Lichen sclerosus - women at risk: symptoms, treatment and prognosis in girls. Lichen sclerosus: causes, symptoms and treatment Lichen disease

Lichen sclerosus is a chronic disease that develops on the human skin. With the progression of the pathology, the skin begins to die, which is an irreversible process. It is found most often on the genitals. Women suffer from it ten times more often than men.

The name of the disease changes depending on the location of the lesion, for example, a gynecologist will diagnose a woman with ‒, and a urologist will tell a man that he has sclerotic obliterans. Lichen is a complex of various diseases of the skin. This is a Greek word, which literally means infection or.

Etiology

The main reasons for the appearance of such a disease include:

• Heredity. In medicine, cases were recorded when this pathology was found in twins, sisters, as well as in a daughter and her mother. In the study of the development and progression of the disease, it was found that certain genes are inherited.
• Autoimmune diseases. After a series of studies, scientists have found that there is a connection between such an ailment and autoimmune pathologies. However, lichen sclerosus can present with symptoms similar to connective tissue disease in a diagnosed autoimmune disease.
• Viral and infectious diseases. Certain viral diseases, such as spirochetes, may be associated with the appearance of this ailment. For example, spirochetes contribute to the development of Lyme disease, and acrodermatitis may develop against its background: its symptoms are very similar to lichen sclerosus. But despite this, if a person still suffers from lichen, then it is not possible to find the causative agent of Lyme.
• Violation of the integrity of the skin. In some cases, this pathology manifests itself after skin damage. For example, damage to old scars, radiation treatment of the skin, abrasion, chronic irritation of the genital organs with urine in people suffering can start development.
• Hormonal imbalances. If the process of assimilation of the male sex hormone by body tissues is disrupted, then this is also one of the factors in the development of lichen.

Scientists decided to treat this pathology with a cream that contains testosterone (male sex hormone). However, this therapy did not give the expected results.

Classification

Today in medicine there are several varieties of the disease:

• brilliant lichen;
• spiny;
• hair;
• scrofulous;
• chronic;
• red flat;
• scleroatrophic;
• tropical;
• amyloid;
• linear;
• myxedematous;
• striped.

With each of these diseases, a rash appears on the skin in the form of small white bumps. However, they also have a difference: the rash appears in different places of the human body and can be a seasonal manifestation. For example, a tropical type of pathology most often occurs in the hot season, that is, in summer.

Stripe and linear lichen are located only in one row. The shiny type does not cover some areas, for example, mucous membranes, palms, feet, face, head under the hair. Myxedema is most often diagnosed in women of retirement age.

It should be noted that diagnosed scleroatrophic lichen occurs in women aged forty to forty-five years and in men from forty to forty-three years. In childhood, lichen sclerosus is a rather rare phenomenon, but in girls it is diagnosed more often than in boys, and this happens in the period from one to thirteen years. There are cases when the disease went away on its own, without any treatment.

Symptoms

Symptoms of this pathology appear in the form of white spots with pronounced edges, they are also called papules. Their location: neck, upper chest, shoulders, external genitalia. In addition, this pathology can appear on the hands. When appearing, the size of the spots is 0.5 cm in diameter. Nearby spots eventually form one large one, which rises slightly above the skin. In some patients, blisters may appear on large spots. When the disease affects the external genitalia, then the skin in this place dries up and itches.

The development of pathology can occur over several years. The rash that appears does not bother the person, but sometimes it can itch. This explains the fact that patients do not seek help from a specialist. The disease proceeds in waves, that is, the affected area may become larger or, conversely, will decrease.

Cases were recorded when the disease degenerated into oncology - in.

With such a pathology as scleroatrophic diagnosed lichen of the penis, its head suffers. This is mainly a disease of adult men, and it is rarely found. The lesion happens not only on the head of the penis, but also on the inside of the leaf of the foreskin.

First symptoms:

• dryness;
• decrease in elasticity.

Connective tissue begins to grow on the affected area.

