Lichen Sclerosus: Symptoms, Diagnosis, Treatment and Long-Term Care

Dr Salian

AUTHOR

1 Min. Read January 06, 2026

Lichen sclerosus is a chronic inflammatory skin condition that most commonly affects the vulval and perianal skin in women. Symptoms can vary significantly between individuals, but without appropriate treatment the condition may lead to long-term discomfort, scarring, and anatomical changes. Early diagnosis and ongoing management are key to maintaining skin health and quality of life.

What Is Lichen Sclerosus?

Lichen sclerosus is a long-term dermatological condition characterised by inflammation and thinning of the skin, most often affecting the genital area. The exact cause is not fully understood, but it is thought to involve a combination of autoimmune, genetic, and hormonal factors. The condition is not infectious and cannot be passed between individuals.

Common Symptoms of Lichen Sclerosus

Symptoms can range from mild to severe and may progress over time. In women, common features include:

Persistent itching (pruritus)
Pain, burning, or soreness
White, patchy skin that may appear thin, wrinkled, or thickened
Easy bruising, fissures, and erosions
Painful urination (dysuria)
Painful sexual intercourse (dyspareunia)

If left untreated, lichen sclerosus can lead to irreversible anatomical changes, including labial fusion, narrowing of the vaginal opening, and clitoral burying. These changes may significantly affect sexual function and daily comfort.

How Is Lichen Sclerosus Diagnosed?

Diagnosis is primarily clinical and based on the characteristic appearance of the affected skin.

Additional investigations may be required in certain situations:

Clinical examination: Careful visual assessment of the vulval skin.
Skin biopsy: Recommended if the diagnosis is uncertain, symptoms do not respond to treatment, or malignancy is suspected.
STI screening: Considered if symptoms are atypical or there are risk factors for infection.

Management and Treatment Options

The main aims of treatment are symptom relief, prevention of skin damage, and early detection of malignant change.

First-Line Treatment

High-potency topical corticosteroids are the cornerstone of management. These reduce inflammation, relieve symptoms, and help prevent disease progression. Treatment usually involves an initial intensive phase followed by long-term maintenance therapy.

General Vulval Care

Supportive measures play an important role in symptom control:

Use gentle, soap-free cleansers or emollients for washing
Apply moisturisers regularly to maintain skin integrity
Avoid irritants such as perfumed products
Use lubricants during sexual activity as needed

Specialist Referral

Patients who do not respond to standard treatment, or who develop significant scarring or anatomical changes, should be referred to a specialist for further assessment.

Advanced and Emerging Treatment Options

For selected patients with refractory symptoms, additional therapies may be considered:

Topical calcineurin inhibitors (such as tacrolimus) may be used under specialist supervision.
Surgical intervention may be required in cases of severe anatomical change or when malignancy is suspected.

Emerging therapies currently under investigation include:

Platelet-Rich Plasma (PRP): May support tissue repair as an adjunctive treatment, though evidence as a primary therapy remains limited.
Autologous fat transfer: Involves transferring the patient’s own fat to improve vulval tissue quality in severe cases. Further research is needed to confirm long-term benefits.

Long-Term Monitoring and Cancer Risk

Lichen sclerosus is associated with a small but significant increased risk of vulval squamous cell carcinoma, estimated at approximately 5%. Regular follow-up and ongoing treatment are essential to reduce this risk.

Patients are encouraged to:

Perform regular self-examination
Attend specialist follow-up appointments
Report any new, persistent, or non-healing lesions promptly

Frequently Asked Questions

Is lichen sclerosus curable?
No. It is a chronic condition, but symptoms can be effectively controlled with appropriate long-term treatment.

Is it contagious?
No, lichen sclerosus is not contagious.

Does it increase cancer risk?
Yes. There is a small increased risk of vulval cancer, which is why regular monitoring is important.

How often are check-ups needed?
An initial review is recommended around three months after starting treatment, followed by annual follow-up if the condition is stable.

What can improve daily comfort?
Using soap-free emollients, wearing loose cotton underwear, avoiding irritants, and minimising scratching can significantly improve comfort.

When to Seek Medical Advice

You should seek medical review if you notice:

New or worsening symptoms
Non-healing sores or skin changes
Persistent pain despite treatment

Final Thoughts

Lichen sclerosus is a long-term condition that requires ongoing care, but with early diagnosis and appropriate management, most women achieve good symptom control and maintain quality of life. Regular follow-up and adherence to treatment are essential for preventing complications and detecting changes early.