Lichen Sclerosus: A Rare Skin Disease in Women

Introduction:

Lichen sclerosus is a skin disease that is not very well known, but it still significantly affects the quality of life of the person living with it. Although it can affect people irrespective of age and gender, it is predominately seen in women, specifically postmenopausal women and young girls who have not yet reached puberty. This chronic skin condition mostly affects the genital and anal areas of the body. Because of its location, symptoms, and the likelihood of the occurrence of complications if left untreated, this disease can pose severe challenges. This article will explore the symptoms, causes, risk factors, diagnosis, and treatment options for lichen sclerosus in women.

What Is Lichen Sclerosus in Women?

Lichen sclerosus is a chronic inflammatory dermatological condition in which white, shiny, thin patches of skin occur in the genital and anal regions. It can occur at any age. However, it is more commonly diagnosed in postmenopausal women and prepubescent girls. This condition can be severe and lead to significant discomfort, emotional distress, and complications if not diagnosed and treated properly at the right time. It can occur in males, too. In males, the affected area includes the glans, penis, and foreskin. It can also lead to phimosis (narrowing of the opening of the foreskin of the penis) in males. Studies have also reported rare cases of lichen sclerosus where the affected area was not the genital area. However, the percentage of such cases is extremely low, affecting approximately six percent of all affected women.

What Are the Symptoms of Lichen Sclerosus?

The symptoms of lichen sclerosus are discussed below.

• Severe Itching: This is one of the most common and, at the same time, very distressing symptoms. It can worsen at night or during periods of stress.

• Pain: The affected area can become painful, especially when the skin cracks or fissures occur.

• Bleeding and Tearing: The skin, being thin and fragile, may bleed or tear easily, often exacerbated by scratching.

• Blistering: In some cases, blisters may form before developing into larger, wrinkled patches.

• Changes in the Skin Color: Apart from the white patches, the skin may become discolored or bruised due to thinning and fragility.

Because of these significant symptoms, the sexual health and personal comfort of women with lichen sclerosus are compromised.

What Are the Causes and Risk Factors of Lichen Sclerosus?

The causes of lichen sclerosis are not fully established. However, several theories and risk factors have been postulated to support its causes and risk factors. These are all discussed below.

• Autoimmune Reactions: Researchers believe that the cause of this chronic skin disease is an autoimmune reaction in which the body’s immune system mistakenly attacks its own cells.

• Hormonal Imbalances: Researchers link its cause with hormonal factors because of the prevalence of this disease in prepubescent girls and postmenopausal women. This suggests that hormonal factors may influence its development.

• Genetic Causes: Some evidence supports that it may be genetic and can run in families. Some evidence revealed that it appears in family clusters.

• Having Damaged Skin: It has been seen that those areas in the skin that are previously injured or scared are more prone to developing lichen sclerosus.

How Does Lichen Sclerosus in Women Diagnosed?

The diagnosis of lichen sclerosus is made on the basis of clinical examinations, which involve the examination of signs and symptoms of the skin lesions and the complete history of the lesions, which involves information on the onset and duration of the skin lesions. Family history is also asked, as this disease runs in families. If the healthcare provider suspects lichen sclerous, the patient is asked for an investigation or test called a biopsy, which involves the microscopic examination of a tiny sample of a skin lesion in the laboratory. A biopsy helps rule out other conditions, such as vitiligo and eczema.

What Are the Treatment Options for Lichen Scleosus?

Although there is no cure for lichen scleosus for lichen scleosus, there are, several treatment options that can ease the symptoms and provide comfort to the patient, thereby improving the quality of life. These treatment options are discussed below.

1. Topical corticosteroids: These are prescription medications that must be used under a doctor's supervision; do not use them without one. These are considered as the first line of treatment and are very effective in reducing inflammation and itching. Although topical corticosteroids are a potent treatment for this chronic inflammatory skin disease, their long-term use can lead to skin thinning.

2. Hormone Therapy: As the cause and risk factors of lichen scleosus have been linked to hormonal factors, hormonal therapy is used to manage the symptoms. Topical estrogen or testosterone is used when the doctor suspects the presence of an underlying hormonal component.

3. Topical Calcineurin Inhibitors: Tacrolimus and Pimecrolimus (immunomodulators) are used as an adjective therapy for cases where corticosteroids can not be used or are effective.

4. Other Local Pharmacologic Agents: It involves phototherapy and laser therapy. Topical retinoids like Tretinoin (0.025%) may be useful, particularly for addressing hyperkeratosis associated with this skin lesion.

5. Emollients and Moisturizers: Essential for daily management, emollients help protect and heal the skin barrier, reduce symptoms, and can sometimes reduce the need for topical corticosteroids. They are particularly useful as protective barriers against irritants and during sexual activity to alleviate discomfort.

6. Combination Therapy: Combining different treatment modalities, like alternating between topical corticosteroids and calcineurin inhibitors, can optimize treatment efficacy and minimize adverse effects, especially in long-term management.

7. Herbal Therapies: Herbal therapies, including chamomile, coconut oil, shea butter, and aloe vera, have been used with variable results. Further studies are required to prove their efficacy in the treatment of Lichen Sclerosus.

8. Maintenance Therapy: Regular assessments are necessary to monitor treatment efficacy, side effects, and disease progression. Maintenance therapy with emollients and periodic use of topical steroids may be required to prevent recurrence.

Conclusion

In conclusion, although lichen sclerosus can be a challenging condition for women, it can be managed, and the quality of life of women with this disease can be improved if they are properly educated about this condition. Treatment should be carried out properly, and patients should follow the complete course of treatment. Since it is a chronic disease, the treatment extends for a long duration. The positive outlook and consistency in the treatment can help in controlling the symptoms effectively.