With such a localization of the disease, a person may experience the following complications:

• narrowing of the foreskin, which can lead to a condition where it is impossible to completely expose the head of the penis;
• narrowing of the opening of the urethra;
• formation of cracks in this area;

The disease is divided into four stages of development:

• there is a defeat of the foreskin;
• the disease covers the head of the penis;
• the pathology passes to the penis, while covering the foreskin and urethra from the outside;
• precancerous condition (the patient is fully examined, which will help to exclude or confirm oncology).

When a woman suffers from such a disease, the doctor makes a diagnosis - diagnosed scleroatrophic lichen of the vulva.

It manifests itself with the following symptoms:

• Burning.
• Itching of the vulva and anus.
• The appearance of erosion. When they begin to tighten, scarring of the tissue occurs. In some patients, overgrowth of the labia minora is observed.

Experts say that the affected area looks like a "figure eight". If during such a pathology a woman becomes ill with an infectious disease, then the course of lichen may become more complicated.

Diagnostics

When the first signs of the development of pathology occur, it is urgent to seek help from a specialist. In no case do not start treatment on your own: there may be big health problems.

During the appointment, the doctor:

• perform a visual inspection;
• collect an anamnesis based on your complaints;
• study the external manifestations of the disease;
• prescribe a biopsy (performed as an additional diagnosis to confirm or refute a preliminary diagnosis).

Based on the results of the diagnosis, the doctor will determine the tactics of treatment.

Treatment

To date, it is reliably known that if the therapy of the disease was not carried out, then scarring occurs on the genitals, which subsequently has a rather deplorable effect. In severe pathology, the lumen of the urethra begins to narrow, because of this, the outflow of urine is disturbed. The patient's quality of life is deteriorating, and the urinary tract may also become inflamed (,). It also threatens.

This disease can be treated with the help of medications (special ointments). In advanced situations, they may resort to surgical intervention, while the affected part is removed.

If lichen in men has covered the head of the penis, then the foreskin is removed.

The volume of therapy will depend on the area of ​​the lesion, so we will consider the treatment according to the stages of the development of the disease:

• First stage. At this stage, the disease has affected only the foreskin, and if the man is not circumcised, then a whitish ring will be visible on it. At this stage, there is no damage to the head of the penis and the outer part of the urethra. In this case, the foreskin is circumcised and further recovery is carried out under the strict supervision of a physician.
• Second stage. This stage is characterized by damage to the foreskin and skin of the penis. There are whitish transitions from the foreskin to the groove and the skin of the head. The disease at this stage is often diagnosed in circumcised men. At this stage, the urethra can narrow on the outside, which will lead to difficulty urinating. The treatment will be as follows: surgical removal of the foreskin is performed, and if necessary, the lumen of the urethra is surgically expanded. Also, the patient is prescribed long-term local therapy with anti-inflammatory drugs.
• Third stage. The disease has already affected the foreskin, head and external opening of the urethra. Visually, the penis has undergone great changes. This stage of the disease is typical for men who have previously been treated for this particular pathology, and who underwent an expansion of the urethra or urethra. The treatment looks like this: surgical operations are performed to help eliminate the strictures of the urinary canal, scars are excised. In addition, long-term treatment with local anti-inflammatory drugs (ointments, creams) is recommended.
• Fourth stage. The entire penis is involved in the disease process. It can be precancerous conditions and even oncology. This stage is treated with surgical removal of the resulting scars. But before excision, it is necessary to conduct a biopsy of the skin of the penis of the urinary canal in order to exclude oncology.

In addition to the described treatment, all patients are prescribed a special diet.

Possible Complications

Sample list of complications:

• Lichen can degenerate into oncology, although this happens quite rarely. However, it happens more often in women than in men. But if you start the necessary treatment on time, the risk of cancer will decrease.
• A progressive disease causes pain in women during intimacy. Itching and scarring narrow the vagina, so the desire for intimacy disappears. You should also not forget about the possible appearance of blisters in this place.
• Thinning of the foreskin (only in uncircumcised men). The consequences in this case are problems with erection and urination.

