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Women's Health

Lichen sclerosus

A chronic inflammatory dermatosis that usually affects anogenital skin, causing itch, soreness, white fragile plaques and scarring; recognise suspicious change because vulval lichen sclerosus carries a small but important risk of squamous cell carcinoma.

In a nutshell

Lichen sclerosus is a chronic inflammatory anogenital dermatosis causing itch, soreness, white fragile plaques and scarring. Diagnose clinically when typical, treat with an ultrapotent topical corticosteroid plus irritant avoidance and emollients, and biopsy or urgently refer any persistent thickened, ulcerated, changing or non-healing lesion because of the small risk of squamous cell carcinoma.

Classic presentation

A woman, child or man has persistent anogenital itch or soreness with white smooth or crinkled plaques, fissures or purpura and possible figure-of-eight involvement; chronic disease may cause labial fusion, introital narrowing or phimosis.

Key points

  • It is an inflammatory dermatosis, not an infection or STI, and the vagina is usually spared.
  • Look for white fragile plaques, fissures, purpura and architectural loss; the figure-of-eight pattern is helpful but not essential.
  • Diagnosis is usually clinical; biopsy atypical, uncertain, treatment-resistant or suspicious focal lesions.
  • First-line treatment is an ultrapotent topical corticosteroid such as clobetasol propionate, used according to the current BNF or specialist regimen.
  • Use emollients and soap substitutes, avoid irritants, and arrange long-term review with self-examination advice.
  • A persistent lump, thickening, ulcer, bleeding lesion or non-healing sore needs prompt specialist assessment and usually biopsy.

First-line investigation

History and examination of the anogenital skin; arrange targeted biopsy when the appearance is atypical, persistent, treatment-resistant or suspicious for neoplasia.

Management

Identify cancer and functional red flags

  • Examine for a persistent lump, thickening, ulcer, non-healing sore, bleeding lesion, urinary obstruction or severe scarring; use an urgent specialist pathway when present.1,2

Treat inflammation correctly

  • Use an ultrapotent topical corticosteroid induction and tapering regimen according to the current BNF or specialist pathway; correct application and adherence matter more than avoiding steroid treatment.1,5

Protect fragile skin

  • Use emollient or soap substitute, avoid fragranced products and friction, and use barrier ointment or lubricant when appropriate.2,3

Maintain control and safety-net

  • Review response, continue the agreed maintenance plan, teach self-examination and reassess promptly for any new focal change; children and complicated disease need specialist follow-up.1,2,3

Exam traps

  • Do not label persistent itch and white plaques as candidiasis without examining the skin.
  • A biopsy is not mandatory for every classic presentation, but a focal thickened, ulcerated, changing or non-healing lesion must enter a biopsy and cancer-exclusion pathway.
  • The correct treatment is an ultrapotent topical steroid; fear of steroid atrophy should not lead to under-treatment when it is used as prescribed.
  • Lichen sclerosus can affect children and males, not only postmenopausal women.
  • Established scarring may need specialist surgery, but surgery does not treat the underlying inflammation; control the dermatosis first.
  • It is not contagious, sexually transmitted or caused by poor hygiene.

Illustrations

Vulval lichen sclerosusA clinical photograph of white, atrophic, crinkled vulval plaques in a figure-of-eight distribution with loss of normal architecture. Sensitive image.Mikael Häggström, Wikimedia Commons · CC0
Histology of lichen sclerosusA histology image showing epidermal atrophy, a hyalinised upper dermis and a band of lymphocytes beneath.Nephron, Wikimedia Commons · CC-BY-SA-3.0

Key sources

  1. British Association of Dermatologists, Guidelines for the management of lichen sclerosus, 2018 (UK specialist guideline covering clinical diagnosis, ultrapotent topical corticosteroid treatment, biopsy, follow-up, children and treatment failure; latest dedicated BAD guideline located at the access date.)Published 1 Apr 2018
  2. NHS, Lichen sclerosus (Current NHS information, page reviewed 9 December 2024, including symptoms, skin care, steroid treatment, scarring and cancer safety-netting.)Published 9 Dec 2024
  3. Saint Mary's Managed Clinical Service, Lichen sclerosus in girls and young people (NHS paediatric and adolescent gynaecology patient pathway updated February 2026, including clinical diagnosis, clobetasol use, skin care, follow-up and red flags.)Published 1 Feb 2026
  4. British Society for the Study of Vulval Disease, Vulval lichen sclerosus guidance for healthcare professionals (UK vulval-disease professional guidance cross-check for diagnosis, topical treatment, biopsy and referral; local specialist pathways apply.)
  5. BNF, Topical corticosteroids (Current UK prescribing cross-check for topical corticosteroid potency, safe use, contraindications and monitoring; detailed BNF access is restricted in this environment, so no dose-specific claim is made beyond the referenced specialist regimen.)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.