Lichen Sclerosis:

A Guide for Teens
Lichen sclerosis is a skin condition that usually affects the vulva area (the outside parts of the female genitalia) and the anal area in young girls, adolescents, and adults. Similar to other skin conditions, there are treatments available to help the symptoms.

What is lichen sclerosis and what does it look like?
Lichen sclerosis (LS) is a skin condition that makes the vulva look white, slightly shiny, and smooth. The skin's surface becomes thin and delicate so that it tears easily. This can cause bleeding under the skin. In severe cases of lichen sclerosis of the genital area, scarring can occur. This causes the inner lips of the vulva to get smaller. The clitoris can become covered in scar tissue.

What causes lichen sclerosis?
We do not know the exact cause of lichen sclerosis. Scientists have different theories to try to explain the cause. Some scientists think that an overactive immune system may play a role in causing the disease. Some people may also develop lichen sclerosis due to their genes or to changes in hormones. Since lichen sclerosis is not caused by an infection, it cannot be spread and is not contagious.

What are the symptoms of lichen sclerosis?
Symptoms of lichen sclerosis may be different from one person to another and can be mild to severe. Girls and young women who have this disease may experience some or all of the following symptoms in the vulvar area:
mild to severe itching in the vulvar area
skin that appears fragile, pale, and/or white
bruised skin with broken blood vessels or "blood blisters"
small tears or fissures in the skin
scar tissue covering the labia or clitoris
bleeding or tearing of skin when having bowel movements
How is lichen sclerosis diagnosed?
Lichen sclerosis can be a difficult diagnosis to make. It is not unusual for someone to see more than one doctor before the disease is finally diagnosed. This can be very frustrating for you if the treatment you are receiving isn't working. Most of the time, doctors who see a lot of patients with lichen sclerosis can often make the diagnosis just by looking at the skin, but still may need to do a biopsy. If you are in the early stages of lichen sclerosis, the doctor may have to do a biopsy (removal and examination of a small sample of affected skin) to identify the cause of your symptoms.

Will I need treatment?
Even if you do not have symptoms such as itching or pain, it is important for you to receive medical treatment for lichen sclerosis. Treatment to genital skin is necessary to try to prevent scarring of the vulva. Without treatment, there can be scarring that causes parts of the vulva to narrow and cause problems with passing urine or pain with sexual activity. Severe scarring can cause the opening to the vagina to narrow. Intercourse may be painful if the vagina narrows too much.

Are there medicines to treat lichen sclerosis?
Yes. Medications are available to help with the symptoms of lichen sclerosis. They are only available by a prescription from your doctor. If you have lichen sclerosis, your doctor will most likely prescribe a strong topical corticosteriod, which is a type of ointment that reduces swelling and itching on your skin. This medicine also decreases the body's immune response. Your doctor will probably tell you to apply this drug every day so that your skin can return to its normal surface and strength. The amount of time it takes for this to happen is different from patient to patient. It is important to realize that the treatment may not undo the scarring that may have already occurred.
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