Centro Studi GISED

Lichen sclerosus et atrophicus

Is a chronic, atrophic disease characterised by papules and white plaques. They are polygonal in shape, clear-cut and of a hard texture. At times, follicular hyperkeratosis also occurs.

I’m a man of 27 years and for about 1 year I have been affected by a redness and itchiness of the perianal area. Initially my family doctor thought I had caught a fungal infection from the gym and gave me a cortisone ointment, during the treatment the situation had improved but reappeared every so often. Today, a visit to the dermatologist showed that I was affected by “perianal sclero-atrophic lichen.” The dermatologist suggested that I have a proctoscopy and following it, as necessary, a histological examination. In the meantime I must continue to use the cortisone cream. Could you give me some more information and advice, keeping in mind that I go to the gym 4 or 5 times a week and that I do indoor cycling? I’ve often noticed, in fact, that a couple of hours after having a shower following physical activity , the symptoms of the lichen reappear and continue throughout the night until I fall asleep when I automatically start to scratch myself and aggravate the situation even more. What could I expect besides? Including from the proctoscopy and histological examination? Yours sincerely.

Dear Friend, Sclero-atrophic lichen is an inflammatory disease not very common, usually chronic. It’s an irritating but benign illness of which, unfortunately, we don’t know the causes and therefore treatment cannot be anything but symptomatic (elimination of the irritation connected with it). Locations including the anus, vulva and foreskin of the penis are rather common. You observe very itchy white scabs with a red ring. The lesions evolve into atrophic patches. At times you can observe blisters. A histological examination is essential for it’s diagnosis. The treatment will entail topical steroids and in cases more severe, oral administration of a vitamin A derivative (acitretin). Periodical check-ups are useful for monitoring the development of the disease. Best regards Dr. Luigi Naldi - Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED

I’m affected with lichen of the penis. After various visits to specialists in..., I haven’t seen any improvement. I’m a student at the University of... and I’m 24. I’m looking for information regarding specialists or centres for a solution to my case. Thank you.

Considering the location I think that you could have sclero-atrophic lichen. It’s a chronic, progressive disease that responds badly to treatment. As you will have to undergo periodical check-up visits, I would advise you to trust yourself to a specialist in your area of residence. If you still have doubts about the diagnosis it’s possible to have a biopsy taken. A course of topical steroids could be enough. Oral retinoids could also be useful. Best regards, Dr Lorenzo Peli – GISED.

Dear Doctor, My name is (…) and I’m affected by sclero-atrophic lichen of the genitals. Phimosis has developed, which renders it difficult for the glans penis to emerge when erect. Further to the white sclerotic ring, a white mark under the skin of the glans penis has also appeared. I wanted to ask if I need to be circumcised (if yes, is it a dermo-surgeon that operates or a urologist?) or do I need to undergo a course of treatment. Do I risk being affected by other pathological conditions more serious than sclero-atrophic lichen? Thank you and best regards.

Dear Sir, Thank you for the message. Sclero-atrophic lichen is a chronic inflammatory illness of unknown cause, which frequently targets the genitals. Unfortunately there is no treatment available for sclero-atrophic lichen that is sure to work. Topical steroids are used in the first instance. When, as in your case, it causes phimosis, circumcision is usually recommended. Best regards Dr. Luigi Naldi - Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED.

My partner, aged 45, is affected with sclero-atrophic lichen of the glans penis, which has caused marked phimosis. In fact, the glans penis can’t be completely exposed. We’re waiting for the results of a biopsy and he’s actually already doing a course of cortisone (1 injection 3 times a week) and using an ointment. In spite of the fact that the dermatologist told me that this disease isn’t contagious, I’m very worried and I would like to know if there really is no risk of it being contagious and if this disease can be cured. I would be very grateful if you could reply as soon as you can.

Dear Writer, sclero-atrophic lichen is an inflammatory disease of the skin and mucous membrane that leads to atrophy of the skin and scarring. The cause is unknown. It’s not a contagious disease. The treatment comprises, in general, of topical steroids and retinoids, administered either locally or systemically. Best Regards, Dr. Luigi Naldi - Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED.

Dear Doctor, I’m a 28-year old woman. 2 years ago, after a curettement, I noticed that I had what looked like a small wart. The gynaecologist didn’t know what to make of it so I went to a dermatologist who gave me a tiny operation to remove the small “wart.” The results of a biopsy showed that it was sclero-atrophic lichen of the vulva, the mucous membrane and the small lips were affected! was treating it for a month with a topical steroid, which wasn’t strong enough and she has changed the ointment again and vitamin E in a gel. The reason that I’m worried is because I want to know if this illness can cause me to have problems having a baby, is it true that I couldn’t given birth naturally and that I’m obliged to have a caesarean? Will I have this illness my whole life? Can I go swimming? Awaiting your kind response, thank you.

Dear Writer, sclero-atrophic lichen is a chronic-progressive disease that is rarely cured, more often it tends to get progressively worse slowly over time. There are no particular problems associated with pregnancy, rather more when giving birth as such an illness can reduce the elasticity of the tissue appreciably. In many cases it’s rendered necessary to undergo a caesarean. There are no problems with going to the swimming pool. Follow the advice of your dermatologist. Best Regards Dr. Lorenzo Peli – dermatologist – GISED.

Is there a connection between the chronic form of Hepatitis C and sclero-atrophic lichen of the foreskin? Treatment for lichen: ... and ointment. Your opinion, thank you.

From our research, no correlation between sclero-atrophic lichen and hepatitis C has been noticed; instead, a correlation has been noticed between hepatopathy and Lichen Ruber Planus, which is something different to sclero-atrophic lichen. In general it’s advisable to have a follow up periodically. There is a tiny risk of developing epithelial tumours on the lesions caused by long-standing sclero-atrophic lichen. Among attempted treatments, other than those you’re prescribed, there are also topical steroids and isotretinoin in creams. Best regards Dr Anna Di Landro – GISED.