LICHEN SCLEROSIS or The White Lesion: A Guide by Dr. Anu Vij

LICHEN SCLEROSIS or The White Lesion

Lichen sclerosis (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals.

Lichen sclerosis is not contagious. There is a well-documented increase of skin cancer risk in LS, potentially improvable with treatment. LS in adult age women is normally incurable, but improvable with treatment, and often gets progressively worse if not treated properly.

Most males with mild or intermediate disease restricted to foreskin or glans can be cured by either medical or surgical treatment

Signs and symptoms: LS can occur without symptoms. White patches on the body, itching, pain, dyspareunia (in genital LS), easier bruising, cracking, tearing and peeling, and hyperkeratosis are common symptoms in both men and women.

In women, the condition most commonly occurs on the vulva and around the anus with ivory-white elevations that may be flat and glistening.

In men, the disease may take the form of whitish patches on the foreskin of penis and its narrowing (preputial stenosis), forming an "indurated ring", which can make retraction more difficult or impossible (phimosis). In addition there can be lesions, white patches or reddening on the glans. In contrast to women, anal involvement is less frequent. Meatalstenosis, making it more difficult or even impossible to urinate, may also occur.

Causes:Lichen sclerosis is not contagious

Several risk factors have been proposed, including autoimmune diseases, infections and genetic predisposition.

There is evidence that LS can be associated with thyroid disease

Autoimmunity is a process in which the body fails to recognize itself and therefore attacks its own cells and tissue. Specific antibodies have been found in LS. Furthermore, there seems to be a higher prevalence of other autoimmune diseases such as diabetes mellitus type 1, vitiligo, alopecia areata, and thyroid disease.

Hormones: Since LS in females is primarily found in women with a low estrogen state (prepubertal and postmenopausal women), hormonal influences were postulated.

Diagnosis:by biopsy of the affected area.

Treatment: There is no definitive cure for LS.

Behaviour change is part of treatment. The patient should minimize or preferably stop scratching LS-affected skin. Any scratching, stress or damage to the skin can worsen the disease. Scratching has been theorized to increase cancer risks.

Some general self-help measures can make the condition more comfortable to live with. These include:

• • Applying an appropriate moisturizer to the affected areas
• • Avoiding scented bathing products and detergents that can irritate the skin
• • Using a lubricant during sex
• • Avoiding rubbing or scratching the affected areas
• • Wearing loose-fitting clothing and underwear made of natural fibers

AtoImmunosuppressants :

These medicines prevent the immune system from attacking the normal cells eg calcineurin inhibitors (eg, tacrolimus or pimecrolimus), which are sometimes prescribed for patients who respond poorly to steroids or cannot tolerate steroid treatment.

Surgery in extreme cases of scarring and stenosis.

Phototherapy (light therapy). Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps which may reduce inflammation and minimize itchiness