Lichen Sclerosus Diagnosis & Treatment in London

Understanding Lichen Sclerosus

Lichen sclerosus (LS) is a chronic, relapsing skin condition that leads to thinning and scarring of the skin. It most often affects the vulva, penis, or anal region but may also occur on the trunk, upper arms, or breasts. The hallmark features are porcelain-white, fragile patches that can crack, bleed, and cause significant discomfort. Early diagnosis and treatment are critical to avoid long-term complications, including scarring and increased cancer risk.

Causes and Risk Factors

The cause of lichen sclerosus is not fully understood, but several contributing factors are recognised:

• Autoimmune response: The immune system attacks skin tissue, leading to inflammation.
• Hormonal influences: More common after menopause, suggesting oestrogen deficiency plays a role.
• Genetic predisposition: Family history increases risk.
• Skin injury (Koebner phenomenon): Areas of trauma may trigger new lesions.
• Associated conditions: Thyroid disease, vitiligo, and other autoimmune disorders.

Symptoms

Lichen sclerosus presents with:

• Intense itching (especially at night)
• Burning, stinging, or pain
• Fragile white patches of skin
• Skin cracks, bleeding, and tearing
• Painful intercourse (dyspareunia)
• Difficulty passing urine or stools in severe cases
• Scarring that can shrink or distort affected areas

Complications

If untreated, lichen sclerosus can cause:

• Fusion of labia or narrowing of the vaginal opening
• Phimosis in men (tightening of foreskin)
• Scarring leading to functional and cosmetic changes
• Increased risk of squamous cell carcinoma (SCC)
• Sexual and psychological distress

Diagnosis

Diagnosis is usually clinical, based on appearance. In uncertain cases, a skin biopsy confirms features such as thinning epidermis, sclerosis, and lymphocytic infiltration. Regular monitoring is recommended due to the small cancer risk.

Treatment Options

There is no cure for lichen sclerosus, but effective treatments help control symptoms and prevent complications:

• Topical corticosteroids: High-potency ointments (e.g., clobetasol propionate) are first-line therapy, reducing inflammation and itch.
• Moisturisers and emollients: Protect skin and reduce dryness.
• Topical calcineurin inhibitors: Alternatives for steroid-resistant or long-term management.
• Surgical management: For phimosis or severe scarring, circumcision or reconstructive procedures may be needed.
• Laser or phototherapy: Considered in selected resistant cases.

Living with Lichen Sclerosus

With appropriate treatment, many patients achieve long-term control. Regular follow-ups are essential for monitoring. Emotional support, counselling, and sexual health advice may also be beneficial. At Skinhorizon Dermatology London, we combine medical expertise with patient-centred care to ensure comfort and confidence.

Your first visit — what to expect

1. Consultation: Discuss symptoms, history, and impact on daily life.
2. Examination: Careful assessment of affected areas, maintaining sensitivity and privacy.
3. Investigations: Skin biopsy if diagnosis is unclear.
4. Treatment plan: Personalised plan with topical steroids and support measures.
5. Follow-up: Regular reviews to monitor progress and reduce cancer risk.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025