Lichen Sclerosus: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Lichen Sclerosus?
A dermatologist, a doctor who treats skin conditions, usually treats lichen sclerosus. A gynecologist, a doctor who cares for the female reproductive system, may also help when it affects the vulva, the skin around the vaginal opening. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is lichen sclerosus?
Lichen sclerosus is a long-lasting skin condition that causes itchy white patches. It most often affects the genitals and the skin around the anus. It affects people of all ages, including children, but it is much more common in women over 50.
It is not contagious, and it is not a sexually transmitted disease. Some people have no symptoms. Others have strong itching, discomfort, or sores.
Symptoms
The patches are usually itchy, white, and smooth or crinkled. The skin can become thin and shiny. It is easily damaged, so it may bleed or hurt if it is rubbed or scratched. Other signs include:
- Burning and pain along with the itching.
- Painful sex, because the vulva may shrink or tighten.
- In men, a tight foreskin and painful erections.
Over time, the skin can sometimes become scarred and tight. This can cause discomfort when you urinate, pass stool, or have sex. Lichen sclerosus also raises the risk of cancer on the vulva, penis, or anus. The risk is low.
Causes and who gets it
The exact cause is not known. Most research suggests it is an autoimmune condition, which means the immune system mistakenly attacks healthy tissue. The most likely cause is an autoimmune reaction in people whose genes make them more likely to get it.
Rubbing or damage to the skin can trigger it or make it worse. It is not caused by an infection or by poor personal hygiene. Females are six times as likely to be affected as males. In males, it is much more likely in those who have not been circumcised.
How doctors diagnose it
A doctor usually diagnoses lichen sclerosus by looking at the affected skin and asking about your history. A skin biopsy may be needed to be sure of the diagnosis. In a biopsy, a doctor takes a tiny piece of skin to study under a microscope. A biopsy may also be done if skin cancer is suspected.
Treatment
Lichen sclerosus cannot be cured, but a strong prescription steroid ointment usually helps relieve the symptoms. Very strong steroid ointments, not creams, are the standard of care. They ease itching within days or weeks and restore skin strength and texture over months. They cannot reverse scarring that has already happened.
You may need to use the ointment regularly for a few months to get symptoms under control. After that, you may need a weaker steroid ointment or a moisturizing cream. In females, regular use helps prevent scarring and lowers the chance of skin cancer in the affected area. Follow your doctor's advice about how and when to use any medicine.
Other treatments depend on the case. Tacrolimus or pimecrolimus ointments are second-line choices. Medicines that work throughout the body, such as methotrexate or retinoids, may be used for severe disease. They have many side effects and need a specialist's supervision. Surgery is mostly kept for scarring, such as circumcision in males or surgery to widen the vagina. Laser treatment and platelet-rich plasma injections are still being studied.
Daily skin care also helps. Wash with an emollient soap substitute, a gentle moisturizing cleanser, instead of regular soap. Gently dab the area dry after you urinate. Apply a barrier cream or ointment, such as petroleum jelly. Wear cotton or silk underwear. Do not scratch or rub the skin, and do not smoke. If you use an emollient, stay away from naked flames, because it can make clothing and bedding catch fire more easily.
When to see a doctor
See a doctor if you have an itchy white patch on your genitals or skin. See a doctor if you already have lichen sclerosus and treatment is not helping, or if you have pain when going to the toilet or having sex.
Also see a doctor if you notice a lump, a change in skin texture such as thickening, or an ulcer that does not go away. People with vulvar lichen sclerosus need lifelong follow-up to watch for cancer.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A primary care doctor can look at the skin, ask about your symptoms, and refer you to a dermatologist or gynecologist for a biopsy or treatment.
Common questions
Is lichen sclerosus contagious?
No, lichen sclerosus is not contagious. You cannot spread it to other people through close contact, including sex.
Can lichen sclerosus be cured?
No, lichen sclerosus cannot be cured. A strong prescription steroid ointment usually helps relieve the symptoms.
Does lichen sclerosus cause cancer?
Lichen sclerosus raises the risk of cancer on the vulva, penis, or anus, but the risk is low. In females, regular use of strong steroid ointments lowers the chance of skin cancer in the affected area.
Can children get lichen sclerosus?
Yes, lichen sclerosus can affect children, although it is rare in them. In children with patches around the anus, constipation may be one of the first signs.
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Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