Treatment must be started in a timely manner.

Prevention

To date, there are no specific methods of prevention.

• If whitish spots appear on the skin, you should immediately seek help from a doctor.
• Do not worry if the doctor prescribes the removal of the affected area of ​​​​the skin, because this will only help stop the further development of the disease. In men, the foreskin is excised, and in women, the affected skin on the genitals.
• In some cases, in men, an expansion of the outer part of the urethra is performed.

Seek help only from professionals.

Unfortunately, in some countries, the treatment and diagnosis of lichen sclerosus has ceased to be taught at universities, so many doctors simply do not understand the difference in the signs of this disease and the inflammatory process of the skin, which is why the wrong treatment is prescribed.

Quite often, patients who are being treated for lichen or, in other words, tsumbush, take antibiotics, so doctors confuse this pathology with another disease.

In the structure of dermatological diseases, this pathology is less than 1%, but in recent years there has been a tendency towards an increase in the incidence.

For 130 years, lichen sclerosus et atrophicus has acquired many different names. Among them:

• Lichen sclerosus - correct translation from Latin into Russian.
• Scleroatrophic lichen - tracing paper from Latin.
• White spot disease.
• Guttate scleroderma.
• White lichen Zumbusch (Leo Ritter von Zumbusch - Austrian dermatologist).
• Hallopeau Syndrome (Francois Henri Hallopeau - French dermatologist).
• Chillag's syndrome (J. Csillag - German dermatologist), as well as taking into account the gender of the patient - progressive diffuse atrophy of the vulva and xerotic obliterans balanitis.

Types of lichen

Depending on the localization of the rash, it is customary to distinguish the following forms:

• Extragenital - up to 20% of all cases (rashes on the upper back, neck, armpits, in the navel, extensor surfaces of the legs and arms, palms and soles, very rarely on the oral mucosa).
• Genital.

If spontaneous healing does not occur, then genital scleroatrophic lichen passes into kraurosis (from the Greek krauros - dry, fragile) of the vulva or foreskin - the glans penis, which is characterized by the development of sclerosis with loss of tissue mobility. With kraurosis, the surface of the affected areas is dry, shiny, dense. When the vulva is affected, intense itching and telangiectasia are common. If the disease is not treated, atrophy of the labia minora and labia majora, leukoplakia and, often, cancer develop in the future. Kraurosis of the penis manifests itself in the form of chronic atrophy and wrinkling of the glans penis and the inner layer of the foreskin, leading to phimosis and narrowing of the opening of the urethra. In contrast to vulvar kraurosis, penile lesions do not itch and the disease is not complicated by cancer.

The genital form is divided into:

• Scleroatrophic lichen of the vulva is the most common form of the lesion. Involves the vulva, perianal region, perineum, inguinal folds. The affected area is in the shape of an hourglass. It is more common in women in menopausal and postmenopausal periods, less often in girls under 13 years of age. In the latter case, the debut of the disease in 88% occurs in the neutral period of puberty, and in 12% - in the prepubertal and pubertal periods. Typically, a decrease in estrogen levels, later puberty and signs of menstrual dysfunction. The resolution of foci in girls occurs in 56% of cases in the prepubertal period, in 44% - with the onset of menarche. If girls usually self-heal, then in older women, when the mucosal lesions heal, scarring occurs, leading to adhesions of the labia minora.
• Scleroatrophic lichen of the penis in the same age groups develops only in uncircumcised men, but an order of magnitude less frequently. The glans penis and/or foreskin is affected. With the involvement of the periurethral tissues, a stricture of the urethra develops, and with the defeat of the foreskin - phimosis.

