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Lichen sclerosus: Symptoms and treatment
Lichen sclerosus (atropicus) is a chronic inflammatory skin condition affecting the vulva and anus. In this guide, you'll find information about causes, diagnosis, symptoms and treatment – and how a new form of therapy can help you significantly reduce symptoms or even stop the progression of the condition.
Table of contents:
Before we begin, I’d like to introduce a new approach to treating lichen sclerosus symptoms: with FMS dilators, women affected by the condition can independently and very gently and effectively counteract narrowing of the vaginal opening and adhesions or shrinking of the labia – and even regain flexibility after changes have occurred. FMS dilators differ significantly from conventional ones by softening hardened tissue through gentle massage. They are certified medical devices that meet the legal requirements for clinical studies, proven effectiveness and safety. You’ll find more details on their application for skin conditions such as lichen sclerosus.
Causes and development of lichen sclerosus
Lichen sclerosus is a condition whose exact causes are still not fully understood. It is classified as an autoimmune disease, although hormonal and genetic factors also seem to play a role.
The condition primarily affects women and girls, less frequently men and boys. It usually progresses in flare-ups, with several years between episodes in some cases.
How the diagnosis is made
The diagnosis is usually based on a visual examination of the affected areas and the symptoms present. This allows for a reliable diagnosis – provided that an experienced doctor or gynaecologist has been consulted. Many patients report a long process with multiple doctor visits before receiving a clear diagnosis.
Medicine is not infallible when it comes to diagnosing lichen sclerosus. A Swiss doctor developed the "Lichen Sclerosus Score", which can be very helpful in making a diagnosis. A biopsy (tissue sample) is also possible, though it is rarely used and mainly serves to rule out other conditions. Over time, many patients become experts on their own body and can identify changes with great accuracy.
Symptoms in women and girls
In most cases, the condition begins with burning and itching in the genital area. A reddish-brown eczema initially appears, which later turns into white, often shiny patches – typically forming a figure-eight shape around the vulva and anus. The disease affects only the external anogenital region; the vagina itself is never involved. The skin becomes thinner, with some thickened white areas (atropicus). Small bruises may also appear.
Hardened areas and small tears may also develop, leading to soreness and eventually white scar tissue.
These skin changes are accompanied by intense, persistent itching. The skin is sensitive, cracked, and sore. Pain often occurs during intercourse – and may last for several days. Urination can also be difficult or painful.
It is rare for all symptoms to appear at the same time. The condition presents differently from person to person.
In lichen planus (lichen ruber planus), patients often report similar symptoms, but with additional involvement of the mouth. In advanced cases, painful areas may develop on the gums, the vestibule (vaginal entrance) and even inside the vagina. These changes are usually accompanied by narrowing due to tissue hardening (lichen planus erosivus).
Dilators are one of the tools used for treatment. FMS dilators are special glass dilators with a new shape that allows for an extremely gentle and effective form of therapy. They are also used in many other medical and gynaecological conditions.
Symptoms in men and boys
In men, the foreskin of the penis is usually affected. Hardening leads to narrowing (phimosis), which can cause inflammation as the foreskin can no longer be retracted – or only with difficulty – for hygiene purposes.
Other symptoms are similar to those in women: there may be itching, the skin turns white, and scarring may occur. Pain during intercourse and urination can also develop. Without treatment, the glans (head of the penis) and urethral opening may be affected as well.
Children can also develop lichen sclerosus. In such cases, itching and external symptoms are often milder. However, constipation is commonly reported as a secondary symptom.
Treatment options for lichen sclerosus
Typically, the affected skin areas are treated with cortisone or cortisone-based ointments – initially applied daily in a short-term course, then used less frequently for maintenance. In some cases, cortisone may be injected by healthcare professionals. Cortisone-free creams (e.g. Deumavan, Noreiz, Dermatol) are gentler for long-term use, but less effective during acute flare-ups.
A complete cure is generally not considered possible in conventional medicine, but symptoms can often be significantly reduced. New laser-based therapies are also available, such as the MonaLisa Touch laser. In clinical settings, gynaecologists often collaborate with radiologists and gastroenterologists.
If only the foreskin is affected in men, circumcision (surgical removal of the foreskin) can lead to long-lasting relief. In men and children, cortisone and fatty ointments such as Dermatol are also the preferred treatment. More information is available from the German lichen sclerosus support group at www.lichensclerosus.de.
Living with lichen sclerosus
The following measures can help you integrate lichen sclerosus into your daily life:
Dealing with skin changes
- Apply fatty ointments or specialised skincare products such as Dermatol, Deumavan, Linola or Noreiz regularly to the affected areas.
- Avoid conventional soaps in the intimate area and use gentle, skin-friendly washes instead.
- Wear breathable clothing and underwear made of natural materials such as cotton or silk, and avoid wearing thongs.
- Ensure soft bowel movements – especially if the anus is affected – for example by using psyllium husks.
Because lichen sclerosus is an autoimmune condition, it’s also helpful to support your immune system through nutrition:
- Eat plenty of fresh vegetables and fruit. Some people report improvement when avoiding lactose, dairy protein, gluten or histamine – though this hasn’t been scientifically proven.
- Take care of your mental health and balance: learning relaxation techniques and meditation may also be beneficial.
Support groups
- Exchange experiences with others in support groups. Be cautious with online forums run by “patients” – sometimes a simple phone call can reveal whether the person really exists.
Self-care and treatment
You can actively support your body in treating lichen sclerosus: The foundation is gentle daily care of the vulva or foreskin using fatty ointments to improve skin elasticity and relieve itching.
Daily, gentle stretching of the vaginal introitus (vaginal opening) in women or the foreskin in men is also very important – this helps prevent narrowing or adhesions. It’s essential to use a very mild lubricant to avoid irritating sensitive skin.
To prevent surgical intervention due to scarring and narrowing of the vulva, we developed FMS dilators:
They are extremely smooth and gentle. Their special effectiveness does not rely on stretching, but on movement and flexibility – gently massaging the affected skin areas. FMS dilators are available in 27 sizes, allowing you to choose what fits your needs best. In addition, the Theros® Bougie Dilators are also available in even smaller diameters.
FMS dilators are certified medical devices.
Learn more about their special features here.
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