Ask the doctors: Lichen sclerosus can occur in many places on the body

Dear Doctors: I am a 64-year-old woman, and I was shocked when I was told I have lichen sclerosus. I have lesions on my wrist and arms, which cortisone cream has helped. I’m wondering if the gynecological changes that I have experienced are permanent. Any info?

Dear Reader: Lichen sclerosus is a chronic inflammatory condition of the skin. It’s believed to have an autoimmune component. It typically occurs in the genital and anal areas. It can also affect the skin on the arms, neck and upper back, but this is not as common. Although lichen sclerosus can develop in anyone and at any age, it affects women more often than men. It’s also more common in people aged 50 and older.

The condition causes isolated patches of pale or white skin that are also crinkly or wrinkled. Sometimes the patches are unusually smooth and slightly shiny. These patches usually cause mild to severe itching. When the genitals are involved, the affected areas typically appear on the vulva in women and the tip and foreskin of the penis in men. They can also develop in the skin around the anus. Besides chronic itchiness, the presence of lichen sclerosus can cause discomfort or pain during sexual activity. As with many autoimmune conditions, these symptoms can ebb and flare. They may disappear for weeks or months at a time and then reappear.

Unfortunately, there is no cure currently. Treatment focuses on medications and lifestyle changes to ease or manage symptoms. This includes the cortisone cream that brought you relief. Unlike over-the-counter cortisone creams, these are strong preparations that require a prescription. They must be used with a doctor’s supervision. Lifestyle changes can also be helpful in reducing symptoms. Avoiding tight or restrictive underwear or pants can help. Using a gentle emollient to keep the affected skin from drying out and cracking is another. Switching to hypoallergenic and unscented soaps, lotions and laundry detergents may also help. During a flare, avoiding activities such as cycling or horseback riding may be advised. These activities can worsen symptoms and possibly damage delicate skin.

One of the side effects of the condition is that over time, the affected skin can develop scarring or become tighter than the surrounding tissue. This can make urinating and bowel movements difficult or painful. Early treatment with topical corticosteroids may help prevent these structural changes to the skin. Scarring and skin tightening are rare outside the genital and anal areas. So, it’s unlikely this would happen to patches on wrists and arms.

There is evidence that people living with lichen sclerosus have a slightly increased risk of genital or anal cancer. This risk is low, but it is wise to do self-checks and regular screenings. You and your doctors will be checking for unusual changes to the texture of the skin and areas of thickening. Also look for sores that do not have a direct cause and don’t heal. The good news is that prompt medical care and regular treatment help many people manage their symptoms and maintain quality of life.

Send your questions to askthedoctors@mednet.ucla.edu.