Clinical picture

• On the affected areas appear small (up to 1.5-2 cm) rounded multiple scattered or grouped papules that do not protrude above the skin level, merging into pearly white or ivory plaques, sometimes with a bluish tint.
• Sometimes closely spaced foci merge to form shiny plaques.
• The borders of the elements are clear.
• The rash tends to resolve spontaneously, leaving atrophic, hypo- or pigmentless patches.
• As the disease develops, the lesions slightly sink, horny plugs appear that fill the mouths of the sweat glands, which makes the surface of the foci look warty.
• Telangiectasias are possible, as well as erosions and hemorrhagic blisters.

Lichen sclerosus is not a sexually transmitted disease.

The course of the disease is undulating - the area and intensity of the rash can decrease and increase. Often, scleroatrophic lichen is complicated by the addition of a fungal and / or bacterial infection.

The occurrence of lichen

The occurrence of scleroatrophic lichen is also associated with frequent trauma to the mucous membranes, exposure to irritants, metabolic disorders, endocrine, neurogenic and other factors. Dominated by 2 theories of the occurrence of lichen sclerosus:

Autoimmune

Arguments: the presence of a family history, association with certain HLA classes, the presence of autoantibodies, combination with focal and systemic scleroderma, vitiligo, lichen planus, other autoimmune pathology of the skin and / or mucous membranes.

infectious

Arguments: in half of the cases, the disease is formed against the background of acute or chronic infectious diseases, there is a connection with Lyme disease (borreliosis). During the diagnosis, it is often possible to detect a high titer of antibodies to Burgdorfer's spirochetes, and the clinical picture improves significantly after treatment with penicillin.

Specific preventive measures have not been developed. Traditionally, it is recommended: to provide gentle and gentle care for sore spots, use cotton underwear and choose models that do not put pressure on the lesions, regularly and abundantly use means to soften and moisturize the mucous membranes, and use neutral detergents to use the toilet.

Lichen treatment

Treatment of lichen sclerosus is aimed at the following tasks:

• Achievement of anti-inflammatory, regenerating and absorbing effects.
• Prevention of the progression of the inflammatory process.
• Increasing the functional activity of compensatory-protective mechanisms.
• Restoration of the disturbed morphofunctional state of the reproductive system.

The complex of therapeutic measures is determined by three dominant pathogenetic mechanisms:

• Excessive fibrosis.
• Let's break the microcirculation.
• Immune disorders.

At the same time, Longidase® allows to influence all pathogenetic links.

The pharmacodynamics of Longidase® is due to the fibrinolytic activity of hyaluronidase, enhanced and prolonged due to fixation on a high molecular weight carrier.

Accordingly, drug treatment is carried out:

• Corticosteroids (have an inhibitory effect on the functions of cellular and humoral immunity); Long-term steroid therapy in the form of creams and ointments can thin the skin and cause discomfort.
• Calcineurin inhibitors - inhibit the activation of T-lymphocytes by blocking the production of pro-inflammatory cytokines in T-helpers 1 and 2, such as interleukins IL-2, -4, -5, -10, tumor necrosis factor TNF and granulocyte-macrophage colony-stimulating factor GM- CSF. Tacrolimus - Protopic ointment 0.03% and 0.1%. Among the undesirable effects of this drug: burning and itching, redness, pain, irritation, rash at the site of application, the development of folliculitis and acne. Isolated cases of malignancy (skin and other types of lymphomas, skin cancer) have been registered. Pimecrolimus - Elidel cream 1%. Among the side effects are burning at the site of application of the cream, the development of impetigo and skin infections, rhinitis, and urticaria.
• Enzyme preparations (contribute to the resorption of scars): hyaluronidase, trypsin, chemotrypsin.

Therapeutic effect of Longidase®

The high-molecular carrier not only stabilizes hyaluronidase, but also binds (inactivates) products released during matrix hydrolysis (iron, copper, heparin, etc.) that can both inhibit hyaluronidase and stimulate connective tissue synthesis.

Thus, Longidase® not only selectively depolymerizes the matrix of fibrous-granulomatous formations, but also blocks the body's attempt to compensate for the consequences of this depolymerization by increasing collagen synthesis.

