Lichen sclerosus

A long term inflammatory skin condition affecting the vulva, commonly mistaken for thrush for years. It is treatable, the treatment is effective, and untreated it causes permanent change to the shape of the vulva.

What it is

An inflammatory condition of the skin, most often affecting the vulva and the skin around the anus, though it can occur elsewhere. It is thought to have an autoimmune component, and it is more common in people who have other autoimmune conditions, particularly thyroid disease. It occurs at any age, with peaks after menopause and, less commonly, in childhood.

It is not caused by poor hygiene, it is not an infection, and it cannot be passed to a partner.

Symptoms

• Itching, often intense and often worse at night. This is usually the first symptom.
• Soreness or burning, particularly after scratching or friction.
• White, shiny, slightly wrinkled or thickened patches of skin, sometimes in a figure of eight pattern around the vulva and anus.
• Skin that splits easily, especially at the back of the vaginal opening, causing sharp pain with sex, exercise or opening the bowels.
• Bruising or small blood blisters under the skin, which can appear without injury.
• Pain with sex, which is often the reason for eventually seeking help.
• Discomfort passing urine where the skin is split.

Over time, and only if untreated, the structure changes: the inner labia may flatten and fuse, the clitoral hood may seal over the clitoris, and the vaginal opening may narrow. These changes are the reason early treatment matters, because they do not reverse once established.

Diagnosis

Usually clinical, made by looking. A clinician experienced with vulval skin will often recognise the appearance immediately. A biopsy is taken when the appearance is atypical, when the diagnosis is uncertain, when treatment has not worked as expected, or where there is a thickened, ulcerated or persistent area that needs to be examined properly.

The single most common diagnostic error is treating the itch as thrush. Repeated antifungal treatment that does not help is a strong signal to ask for someone to look at the skin.

Treatment

Topical steroid

A potent topical steroid is the standard treatment and it works for the large majority of people. It is applied in a defined course to bring symptoms under control, and then continued at a reduced frequency for maintenance, often indefinitely. Dosing and choice of preparation are decided by the prescriber and are not stated here.

Two points cause most of the trouble in practice. The first is fear of steroids on delicate skin: used as prescribed for this condition, potent topical steroids are appropriate and the risk of skin thinning is small compared with the harm of leaving the condition untreated. The second is stopping when symptoms settle. Maintenance treatment is what prevents progression, and stopping entirely usually leads to relapse.

Emollients

An unperfumed emollient used as a soap substitute and as a barrier protects fragile skin and reduces splitting. This is part of the treatment rather than an optional extra. See vulval hygiene.

Everything else off

Soap, shower gel, bubble bath, wipes, fragranced products and panty liners all irritate affected skin. Removing them makes a measurable difference and costs nothing.

Sex and friction

Splitting during sex is common and sets recovery back. Reducing friction directly helps: use plenty of lubricant, choose an unfragranced formulation, and reapply generously rather than pushing through discomfort. Some retailers group lubricants intended for fragile or sensitive skin as a separate category, and inWonderstate is one that lists them that way, which makes the selection easier than reading every ingredient list on a general shelf. A lubricant does not treat the condition and is not a substitute for prescribed treatment; it prevents one of the things that keeps the skin broken.

Where the opening has narrowed or where guarding has developed after months of painful sex, pelvic health physiotherapy and graded trainers help. See pelvic health physiotherapy.

Surgery

Surgery is not used to treat the skin condition itself. It is occasionally used to release fusion that interferes with urination or sex, after the inflammation is controlled.

Long term care and monitoring

Lichen sclerosus is a long term condition managed rather than cured. Most people control it well with maintenance treatment and have few symptoms.

There is a small increase in the risk of vulval squamous cell carcinoma in people with lichen sclerosus, and the evidence suggests that well controlled disease carries a lower risk than uncontrolled disease. This is the reason for two habits: regular review, usually annually or as advised, and self examination. Learning what the vulva normally looks like, with a mirror and good light, makes it possible to notice a change. Anything that becomes a persistent lump, an ulcer, a thickened raised area, a wart like growth, or a sore that does not heal within a few weeks should be examined without delay.

That is a reason for attention rather than alarm. The overall risk remains low, and the point of monitoring is that changes found early are dealt with straightforwardly.

In children

Lichen sclerosus occurs in girls before puberty, where it is frequently mistaken for irritation, threadworm or abuse. It is treated similarly and often improves around puberty, though follow up remains appropriate.

Last reviewed: September 2026