Lichen sclerosus is a long-term (chronic) skin condition. It causes the skin to become thin, white, and wrinkly. Lichen sclerosus may occur in adults and children at any age. It's most common in women older than age 50.

Skin has several layers. The outer layer is the epidermis. Under the epidermis is the dermis. The dermis contains blood vessels, nerve endings, hair roots, and sweat glands. With lichen sclerosus, the epidermis may become thin. Inflammatory cells invade the dermis. This may cause swelling and broken blood vessels. Stretchy fibers in the skin (elastic and collagen) may break. All of this can lead to symptoms such as itching, pain, and blisters.

This condition often affects the genital and anal areas. Vulvar lichen sclerosus is a common form of the condition that affects a woman's external genital areas. Less often, lichen sclerosus can affect other parts of the body. These may include the neck, shoulder, breast, thighs, and mouth.

Experts are still working to understand what causes lichen sclerosus. It runs in families, so experts think that certain genes may play a role. It does not seem to be contagious. So you can't catch it from another person. Some factors that may lead to the condition are:

• Problems with your immune system.
• Hormonal imbalances, especially with estrogen.
• Past skin damage.

You may have a greater risk for lichen sclerosus if you have an autoimmune disease, such as:

• Autoimmune-related thyroid disease.
• Autoimmune-related anemia.
• Vitiligo.
• Type 1 diabetes.
• Alopecia areata.

Other factors that can increase your risk include:

• A history of sexual abuse.
• A history of the condition in your family.

Circumcision greatly lowers the risk of lichen sclerosus in men.

Lichen sclerosus causes skin changes. Very early on, you might not have any symptoms at all. A little later, you may see small white spots on your skin.

Common symptoms include:

• Vulvar itching (very common).
• Anal itching, bleeding, or pain.
• Pain during sex.
• Skin bruising and tearing.
• Blisters.
• Easy bleeding from minor rubbing of the skin.
• Pain or bleeding when having a bowel movement.
• Trouble urinating or pain with urination.
• Painful erections (in men).

Lichen sclerosus doesn't affect the inner reproductive organs, such as the vagina or uterus.

Your doctor will ask about your health history and symptoms. You'll also have a physical exam. This will include a close look at the affected areas.

Often, this is enough for a diagnosis. In some cases, you may have a skin biopsy. For a biopsy, small skin samples are removed and looked at in a lab.

In some cases, you may need other tests. This is to make sure you don't have other health conditions. These may include lichen planus, low estrogen levels, or vitiligo. Your doctor may also want tests to check you for other conditions, such as autoimmune thyroid problems. The area of skin may also be checked to make sure it isn't infected.

You may be treated by a primary doctor, a skin doctor (dermatologist), or a doctor specializing in the reproductive organs.

Often, patches outside the genital and anal area may go away with time. Your doctor may choose to watch these areas before starting treatment. But symptoms in the genital and anal area don't often get better without treatment.

Treatment is done to ease symptoms and keep the lichen sclerosus from getting worse. The treatment often starts with steroid ointment. This reduces pain, itching, and inflammation. When used regularly, it helps manage symptoms for most people. Other possible treatments include:

• Steroid injections. These are more likely to be used if steroid ointment doesn't work well.
• Tricyclic antidepressants at low doses. This may decrease vulvar pain.
• Other medicines. These may be used if other treatments have failed. The medicines may include acitretin (except in women of childbearing age due to risk of severe birth defects) or tacrolimus.
• Ultraviolet light treatment. This is done if other treatments fail.

For men, removing the foreskin (circumcision) is often a successful treatment. In women, surgery is often not a preferred treatment. That's because lichen sclerosus often comes back.

These treatments often reduce most of the symptoms and keep the condition from getting worse. You will likely need to use medicine on a regular, long-term basis. If untreated, the condition tends to get worse over time.

Lichen sclerosus on the genitals may increase the risk of skin cancer. (But lichen sclerosus on other parts of your body does not seem to increase your cancer risk.) Your doctor may need to check your skin on a regular basis. You may need a biopsy of any abnormal areas to check for skin cancer. You should also check yourself regularly for lumps or sores that don't heal.

Untreated advanced lichen sclerosus may permanently change the look of your genitals. The vagina's opening may narrow. The outer and inner lips of the vulva may stick together. You may need surgery to fix these changes. In men, the foreskin may scar and shrink. This leads to trouble pulling back the foreskin. In both men and women, the condition may cause pain during sex.

Treatments for lichen sclerosus can also cause complications. For example, using steroid ointment for a long time may cause genital yeast infections.

Practicing good hygiene may help you reduce some of the symptoms of lichen sclerosus. Your doctor may advise you to:

• Not scratch the area.
• Not wear pantyhose (wear thigh-high stockings instead).
• Wear cotton underwear instead of synthetic underwear.
• Wear loose-fitting pants or skirts instead of tight-fitting pants.
• Not use scented soaps, detergents, or bubble baths.
• Not apply soap directly to your genitals.
• Use your fingertips and not washcloths for washing the vulva.
• Pat the vulva dry after washing, and don't rub.
• Not use feminine sprays or douches.

• Lichen sclerosus is a long-term skin condition that mostly affects the genital and anal areas. It causes your affected skin to become thin, white, and wrinkly.
• It is due to inflammation and other skin changes in the affected area.
• Common symptoms include itching, irritation, and pain during sex.
• Most people with will need long-term treatment to manage their symptoms.
• It increases your risk of squamous cell skin cancer. You and your doctor should check for signs of this.
• Good hygiene may also help reduce some symptoms.

Tips to help you get the most from a visit to your doctor:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your doctor tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose of that visit.
• Know how you can contact your doctor if you have questions, especially after office hours or on weekends and holidays.