Longidase® suppresses connective tissue hyperplasia, controlling the pathological process at all stages of its development.

Longidase®, facilitating the hydrolysis of the connective tissue matrix:

• improves trophism;
• increases the bioavailability of antibiotics;
• increases the elasticity of cicatricial areas.

Longidase® does not have antigenic properties, mutagenic activity, does not have an allergenic, embryotoxic, teratogenic and carcinogenic effect.

• Date: 30-04-2019
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Lichen sclerosus (SL) is an inflammatory disease of the skin and is chronic. Most often it affects the reproductive organs. It affects both women and men. It is known that if this disease is started, it can cause scar formations on the genitals, eventually leading to serious complications.

Men subsequently develop a narrowing of the foreskin, known as phimosis. More difficult cases are characterized by narrowing of the navicular fossa and the external opening of the urethra, and this provokes a violation of urination and hydronephrosis.

Such pathologies significantly reduce the quality of life, and sometimes cause urolithiasis, infections of the genitourinary system. Also, the disease in severe forms can lead to the development of oncology of the penis.

Alternative SL names

The name scleroatrophic lichen has a number of synonyms. Usually the names of the diagnosis depend on the affected area and the specialty of the doctor. In gynecology, for example, this disease is usually called vulvar kraurosis, in urology xerotic balanitis obliterans, in dermatology - scleroatrophic lichen. Terms such as lichen sclerosus and lichen sclerosus are known.

At the end of the 70s. The ISSVD, an international community dedicated to research into diseases of the vulva and vagina, has made recommendations to use the term lichen sclerosus to refer to this disease. In the late 90s. this recommendation was supported by the American Academy of Dermatology.

To date, professionals in the field of urology have not been able to agree on the use of the term lichen sclerosus.

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The prevalence of lichen sclerosus

It is extremely difficult to determine most precisely how common lichen sclerosus is in a population of different age groups, because this disease often goes unnoticed and is not diagnosed at all. The most accurate calculations suggest that lichen sclerosus is common among women aged 1 to 70 years. The disease is 10 times more common in women than in men. It is known that 1 in 1000 women suffers from it. The peaks of this disease capture the prepubertal period, postmenopause. During these periods, the prevalence increases by 1:30. It is known that about ¼ of the female population addresses this problem in clinics.

The causes of her illness

To date, the causes of this disease are not fully understood. It is believed that pathologies in the endocrine, immune and nervous systems, as well as infections, play an important role in its formation. Experts suggest associations of lichen sclerosus with genetic causes, autoimmune diseases, and reduced levels of endogenous hormones. Doctors have found that about 1/5 of women with lichen sclerosus also suffer from autoimmune disorders:

• alopecia areata;
• vitiligo;
• thyroid disorders.

In addition, scientific studies show that more than half of women with this condition have circulating autoantibodies. The spread of SL in close relatives supports the theory of the presence of a genetic component. Often, patients have a low endogenous level of steroid female sex hormones. During menstruation, pregnancy, hormonal therapy or the use of oral contraception, changes in symptoms were not recorded.

So, we can distinguish certain factors involved in the formation of the disease:

• autoimmune (sometimes manifestations of tissue damage that provokes lichen sclerosus are similar to those characteristic of autoimmune connective tissue diseases);
• genetic (research data indicate a relationship between development and the level of expression with the transfer of certain genes);
• hormonal (disturbances in the assimilation of male sex hormones can give rise to the development of SL);
• infectious (such infectious and viral agents, such as spirochetes and human papillomavirus, can affect the appearance of SL);
• local (periodically sclerosing lichen may be associated with local trauma to the skin, such as radiation exposure, trauma to old scars, chronic irritation of the dermis, abrasions).

Symptoms of the disease

Lichen sclerosus among the female population is diagnosed more often. Rashes are mainly localized in the genital area, shoulders, upper chest, neck, axillary cavities, less often in the abdomen, back, and thighs. First, a nodule appears the size of a lentil grain (3-5 mm in diameter), it has a chalky or gray-white color with mother-of-pearl. Lichen sclerosus may resolve aggressively, or symptoms may not be noticeable for a long time.

