvement. Patients are advised to gently cleanse the affected areas with mild soap for sensitive skin and rinse thoroughly.
If conventional treatments, like topical steroids or oral medications, are ineffective or if steroid treatment is not recommended, calcineurin inhibitors, such as tacrolimus and pimecrolimus, may be considered in consultation with a vulvar dermatologist.
Severe cases of either of these conditions for women can cause a very significant narrowing of the vaginal opening or even fusion of the vaginal canal. Vaginal dilators may help in milder cases of vaginal narrowing, but more severe cases, including fusion of the vaginal canal, would likely require surgical correction, which should only be performed by doctors with expertise in vaginal reconstruction, as we have at Tower Urology.
Depending on your anatomy, this surgery could involve widening the opening of the vagina using specialized reconstructive techniques or recreating the vaginal canal with a tissue graft.
In severe cases for men, it can cause tightening of the foreskin (phimosis) to the point where you aren’t able to retract it. In this case, a circumcision or dorsal slit procedure may be necessary to release the glans of the penis.
Both conditions are manageable with proper treatment; however, ongoing care is necessary to prevent complications and improve quality of life.
Tower Urology is your best care option for lichen planus and lichen sclerosus in Los Angeles
If you’re experiencing symptoms such as itching, pain, or unusual skin changes, it’s essential to get evaluated so we can confirm the diagnosis and develop the appropriate treatment plan for you. We will work together to address your symptoms and help you feel more comfortable. Treatment plans will include all necessary follow-up appointments.
Tower Urology’s advantage lies in our unwavering commitment to providing world-class urologic care through advanced technology, personalized treatment plans, and a patient-centered approach. With a reputation for excellence and innovation, we deliver superior outcomes that distinguish us as leaders in urologic health.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
We invite you to establish a care plan with Tower Urology.
Tower Urology is conveniently located for patients throughout Southern California and the Los Angeles area, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, and Downtown Los Angeles.
Our services include treatment for pelvic organ prolapse, menopause/hormone management, chronic pelvic pain syndrome in women, shockwave therapy for pelvic pain, interstitial cystitis, lichen sclerosis and planus, urethral diverticulum, urethral stricture disease, urinary fistulas, and vaginal mesh complications.
Lichen Sclerosus and Lichen Planus FAQs
LS is frequently misdiagnosed and can lead to years of delayed proper treatment because it presents similar to other conditions. These include:
- Fungal Infections
- Yeast infections (candida vulvitis) are one of the most common misdiagnoses,
- Inflammatory conditions
- Lichen planus (especially the erosive type)
- Lichen simplex chronicus
- Contact dermatitis
- Psoriasis
- Morphea (localized scleroderma)
- Discoid lupus erythematosus
- Vitiligo
- Mucous membrane pemphigoid
- Bullous lupus erythematosus
The estimated incidence ranges from 0.1% to 0.3% for both males and females. Recent data from Sweden show an overall incidence of 80.9 cases per 100,000 persons per year, with females having a significantly higher prevalence rate (114.4 per 100,000) than males (47.2 per 100,000).
Yes, treatment significantly influences the prognosis of vulvar lichen sclerosus (VLS), particularly when started early and maintained consistently.
Topical corticosteroids are highly effective, with 96% of patients prescribed such medication showing symptom improvement and 66% becoming completely symptom-free. About 23% of patients show a complete reversal of skin changes with a return to normal texture and color.
No, VLS is not cancer, but it is associated with an increased risk of developing vulval cancer, so it is essential to seek medical advice.
Without treatment, the condition typically persists and may worsen over time, potentially leading to complications such as scarring and increased cancer risk. Therefore, seeing your healthcare provider, who can provide a formal diagnosis and ongoing medical management for positive long-term health outcomes, is essential.
However, even if symptoms temporarily improve without treatment, the condition may return. Seeking the advice of an experienced urologist, such as those at Tower Urology, who are committed to providing the best treatment and guidance for each individual, will give you peace of mind.
Sources
Diagnosis and Treatment of Lichen Sclerosus
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691475
Association of Retinoic Acid Receptor β Gene With Onset and Progression of Lichen Sclerosus–Associated Vulvar Squamous Cell Carcinoma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128494
Long‐term management of vulval lichen sclerosus in adult women
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1479-828X.2010.01142.x
Lichen sclerosus in female children
https://www.bad.org.uk/pils/lichen-sclerosus-in-female-children/
Lichen sclerosus
https://www.dermnetnz.org/topics/lichen-sclerosus/
