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by Jones P
(LS, White Spot Disease)

Definition

Lichen sclerosus (LS) is a long-term skin problem that often causes white patches. It is most common on genital and anal skin. A mild form can grow on the upper body and arms.

Causes

The exact cause is not known. Some things that may play a role are:

  • Immune system overreaction
  • Genes passed down in a family
  • Injuries or infections that caused scarring
  • Hormone changes

Risk Factors

LS is more common in women after menopause. Other things that may raise the risk are:

  • Tissue damage during labor and delivery
  • Surgery in the area
  • Genital jewelry
  • A history of sexual abuse

Men with an uncircumcised penis may be at greater risk.

Symptoms

Symptoms start slowly and can worsen over time. Later stages may cause:

  • Itching that may be worse at night
  • Small white spots that grow into larger patches
  • Pain, including pain during sex
  • Skin that tears or bruises easily
  • Bleeding
  • Pain when passing urine or stool

Men may also have:

  • Tightening of the foreskin
  • Pain with erection

Diagnosis

The doctor will ask about your symptoms and past health. A physical exam will be done. This may be enough to diagnose LS. A biopsy may be done if LS is not clear. A small sample of skin will be scraped off and sent to a lab.

Treatment

Patches in the genital and anal area should be treated even if they are not causing symptoms. LS can cause scarring. The scars can cause pain during sex and problems passing urine or stool. Early treatment may stop these problems from starting. Treatment choices may be:

  • Medicated creams or ointments that are placed over the area. They can help ease irritation and itchiness. They may be used during flare ups or on a regular basis to prevent flare ups.
  • Surgery may be done to remove scarring in women or remove patches in men. This may only be used if scarring or patches are causing problems.
  • Some irritants can make problems worse. Soaps and clothing that irritate the area should not be used.

LS patches on the upper body or arms may go away on their own. They will be watched closely by a doctor.

Skin cancer can grow in LS patches, but this is rare. A doctor will want to check the area every 6 to 12 months to look for changes.

Prevention

LS cannot be prevented. The cause is not known.

RESOURCES

Family Doctor—American Academy of Family Physicians  http://www.familydoctor.org 

Urology Care Foundation  http://www.urologyhealth.org 

CANADIAN RESOURCES

Canadian Urological Association  http://www.cua.org 

Health Canada  https://www.canada.ca 

References

Lichen sclerosus. EBSCO DynaMed website. Available at:  https://www.dynamed.com/results?q=lichen+sclerosis&lang=en . Updated July 16, 2018. Accessed February 19, 2020.

Lichen sclerosus. National Institute of Arthritis and Musculoskeletal and Skin Disorders. Available at: https://www.niams.nih.gov/health-topics/lichen-sclerosus#tab-overview. Accessed February 19, 2020.

Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013 Feb;14(1):27-47.

Revision Information