At the first stage of the disease, the rash looks like white spots. The papule may be surrounded by a thin pink rim. Papules that are nearby are combined into plaques and may rise slightly above the surface of the rest of the skin. Later they sink a little. Sometimes the surface of these formations is covered with vesicles, petechiae or telangiectasias.

The follicular location provokes the expansion of the hair follicles, follicular horny plugs appear, which have a dirty brown tint and resemble comedones.

Genital organs affected by scleroatrophic lichen are dry and sclerosed. The entrance to the vagina becomes narrower, there is severe itching. This causes the formation of cracks in the vulva that occur arbitrarily or after physical impact (combing, sexual intercourse). Scarring cracks often cause pain during intercourse, urination disorders, pain when emptying the rectum and bleeding.

Men do not notice certain sensations, but the tapering foreskin provokes the development of phimosis. Later, the skin atrophies and darkening of the lesion occurs. Due to the deterioration of the elasticity of the outer edge of the skin on the foreskin, it can crack.

Treatment of lichen sclerosus

People with LS are treated in a clinic under outpatient supervision. Complex therapy designed to limit the progression of the disease includes drugs that improve microcirculation (Dipyridamole (3-5 mg per 1 kg of weight per day), Retinol acetate 10,000-20,000 IU).

Locally, Actovegin 5% ointment or Solcoseryl is applied in a small layer to the damaged area. Hyperbaric oxygen therapy is used to better saturate the blood with oxygen, stimulate regeneration and fight inflammation.

This method allows drugs to be delivered through the lymphatic vessels to the surface tissues. If necessary, patients undergo physiotherapy.

In addition, treatment involves:

• etiotropic therapy;
• basic therapy;
• symptomatic treatment of comorbidities.

Possible prevention

Unfortunately, there are no unambiguous preventive measures that can prevent lichen sclerosus. But if the first symptoms of the disease appear, you need to contact a specialist as soon as possible. If proper measures are not taken, the likelihood of quite serious complications is high.

Rapid excision of damaged genital skin and subsequent control, as well as treatment with ointments, can stop the process and prevent it from developing into more severe complications.

Before you go to a specialist, you need to make sure that he is competent in diagnosing lichen and can prescribe adequate therapy. Men should not forget that the treatment of advanced forms of this disease sometimes requires complex operations to restore the patency of the urethra. Therefore, the doctor who will be involved in the treatment must be fluent in such operations.

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Unfortunately, in our country, most universities do not teach lichen sclerosus at all to students as a separate form of inflammation. As a result, many doctors simply cannot distinguish the symptoms of this disease and, accordingly, are not able to select adequate therapy.

It often happens that patients with lichen receive antibiotic treatment as part of complex therapy, because doctors mistake it for herpes, balanoposthitis, chlamydia, acquired phimosis, etc. But, since antifungal drugs and antibiotics in the treatment of SL most often do not give a result, and surgical intervention for phimosis is not supported by the necessary treatment, patients remain without appropriate medical care.

What is the purpose of this article?

This article has been written to help you understand more about genital lichen sclerosus in men(also known as xerotic balanitis obliterans). She will tell you what the condition is, what causes it, what can be done about it, and where you can learn more about it.

What is male genital lichen sclerosus?

Lichen sclerosus is a chronic inflammatory skin condition that can affect any part of the skin, but in men it is most common in the foreskin and the tip of the penis. It can affect both boys and men of any age.

In some people, lichen sclerosus also affects the skin elsewhere on the body, where it can cause whitish patches of skin, but usually does not cause discomfort.

What causes male genital lichen sclerosus?

It's not entirely clear what causes male genital lichen sclerosus. This condition almost never occurs in men who have been circumcised at an early age.

Lichen sclerosus is not caused by infection, and although the genital area is affected, is not transmitted to a sexual partner.

