Lichen sclerosus is a chronic muco-cutaneous inflammatory disorder affecting the skin and the genital region. It leads to thinning along with wrinkles and white patches on the skin. It can occur in both males and females, but is about 10 times more prevalent in females. It mostly affects the pre-pubertal and postmenopausal women.
What Cream Do You Use For Lichen Sclerosus?
Diagnosis of lichen sclerosus is made on the basis of thorough history and physical examination. A skin examination of the affected body parts gives an idea about the type of lesions present. A biopsy will confirm the diagnosis of lichen sclerosus lesions. The other tests to rule out similar skin conditions should also be done for effectively treating the disease. The other conditions, which can cause similar skin lesions, include vitiligo, lichen planus, pemphigoid and low estrogen levels. All these conditions usually co-exist with lichen sclerosus.
The mainstay of treatment remains topical steroids, which soothe the itching and inflammation. Cortisone is widely used for skin conditions such as dermatitis, psoriasis, lichen sclerosus and lichen planus. However, the right strength and the part of the skin to be treated should be kept in mind with steroids topical application. The application should be stopped once the skin has recovered to its normal state because its overdose can lead to thinning of skin making the skin fragile so it tears easily, and can lead to redness and burning sensation along with stretch marks around the anal region.
The creams usually used are desonide, clobetasone butyrate, methylprednisolone aceponate, mometasone furoate, betamethasone diproprionate, and clobetasol proprionate. These ointments are readily available over the counter even without prescription. The other cortisones such as betamethasone valerate and triamcinolone are not suitable to be used on vulva because they can cause undesirable side effects.
The long-term management for lichen sclerosus includes regular visits to a doctor and using the ointment under their guidance until the condition is cleared and restored to its natural state. If a certain cream is not working for you then you can consult your doctor and another medicine can be prescribed. It is generally advised to use these creams under the guidance of a medical practitioner only, due to the side effects they produce when used for a prolonged period of time.
The other treatment options for lichen sclerosus include cryotherapy of the affected genital lesions; narrow band UVB, psoralen plus UVA (PUVA), and photodynamic therapy using a photosensitizer with laser light activation have been beneficial in many cases where other methods have failed.
Signs and Symptoms of Lichen Sclerosus
The etiology of lichen sclerosus is not known, but it thought to be an autoimmune disorder that is genetically inclined where the body’s defense mechanism attacks its own skin cells. It is also thought to be aggravated by trauma, infections, hormonal and skin changes. It is not contagious therefore cannot be passed onto others by contact.
Skin lesions caused by lichen sclerosus are flat, shiny, whitish, stiff papules that lead to plaque formation. The skin lesions are usually seen in the neck region and trunk. They are asymptomatic but in some cases pruritis or itching may occur.
Lichen sclerosus affecting the anorectal region result in lesions in the vulva that are ivory or white flat lesions with intense itching, which leads to erosions and purpura. In men the foreskin and glans are affected that causes difficulty in retracting the foreskin (phimosis). This can cause dyspareunia (painful sexual intercourse), dysuria and painful defecation.
Oral lesions of lichen sclerosus are rare and may or may not be associated with genital lesions. The oral mucosal lesions are very rare and appear white, flat demarcated lesions similar to the ones in the vulva but differ from that of lichen planus. The most affected intraoral sites are buccal, labial and palatal mucosal regions.
The other sites affected by lichen sclerosus are the thighs, breasts, submammary region, neck, back, chest, shoulders and wrist, but the lesions present here usually remain asymptomatic.
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