All you need to know about White Spot disease.
Know your ailment well, so you can manage it better!!
Here we come with Lichen sclerosus today!
What is Lichen sclerosis?
Lichen sclerosus is an unusual disorder in which patchy, white skin appears thinner than normal. Typically it affects both the genital and anal regions.Anyone may get lichen sclerosis but there is a higher risk for postmenopausal women.
Your doctor may prescribe treatment with creams or ointments that help return your skin to a more natural appearance and decrease the scarring tendency. The disorder appears to recur so there may be need for long-term follow-up treatment. Rarely does lichen sclerosus improve untreated.
Lichen sclerosus is characterized by changes in the skin of the outside genitalia. The most popular distribution is a figure of 8 that includes the perianal and vulva regions. It can also affect the head of the penis, and other parts of the body. Actually, this skin condition can affect any surface of the skin. Some lichen sclerosus patients have no symptoms, while others experience extreme scratching, pain and/or erosions/ulcers. Usually, lichen sclerosus has a remitting relapsing path which is complicated by permanent scarring of affected areas. This causes functional issues for affected women such as difficulty with urination, defecation and intercourse and difficulty with urination or erections in men. The disease is neither infectious nor a sexually transmitted illness.
Who gets the disease:
Lichen sclerosus appears:
- Most often in women (usually after menopause).
- Less commonly in men.
- Rarely in children.
Lichen sclerosus is more likely to occur in women, especially after menopause. It is uncommon in infants. Your parents may have inherited an elevated risk of lichen sclerosus.
What are the symptoms of Lichen Sclerosus?
There may be no symptoms in mild cases of the disease. If you do have signs, they can include:
- Small white spots on the skin (early in the disease).
- Spots that grow into bigger patches, with skin over patches becoming thin and crinkled.
- Skin that tears easily, producing a bright red or purple bruise.
- Skin that becomes scarred.
- Itching, which is very common.
- Discomfort or pain.
- Bleeding.
- Blisters.
Often the skin tissue becomes small, glossy, wrinkled and like a parchment. Fissures, fractures, and patches of purplishes (ecchymoses) also occur. The earliest lichen sclerosus areas show a white porcelain core that appears rounded by redness. This grows together to form larger sclerosal areas of lichen. The rubbing and friction-prone areas may develop blisters or bruise. The long-term outcome of lichen sclerosus is areas of shiny, thin skin which tends to be dry, crack, or bleed. This also results in loss of the usual sections of the outer genitals, narrowing of the urerthra / vagina / anus gap, and phimosis (incapacity to retract the foreskin) in males. The appearance of non-healing ulcers or elevated ulcerated areas in women’s external genitalia increases concern that squamous cell carcinoma can grow.
In males, lichen sclerosus most often affects the penis foreskin although it can affect other areas of the body. The opening through get narrow and scarred at the end of the foreskin. Changes in skin and discolouration can also occur. The signs may include scratching, painful erections and soreness. In men perineal involvement is rare.
Skin lesions can also develop in the mouth, in some rare cases. The lesions consist of irregular bluish-white patchy patches on the inside of the cheeks and/or palates. Can often include the tongue, lips, and gums.
What are the causes of Lichen Sclerosus?:
The cause of sclerosal lichen is unknown. An overactive immune system or a hormone imbalance can play a part in this. Previous skin damage on your skin at a particular site may increase the likelihood of lichen sclerosus at that site.
Lichen sclerosus is not contagious, and can not be spread through sex.
Lichen sclerosis occurs frequently in postmenopausal women, but also men and children. In women, the vulva usually involves lichen sclerosus. Uncircumcised males are the most at risk in boys and men, because the condition affects the foreskin generally.
In children, the signs and symptoms may improve at puberty, but disease activity will still require monitoring.
What are the complications of Lichen Sclerosus?
Complications of lichen sclerosus include painful sex, urinary retention, constipation and an inability to retract the foreskin. People with lichen sclerosus are also at an increased risk of squamous cell carcinoma of the affected area.
What are the risk factors of Lichen Sclerosus?
The risk of lichen sclerosus is higher for postmenopausal women, although it can occur in men and children. Men who are uncircumcised have a higher risk because the condition often affects the foreskin.
How is Lichen scelrosus diagnosed?
Typically a doctor takes a small piece of skin and looks at it under a microscope to identify sclerosus lichen. Doctors will look at you in more serious cases just to diagnose the disease depending on how it has affected the skin.
What is the treatment for Lichen Sclerosus? Patches on arms or on the upper body do not typically need care. They ‘re going to go away over time. Genital skin patches should be treated, even though they are neither sore nor itchy. These patches may scar off, causing urination or sex problems. There’s also a very small risk that skin cancer in the patches can grow. You should see your doctor every six to twelve months to monitor and treat any changes in your skin. If you have lichen sclerosus on or around your genitals or anus, or other areas of your body with a more advanced case, your doctor will prescribe medication. Treatment helps to minimise scratching, to enhance the texture of the skin and to prevent further scarring. Repetition is popular. Rarely does lichen sclerosus develop on its own.
If a young girl gets lichen sclerosus, sometimes it can get away with puberty. This means lifelong treatment may not be needed, although scarring and skin colour changes can remain.
Possible lichen sclerosis therapies include:
- Surgery: Circumcision is the most commonly used treatment for men with lichen sclerosus and typically after this operation, the disease does not return. However, surgery is not a viable choice for women, as the disease typically returns after patches of lichen sclerosus have been removed from their genitals.
- Medications: Including heavy cortisone creams or skin ointments. For several weeks these should be applied to skin patches every day to avoid the scratching. Using the cream or ointment for a long time , two days a week, will prevent the disease from returning. Treatment doesn’t repair the scarring that might already have taken place.
See your doctor on a regular basis, since long-term use of these creams and ointments can cause:
- Thinning and redness of the skin.
- Stretch marks where the cream is applied.
- Genital yeast infections.
Sometimes, you don’t get better when using the cortisone creams. Reasons for this can include
- Low estrogen levels.
- Infection.
- Allergy to the medication.
When creams and ointments don’t work, your doctor may suggest:
- Retinoids, or vitamin A-like drugs.
- Tacrolimus ointment to suppress the body’s misguided immune system.
- Ultraviolet light treatments (not used on skin of the genitals).
How to Cope up:
These self-care tips may help, whether you are undergoing treatment or not:
- Apply lubricant (petroleum jelly, A and D ointment, Aquaphor) to the affected area.
- Gently wash the affected area daily and pat dry. Avoid harsh soaps and bathing too much.
- Ease burning and pain with oatmeal solutions, sitz baths, ice packs or cool compresses.
- Take an oral antihistamine at bedtime to help control the itching as you try to sleep.
References:
https://www.mayoclinic.org/diseases-conditions/lichen-sclerosus/diagnosis-treatment/drc-20374452
https://rarediseases.org/rare-diseases/lichen-sclerosus/
https://www.niams.nih.gov/health-topics/lichen-sclerosus/advanced#tab-treatment
By,
Gopala Krishna Varshith,
Content Developer & Editor,
Clipo.