Lichen sclerosus may affect some men with autoimmune conditions such as thyroid disease or diabetes, although this association is more common in women. It may also be associated with atopic conditions such as eczema, asthma, and hay fever.

Friction or skin damage can cause lichen sclerosus and worsen its course. This is called the "Koebner reaction" and is sometimes seen after surgery. Some men pass small amounts of urine after urinating, and it is believed that collecting urine under the foreskin can lead to lichen sclerosus genitals.

Some men have a connection between lichen sclerosus And penis cancer, but that rarely happens. Although circumcision may reduce the risk, it does not completely prevent penis cancer.

Is male genital lichen sclerosus hereditary?

Although there are some reports of family history lichen sclerosus, it usually does not run in families.

What are the symptoms of male genital lichen sclerosus?

Damaged skin can be uncomfortable, sometimes itchy, itchy, and sore, especially during or after sex. It often becomes harder and harder to retract the foreskin, resulting in painful erections. The skin may crack and bleed during intercourse.

When the opening at the tip of the penis is affected, urine may spray out. However, some men do not experience any symptoms.

What does male genital lichen sclerosus look like?

The damaged skin of the penis may look red, with small cracks, sores, bleeding points, or small drops of blood. When the skin becomes inflamed for some time, it can become white and emaciated. On the other hand, thickening of the skin can sometimes be observed. Scarring may develop and change the appearance of the foreskin or tip of the penis. When the foreskin is retracted, it may form a ridge around the penis, like a tight band.

Sometimes the foreskin can be too tight to come off, making it impossible to clean the tip of the penis. If this occurs, it is important to seek the advice of a doctor, as there may be an increased risk of cancer if this problem is not corrected.

How is male genital lichen sclerosus diagnosed?

The diagnosis is often made by a dermatologist after examining the affected skin.

Sometimes a small sample of skin can be taken and examined under a microscope to confirm the diagnosis, especially if there is pain or a thickened area of ​​skin. This is known as a skin biopsy and requires local anesthesia and possibly stitches to close the wound, resulting in a small scar.

Can male genital lichen sclerosus be cured?

Although circumcision is possible in some men, in others the condition may continue or change after surgery. Lichen sclerosus won't go away on its own, but may not cause any symptoms when the right treatments are used.

How can male genital lichen sclerosus be treated?

Strong steroid ointments such as clobetasol propionate and diflucortolone valerate, are used to stop inflammation, as well as to soften the affected skin. This reduces the need for surgery. Please do not worry about the instructions inside the package, which may say that these ointments should not be used on the skin of the genitals. They are completely safe to use for this condition and your dermatologist will advise you on how and when to use steroid ointments safely.

After the initial period of treatment, a maintenance treatment plan may be required. This may include regular use of moisturizers and occasional use of less strong steroid creams.

Tacrolimus and pimecrolimus ointments usually not used as first line treatment for lichen sclerosus. They do not cause thinning of the skin, although there are theoretical considerations for an increased risk of skin cancer.

If the foreskin becomes too tight and is not softened by creams, it may be necessary to see a urologist for circumcision or other surgery. It may cure lichen sclerosus, even at the tip of the penis.

If the opening at the tip of the penis becomes so narrow that urine cannot pass through it easily, the urologist may recommend gently stretching it and/or applying steroid ointments to the area and, if not, consider surgery. Therefore, it is important that you consult if you have problems passing urine.

Self Care

• Avoid washing with soap and use an emollient wash/cream wash instead. Many different non-perfumed creams can be used, but water-based creams can be irritating for some men and should be avoided.
• Dry your genitals thoroughly after you pass urine to reduce urine-to-skin contact.
• Using moisturizing or yellow soft paraffin (such as petroleum jelly) as a barrier cream can protect the skin from exposure to urine.
• Trim your pubic hair to keep it out of the gap between your foreskin and penis.
• Lubricant for sex will reduce excessive friction.
• If you are a smoker, stop smoking to reduce your risk of penile cancer.

