@ Skin Condition

LICHEN SCLEROSUS

Lichen sclerosus is a chronic inflammatory skin condition resulting in well-defined shiny white spots on the skin. The condition can be seen in all ages but occurs more frequently in women of middle age. The condition more commonly affects women than men.

Symptoms
Lichen sclerosus most commonly affects the genital area. The predominant symptom is acute (intractable) itching of the vulval area. There may also be soreness and pain. Blood blisters and sores can occur, especially where the skin is scratched. The vulva thickens and looks white. Scarring may occur. Splitting of the skin can occur in the vulval and perianal area, especially on passing bowel movements.

Atrophy and change in the vulval features occur in long established cases and include fusion of the labia over the urethra, causing difficulty in urination. The clitoris may become ?reg;buried'. There may be narrowing of the vaginal opening making sexual intercourse difficult. Infections (including ?reg;thrush') may be present.

In men the penis is affected by itching, soreness, difficulty in retracting the foreskin and, due to a narrowing of the urethra, in urinating. The skin may look pale.

There is a small risk of cancer currently estimated at around 3%. The condition can also affect other areas of the body, for example the shoulders. Children are similarly affected.

Psychological
One of the main problems is recognition and appropriate diagnosis by the General Practitioner. Misdiagnose of the condition as ?reg;thrush' is relatively common, or as a psychological complaint to be treated with anti-depressants and tranquillisers. An accurate diagnosis is delayed for many years in some people. Earlier specialist referral would reduce the distress caused to people who fail to respond to treatments for infections.

There is a tendency for those experiencing painful sex to have a sense of low confidence and self worth, to feel they are freaks, to experience a loss of femininity/masculinity. Many grieve for their sexuality. There is often a very real feeling of total isolation and despair. Patients have difficulty in coming to terms with the disabling effect lichen sclerosus can have on everyday life.

Treatments There is, as yet, no cure for lichen sclerosus.

Treatments aim to relieve the symptoms of the condition by the use of topical steroid creams. Surgery is not part of the treatment but is sometimes necessary to separate fused labia and to relieve the symptoms of scarring.

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