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Lichen Sclerosus – Symptoms,Causes And Treatment

Lichen Sclerosus History

Lichen Sclerosus was first to report as a lichen plan atrophic by Dr. Hallopeau in 1887. Darier, in 1892 reported the histological features of lichen sclerosis and named it lichen plan sclérux, as not all cases involved atrophic tissue.

Which it was, by the ISSVD International Society for the Study of Vulvovaginal Disease (International Society for the Study of Vulvovaginal Disease). Stuhmer, in 1928, categorized and named the disease involving male genitalia as  BXO (balanitis xerotica obliterans).

LS also called Csillag’s e disease, Lichen Albus, Hypoplastic dystrophy, white spot disease, and kraurosis vulvae.


Lichen Sclerosus Causes

Currently, what known of the Lichen Sclerosus causes is a mystery. Some physicians believe that an overactive immune system and hormones possibly play a part in the disease. Risk factors suggest that immune disorders are more prevalent in LS patients.

With a higher incidence of autoimmune disorders in lichen sclerosus patients, such as thyroid disorders, anemia, alopecia areata, and diabetes.

Unfortunately, to date, none of these has been proven as the lichen sclerosus causes.

Autoimmunity Disorders

Autoimmunity disorders attack the body, damaging normal body tissues. With LS, there is a type of inflammation within the affected skin, which leads to changes to the structure of that skin.

In people with lichen sclerosus, the genital skin may be attacked by some part(s) of the immune system, which then causes inflammation. However, this is a theory and has not been proved at this time.

Approximately one in four suffers from LS has a secondary autoimmune disorder, lending weight to this theory of an immune system etiology.

Genetic Predisposition

Genetic predisposition has not been ruled out as one of the Lichen sclerosus causes, as there does seem to be a higher incidence in some families. But as of this time, this is uncertain and unproven.

The suspected involvement in families thought to be about 17%, meaning that 17 cases out of every 100, have someone else in the family who have LS.

Other areas of consideration in the search for Lichen sclerosus causes is a combination of the risk factors which then triggers the disease.

Again, this is unproven, and more research needs to do. There has also been some investigation as to whether an infectious organism could be the cause. These investigations have not been able to prove this to be a cause at this time.

Other areas of consideration in the search for Lichen sclerosus causes is a combination of the risk factors which then triggers the disease. Again, this is unproven, and more research needs to do.

There has also been some investigation as to whether an infectious organism could be the cause. These investigations have not been able to prove this to be a cause at this time.

Genital Area

Since the area most often affected the genital area, the discussion limited. People are reluctant to openly discuss or admit to having something wrong or different in what they think of as their private parts.

This embarrassment can also lead to sufferers to not seek medical help or if the symptoms are minor – such as vaginal itching, be miss-diagnosed,  furthering the issues of incomplete data.

Sometimes the cause isn’t ever found, and the medical community left with trying to treat a disease they don’t understand. But there is one thing that knows about what isn’t one of the Lichen sclerosus causes.

Patients

Lichen sclerosis affects women most often, but it also can found in men of varying ages. They are even affecting children in rare instances.

Women affected 10 times more often than men, with the most common time of occurrences at the age of menopause. Younger women and girls also diagnosed with the disease, so age is not genuinely relevant.

There does not seem to any a proven specific age group for men who have BXO, although some studies suggest there is a higher risk for middle-aged males.

Lichen Sclerosus

Symptoms of Lichen Sclerosus

Its not yet medically understand that lichen sclerosus symptoms.

contributing factors are:

  • Genetic background
  • Hormone imbalance
  • Skin wounds
  • Radiation therapy

Women’s Symptoms

Women, who affected, as well as girls, most often report itching, pain, and burning in the affected area. The fusion of the vaginal lips can occur after inflammation may cause scarring, narrowing of the vaginal opening, and burying of the clitoris.

This can frequently lead to painful sex, less pleasure, or avoidance of sex entirely. Painful urination or defecation may also be present.

Due to these diseases varying severity, some women will experience such mild symptoms. Medical care may delay. Sometimes lichen sclerosus only discovered during routine gynecological examination. 

Women stricken most often in the vulva area, which often extends to the perianal skin. The involvement in both areas gives the affected area a figure 8 appearance.

These women will also have extragenital lesions up to 20% of the time. Usually involving the upper body area; trunk, shoulders, and neck.

Because of the delay, by the time some patients receive treatment, the whitened areas are showing atrophy or thickening or both. Atrophy recognized by the slightly lowered level of the affected whitened skin.

These depressed areas can also show a wrinkling effect referred to as “cigarette paper.” There is a thickening that occurs as part of this process – hyperkeratosis is part of the disease and can also think of as a callus-like response to the scratching and rubbing of the area.

Tissue fragility can cause linear fissures to develop, particularly after intercourse quickly. Erosions, blisters, hyperpigmentation patches, petechiae – purple spots, can be present or not, depending on the severity of the symptoms of lichen sclerosus.

Children suffer from the same areas of involvement as their adult counterparts. Girls present with vulvar symptoms and boys with a penile.

Girls Symptoms

The most common problems that girls with signs of lichen sclerosus have are vulva itching and painfulness.

