Lichen Sclerosus: Causes, Symptoms, and Treatment

What is Lichen Sclerosus?

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 the genital skin.

Causes of Lichen Sclerosis:

In most cases, the cause remains unknown. It is found to be an immunologically mediated disease. There are several factors found responsible for the development of lichen sclerosis, such as auto-immune diseases, infections, and genetic components. 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 the penis
• Non-genital areas involve hair follicles or sweat glands on the surface of skin, breasts, and underarms.

Signs and symptoms of Lichen Sclerosus:

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 the foreskin of the 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
A biopsy of the 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 estrogen 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 the entire vulva in severe cases, vulvar cancer or pre-cancer.
• Surgery that removes the patches in women is of no use as it comes back
• Circumcision in men
• Ultraviolet light therapy (not used on the skin of the genitals).

Homeopathic treatment:

Homeopathic treatment entails medication based on the understanding of the immune status of the patients and other genetic, hormonal, and 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 of Lichen Sclerosis:

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 undergarments

Homeopathic management:

Homeopathy has good effects in natural treatment for lichen sclerosus. Homeopathic medicines are effective for the management of Lichen Sclerosis. The medicines help to reduce inflammation, reduce itching, 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 intervals). Persons can remain symptom-free with the help of homeopathic remedies.

In the case of phimosis, a surgical procedure has to be carried out. In the 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. A long-term Lichen Sclerosus Homeopathy Treatment Plan is required depending on the case.

Key homeopathic remedies for Lichen sclerosus:

1. Mercurius Solubilis (Merc Sol): Mercurius Solubilis is indicated in cases of Lichen sclerosis with significant itching and intense burning, and the affected skin areas are excessively moist and have a tendency for sweat in the genital region. Merc Sol is useful when the skin develops ulcers accompanied by a sensation of rawness and soreness. The burning sensation is worse at night. There is slow healing of wounds; the skin lesions take time to heal. The lymph nodes in the groin are swollen and tender to touch. The discharge from lesions is offensive, foul, and foul-smelling. The symptoms aggravate with changes in temperatures, especially damp and cold weather.
2. Thuja occidentalis: Thuja is effective in the cases of Lichen sclerosus when the skin is highly sensitive to touch; even the slightest touch causes pain or discomfort. The lesions are painful when touched or due to friction from walking or sitting. The character of pain is sharp, stinging, often described by the patient as needle pricks. There is persistent, severe itching leading to constant scratching. The skin is dry, rough, and scaly with a tendency to crack and peel. It is indicated for complaints of burning after urination, which may lead to additional discomfort.
3. Nitric acid: Nitric acid is highly recommended when the ulcers bleed easily with the slightest pressure or touch. The discharge from lesions is foul-smelling and acrid, which irritates the surrounding skin. The pains are sharp, splinter-like pain around the genitals and anus. The patient experiences pain on touch, making sitting and walking difficult. The symptoms do aggravate with exposure to cold air or cold water, causing the affected areas to become more painful or irritated. Nitric acid is beneficial for cases where ulcers heal slowly and leave scars, causing tightness of the skin in affected areas. These patients tend to have warty growths or small excrescences in the affected areas with pain and itching. ओरल लाइकेन प्लेनस उपचार होम्योपैथी
4. Aurum metallicum: Aurum metallicum is indicated in cases of Lichen sclerosus wherein the lesions result in deep scarring causing tightness or restricted movement in the affected areas. It is suitable when there is a noticeable loss of elasticity causing tightness, discomfort, and movement difficulty. The skin is prone to extreme dryness, causing cracking, particularly in the thickened affected patches. The pains are deep-seated and often described by patients as throbbing or aching. The patients do experience deep depression and hopelessness and sometimes tend to suicide because of the chronic Lichen sclerosus condition. It is indicated medicine, homeopathic medicine for insomnia as well.
5. Sepia: Sepia is indicated when there are distinct white patches on the skin. The cause of Lichen sclerosus can be hormonal changes, especially during menopause. There is the sensation of heaviness or pressure in the pelvic region, which may be linked to the chronic inflammation of the skin. There is a burning sensation in the vulvar and anal regions worse during urination and menses. The symptoms are worse with heat, warm weather, and hot baths. Sepia patients experience significant pain during sexual intercourse due to tightness and dryness caused by Lichen sclerosus.

Written & Approved by-

Dr. Rajesh Shah

M.D. (Hom.)