Lichen sclerosus

Luichen sclerosus is an uncommon condition without a known cause which creates patchy, white skin, eventually resulting in scars. These are often shiny, smooth, white patches of skin resembling porcelain. Changes may occur in the skin and the mucous membranes of the mouth and genitals. However, in 98% of patients Lichen sclerosus occurs in the genital area and around the anus. At first, the changes appear in the form of red bruises with extended follicular openings filled with keratin plugs. Over time, hypopigmentation, atrophy and even sclerosis may occur. Women suffer from this disease far more often than men (10: 1). Patients experience itching, pain, infection tendency, sometimes urination and defecation difficulties and painful, unpleasant sexual intercourses. In men, the foreskin cannot be retracted (phimosis). It should also be noted that this disease causes severe emotional problems. People with this problem are losing interest in sexual intercourses, they are becoming introvert and they lose self-confidence.

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Lichen sclerosus of the tongue

With the support and understanding of your partner, the problem is definitely easier to overcome. Risk factors for the occurrence of this disease are the following: the existence of some other autoimmune disease, infections and genetic predisposition.

Autoimmune etiology is proven by specific antibodies that are found in these patients. In addition, Lichen sclerosus is often associated with other autoimmune diseases (diabetes, vitiligo, thyroid diseases). The examinations of the tissues of the patient suffering from this disease, proves the existence of bacteria Borelia Burgdoferi, human papilloma virus and hepatitis C virus. This implies a possible connection between these agents and Lichen sclerosus. Some researchers suggest that women with low estrogen level suffer from Lichen sclerosus far more often (before puberty and during menopause), but there is no solid evidence that estrogen plays a key role here. There is evidence that a scar or radiation may stimulate the occurrence of the disease, but this hypothesis is not supported by solid evidence either.

Diagnosis

 

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Lichen sclerosus of the anogenital region

It usually takes several months or years until determining the right diagnosis. The reason for that lies in the facts that Lichen sclerosus is a relatively uncommon disease whose precise cause is not known yet. Giving the correct diagnosis is difficult since there are several names for this disease: Lichen balantis xerotica, Lichen sclerosus atrophicus, Lichen albus, Kraurosis Vulvae, dystrophic hypoplasia, white spot disease. Due to being wrongly diagnosed as Colpitis or Vulvar Atrophy, wrong treatments are prescribed.

Patients either administer the treatment after consulting their doctor or at their own will, they use a variety of local medications, vaginalettes etc. but the symptoms persist or even become more serious. Excessive use of medications disturbs the Ph-value of the skin and mucous membrane, thus destroying the normal flora, causing bacterial infections or candidiasis. Based on specific clinical findings, the use of antibiotics or antifungal medicines is recommended and the patient enters into a vicious circle.

A biopsy is the surest way to make a precise diagnosis. Excisional biopsy is recommended since it provides a large enough sample. The findings indicate hyperkeratosis, epidermal atrophy, dermal sclerosis and T lymphocyte activity.

Treatment

There is no causal treatment. However, the symptoms can be brought under control with good hygiene while maintaining normal mucosal pH value, by administering corticosteroids and local hormone therapy (testosterone, estrogen/progesterone in case of vaginal sclerosis). Retinoids and ultraviolet radiation are also used as a part of the treatment with varying success. Antibiotics are occasionally used if corticosteroid therapy gives no results. Surgical treatment should be undertaken in case of severe scars which cause functional difficulties. The most common procedure performed in men is circumcision, whereas removing scars and adhesions and vaginal opening reconstruction are most common procedures performed in women.

New PRP method gives a new hope. It includes the application of platelet-rich plasma which is extracted from the patient's own blood and which has a high concentration of growth factors, onto the target region which stimulates regeneration of damaged structures.

Prognosis

The disease may last for several years. Spontaneous regression of the disease rarely occurs (in young women). Patients suffering from a chronic disease should undergo regular examinations, since in 7% of cases cancer may appear in the same area where chronic Lichen sclerosus is diagnosed.

Related article: What is vaginal atrophy?


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