These symptoms can vary from mild to severe. Girls can respond to or show their physical discomfort in different ways. For example, some girls will merely say that their “private area” hurts or itches, yet others may react by holding their genital area or rubbing or scratching it. The degree of physical distress might not be proportional to the amount of disease present.

Lichen sclerosus can also result in painful urination as well as constipation. Painful urination happens as the urine passes over the vulvar skin area, which damaged and inflamed.

Bowel irregularity occurs from stool withholding due to painful fissures (small rips) in the affected skin near the anus. Simply because it is painful to produce a bowel movement, certain girls will withhold their stool and then create constipation.

Constipation from lichen sclerosus may mistake for a gastrointestinal issue or a behavioral problem.

Some girls with lichen sclerosus are going to have a discharge, which discovered on their underpants. The discharge may be bloody because of small spots of vulvar bleeding from affected skin irritation and scratching the area. This kind of bloodstained discharge is not harmful or unusual.

Since there are other causes of these types of symptoms apart from lichen sclerosus, an experienced medical doctor must perform a careful examination.

Additionally, it is feasible for several girls with lichen sclerosus to have no signs whatsoever. Because of this, the skin disease then usually identified in the course of a regular check-up.

Boys Symptoms

Lichen sclerosus is much more common in boys than what commonly assumed. When LS presents itself in boys, it nearly always attacks the penis and, therefore, frequently causes phimosis needing surgical treatment.

The medical importance of this condition in boys is inadequately recognized. This leads to very little information being available

Men’s Symptoms

For men, symptoms of lichen sclerosus:

  • Most effect area tip of the penis. Become firmm and white-colored
  • Narrowing of the urethral opening
  • Difficulty in erection
  • Sudden narrowing or phimosis of a formerly retractable foreskin, obstructing the stream of urine.

List of Common Symptoms

  • Pale patches of skin
  • Skin fissures
  • Skin cracks
  • Bruises
  • Itching
  • Atrophy of vaginal skin
  • Vulva skin Atrophy
  • Atrophy of foreskin
  • Shrinking of vaginal skin
  • Vulva skin shrinking
  • Shrinking of foreskin

Lichen Sclerosus Treatment

For some, that have no genital involvement, treatment of Lichen sclerosus, may not be needed, particularly if there are no symptoms. LS can get better on its own, and often does when it is a mild or less severe case.

Young girls may not need lifelong treatment of lichen sclerosus, which can, on occasion, disappear at puberty permanently. Scarring and changes in skin color remain even after the symptoms have disappeared.

Treatment of Lichen sclerosus always recommended when the genital or anal areas are affected or when there is an advanced case on other areas of the body. Treatment will help further scarring and help with the itching. There will also be the benefit of improving the appearance of the skin.

Most often, a potent corticosteroid cream/ointment used for genital areas and other body areas. Treatment can last from weeks to months. A small smear of the cream applied to the affected skin daily with your doctor re-assessing the treatment every few weeks/month.

Skin can become thin, red, and uncomfortable with the overuse of the steroid cream. Once your medical professional indicates the affected area appearing better, a maintenance regiment of once or twice a week used to keep Lichen Sclerosus from reappearing.

If there is no appreciable improvement with a steroid cream/ointment, or there is an allergy. Other treatment options include calcipotriol cream, topical and systematic retinoids (acitretin), and oral steroids.

Estrogen creams prescribed for hormonal imbalances that can cause dry thinned, vulva, and vaginal tissues. This will help with strengthening the skin and help to stop fissures.

Tacrolimus and Pimecrolimus

Tacrolimus and pimecrolimus are new immune-modulating creams that are showing some promise in the treatment of Lichen Sclerosus. They can cause burning and are a concern for an increase in the potential rate of skin cancer when in the presence of papillomavirus.

In cases where there is a narrowing of the vaginal opening, dilators can use to stretch the vaginal opening gently. Surgery rarely needed to allow for sexual activity. But this surgery could appear successful only to have to be redone due to the disease reoccurring.

Surgery is required if there are urination difficulties and to allow intercourse, and these procedures can include:

  • A division of adhesion’s called a Simple perineotomy
  • An incision that repaired transversely called a Fenton procedure
  • An excision of involved tissue and vaginal mucosal advancement is a Perineoplasty
  • On rare occasions, a vuvalectomy, where the vulva removed, needed due to cancer or precancer.
  • Surgery is usually not a good option for women. Due to the lichen sclerosus patches that removed from the genitals of women and girls, they often come back.
  • Stem cell treatments used on Lichen sclerosus with some promising results.

Light and ultraviolet light used for non-genital forms and can help with healing and skin appearance.

Penile lichen sclerosus

In men, lichen sclerosus, for the most part, influences the tip of the penis, which comes to be firm and white (likewise called balanitis xerotica perstans). The urethra may narrow such that it is challenging to pass urine, bringing about a weak stream.

Now and then, the section needs to be extended with an uncommon operation called meatal expansion. Sexual function may influence. For men with lichen sclerosus on the foreskin, removal of the foreskin (circumcision) is a standard treatment in cases resistant to other therapies or more advanced cases.

Male genital lichen sclerosus is uncommon in men circumcised early. It has inferred that it may brought on by long term damage by urine.

Penile lichen sclerosus may incline the patient to penile intraepithelial neoplasia and penile malignancy. Long term follows up is required to make sure these conditions/cancers do not appear.

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