What is lichen sclerosus?
Lichen sclerosus is a benign, chronic, progressive skin condition that causes the skin to turn white, thinned and wrinkled, as well as pain and itching. It occurs more commonly in postmenopausal women, but premenopausal women, men and children may be affected. Lichen sclerosus can develop on any skin surface, but it usually occurs in the genital and anal regions. 85 to 98% of cases are found near the clitoris, on the labia and in the anal region of women. Whereas in men, it commonly develops on the glans (head) of the penis and the foreskin. The other 15% is found on other skin surfaces such as the thigh, breast, wrist, shoulder, neck and the oral mucosal. The common symptoms include severe itching at the genital and anal regions, fissures, bleeding, pain, painful sexual intercourse and painful urination. As lichen sclerosus is progressive and inflammatory in nature, it is crucial to start treatments early to prevent the condition from worsening. Lichen sclerosus medication such as topical steroid ointments have anti-inflammatory properties that are shown to be effective in relieving symptoms. Complications of untreated lichen sclerosus include scarring, painful intercourse, urinary retention, constipation, inability to retract foreskin and an increased risk of skin cancer at the affected area.
What is the cause of lichen sclerosus?
The cause of lichen sclerosus is unknown, but several factors have been suggested.
- Genetic factors – Studies showed that lichen sclerosus appears to be more common in individuals who have relations or family members with the same condition. Events of trauma, injury and sexual abuse are possible triggers to the occurence of lichen sclerosus in individuals who are genetically predisposed.
- Autoimmune disease – An autoimmune disease happens when the body’s immune system attacks the healthy cells of the body. A study found that women with lichen sclerosus have a high titer of antibodies against an important protein in the skin, suggesting that lichen sclerosus may be an autoimmune disease.
- Hormones – Lichen sclerosus is found to occur more commonly in individuals during their low-estrogen state, such as prepubertal girls and postmenopausal women, suggesting a hormonal influence on this condition. However, hormonal treatments like hormone replacement therapy, testosterone or progesterone have been ineffective for women with lichen sclerosus.
- Infections – Infectious agents like human papillomavirus (HPV) and acid-fast bacteria have been claimed to cause lichen sclerosus, but there is no evidence that lichen sclerosus is contagious.
- Urine – There is evidence that lichen sclerosus in men is due to urine droplets that pool between the glans penis and foreskin, usually in uncircumcised men.
What autoimmune disease can cause lichen sclerosus?
There is not enough strong evidence to establish the cause-and-effect relationship between autoimmunity and lichen sclerosus. So far, only one study has found that 75% of women with lichen sclerosus have increased antibodies directed against extracellular matrix protein 1, which is a key component of the skin. But the relevance of this antibody to autoimmunity still requires more research. Thus the question of “what autoimmune disease causes lichen sclerosus” cannot be answered.
However, lichen sclerosus has been associated with several autoimmune diseases, namely alopecia areata, vitiligo, thyroid disorders, pernicious anemia, diabetes mellitus and celiac disease. These autoimmune diseases DO NOT cause lichen sclerosus but have been found to be present in individuals with lichen sclerosus. Among 350 women with confirmed lichen sclerosus, 22% of them had an autoimmune disorder and 42% of them had one or more autoantibodies. Another study comparing 190 women with vulvar lichen sclerosus and 922 normal women reported that women with the skin condition have a greater risk of getting other autoimmune disorders; 28% versus 9% respectively have autoimmune disease. In short, if you have lichen sclerosus, you have a greater chance of developing an autoimmune disease.