Very important for all men with lichen sclerosus is regular self-examination throughout life. If any skin changes develop that do not respond to steroid creams particularly any persistent thickening of the skin or soreness, it is important to tell your doctor immediately. A skin biopsy may be required to test for skin cancer.

WARNING . This sheet refers to "emollients" (moisturizers). When paraffin-containing emollient products come into contact with dressings, clothing, bedding or hair, there is a danger that open flames or cigarette smoking can cause ignition. To reduce the risk of fire, patients using paraffin-containing skin or hair products are advised to avoid open flames, including cigarette smoking and being near people who smoke or use open flames. It is also recommended to wash clothes and bedding regularly, preferably daily.

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Contact only professionals.
Use only evidence-based medicine, such as the one in this article, when researching information about your problem.

Lichen sclerosus is a chronic inflammatory skin disease, usually of the genital organs in men and women, the causes of which have not yet been studied. However, today it is clear that if this disease is not treated, then it leads to cicatricial changes in the genital organs, which can cause serious problems. In particular, men may develop narrowing of the foreskin (phimosis) and difficulty opening the glans penis. In more severe cases, a narrowing (stricture) of the external opening of the urethra and the scaphoid fossa (the part of the urethra closest to the external opening) may form, which will lead to urination disorders and a violation of the outflow of urine. Such changes can cause a decrease in the quality of life, lead to complications such as urinary tract infection (pyelonephritis, cystitis), expansion of the renal cavitary system (hydronephrosis), and urolithiasis. Severe forms of the disease are considered predisposing conditions for the development of penile cancer.

Causes of lichen sclerosus
The exact cause of the disease is not known. However, there are a number of factors that may be involved in the development of the disease:
1. Genetic factors;
2. Autoimmune factors;
3. Infectious factors;
4. Local factors;
Sometimes the development of the disease is associated with local damage to the skin. The trigger mechanism for development can be mechanical trauma in the area of ​​old scars, radiation exposure of the skin during radiation therapy, skin abrasions, chronic skin irritation with urine in patients with diabetes mellitus.
5. Hormonal factors;

Symptoms of lichen sclerosus
In men, as a rule, it begins with a lesion of the skin of the penis. Early manifestations are characterized by the appearance on the skin of the foreskin and head of the penis of whitish spots and areas of skin atrophy, as well as sclerotic plaques of spotted color. A characteristic manifestation of the initial stage is a whitish sclerotic ring.
In the future, the development of sclerotic (scar) tissue leads to thickening of the skin of the foreskin, which makes it difficult to open the head of the penis, contributes to the attachment of infection and the development of bacterial inflammation of the head of the penis (balanitis). With the development of the disease, the glans penis ceases to open and cicatricial phimosis is formed.
Due to a decrease in elasticity, tears may appear on the outer edge of the skin of the foreskin.
In men who have been circumcised, the disease may begin on the penis in the area of ​​the skin scar left after the circumcision of the foreskin. Involvement in the process of scarring of the external opening and the initial sections of the urethra leads to the appearance of difficult urination, manifested by thinning of the urine stream and the need to strain to start urination.

Lichen sclerosus treatment
Treatment of lichen sclerosus depends on the degree of tissue involvement in the inflammatory process.
At the initial stage, the operation of circumcision of the foreskin (circumcision) is performed and further observation. In more complex cases, surgical removal of the affected tissues is performed, if necessary, an operation to expand the external opening of the urethra (meatotomy), long-term local treatment with anti-inflammatory drugs. If the process involves the foreskin, the head of the penis, the external opening of the urethra, then it may be necessary to perform complex plastic surgeries to eliminate urethral strictures, wide excision of scar tissue, and prolonged local treatment with a glucocorticoid anti-inflammatory cream.
In a precancerous condition, treatment consists in surgical excision of scar tissue. Unfortunately, there are no effective preventive measures that could prevent the disease. Therefore, at the first symptoms of the disease, seek help from an experienced urologist (gynecologist).