Lichen Planus > Lichen Sclerosus
Introduction:
Lichen Sclerosus is also known as Lichen Sclerosis (or Lichen Sclerosus et atrophicus). It is a painful skin condition that typically affects the vulva (or penis) and anus. It results in white patches on the skin, which causes scarring on and around genital skin.
Causes:
In most of the cases the cause remains unknown. It is found to be an immunologically mediated disease. There are several factors found responsible for development of lichen sclerosis, such as auto-immune diseases, infections and genetic component. It may be associated with thyroid disease in some patients.
Incidence:
Women are more commonly affected than men (10:1) particularly in young girls (prepubertal) and postmenopausal women. Children are rarely affected.
Areas affected:
- In females the vulva and anus
- In males foreskin of penis
- Non genital areas involve hair follicles or sweat glands on the surface of skin, breasts and under arms.
Signs and symptoms:
If the disease is a mild case, there may be no symptoms.
In the early stage small white spots appear on the skin, which is shiny, and smooth in appearance later on the spots grow into bigger patches. The skin on the patches becomes thin and wrinkled. Then the skin tears easily, and bright red or purple bruises are common. Sometimes, the skin becomes scarred.
In Lichen Sclerosis the main symptom is itching along with painful coition, urination and defecation.
In males Lichen Sclerosis can lead to whitish thickening of foreskin of penis causing phimosis (failure of foreskin to be fully retracted from the head of the penis)
Diagnosis:
Lichen Sclerosis diagnosis is done by experienced clinical examination and
biopsy of skin may be required to confirm the diagnosis.
Conventional Treatment:
- Application of strong cortisone or immunosuppressant (ointments or creams) is suggested such as clobetasol propionate and tacrolimus
- Topical oestrogen creams are not effective for Lichen Sclerosus but may be prescribed for postmenopausal atrophy (dry, thinned and sensitive vulval and vaginal tissues due to hormonal deficiency).
- Retinoid, or vitamin A-like drugs
- Surgery to remove entire vulva in severe cases, vulvar cancer or pre-cancer.
- Surgery which removes the patches in women is of no use as it comes back
- Circumcision in men
- Ultraviolet light therapy (not used on skin of the genitals).
Homeopathic treatment:
Homeopathic treatment entails medication based on the understanding of immune-status of the patients, and other genetic, hormonal, stress related factors. Some of the commonly used medicines include ultra-small doses of potentized mercury compounds, gold salts, thuja occidentalis, some nosodes, etc.
Prognosis:
There is an increased risk of cancer in the long-term; Women with Lichen Sclerosis may develop vulvar carcinoma.
In advanced cases, skin that has been scarred as a result of Lichen Sclerosis may cause sexual difficulties or problems in passing urine
Some general measures:
- Use of moisturizers or bland creams
- Avoid soap, bubble baths, scented soap, detergents, perfumes, etc, to the vulva. These may irritate the skin and make symptoms worse.
- Lubricants are useful during sex if having sex is painful.
- Avoid tight clothing and use cotton under garments
Homeopathic management:
Homeopathic medicines are effective for the management of Lichen Sclerosis. The medicines help to reduce inflammation, reduce itching and help to control the pathology and restrict the spread of the disease. They give good relief in the pain, burning and discharge.
Homeopathic medicines help in long-term remissions (disease free interval). Persons can remain symptom free with the help of homeopathic remedies.
In case of phimosis, surgical procedure has to be carried out. In case of Lichen Sclerosus turning malignant, homeopathy will have no scope in treatment.
The medicines are decided after integrating all this information and help in reducing the symptoms, halting the pathology and giving long-term remissions.
