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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A first diagnosis needs an in-person examination; ongoing treatment, flares and repeat ointment can be managed by video.
- What it is: a long-term skin condition that causes itchy, white, fragile patches, most often on the genitals and around the anus.
- Not an infection: it is not contagious, it is not a sexually transmitted infection, and it is not caused by poor hygiene.
- Treatment: a strong steroid ointment usually controls the symptoms within 4 to 12 weeks; it cannot be cured, so many people need long-term care and a check every 6 to 12 months.
- Emergency: call 112 or go to an emergency department if you cannot pass urine at all, or a tight foreskin is stuck back and swollen.
Being unable to pass urine at all, or a tight foreskin stuck behind the head of the penis with swelling, needs emergency care. A new lump, a thickened area or a sore that does not heal needs an in-person examination soon, rather than a change of ointment.
Can an online doctor treat lichen sclerosus?
Partly. Lichen sclerosus is often recognised by how it looks, but a first diagnosis needs an in-person examination, and a small skin sample is frequently recommended, because other conditions look similar and the skin needs long-term checks. Once it is diagnosed, a doctor by video can manage most of the ongoing care: steroid ointment, maintenance plans, flares, self-care and symptoms that need a closer look. You choose what you show on camera, and the doctor may suggest an in-person examination instead.
How an online consultation helps with lichen sclerosus
- A private first conversation: Your symptoms talked through calmly, and a clear answer on what examination you need and where.
- Ointment used well: How much to use, how often, and how to step down once it settles, so it keeps working.
- Flares handled: What to do when itching or soreness comes back, and when a flare needs a fresh look.
- The changes to watch: Which skin changes need a prompt examination, and how often to check yourself.
What the doctor checks in an online consultation
The doctor asks about:
- Your symptoms: itching, soreness, splitting or bleeding of the skin, and when they started.
- Where it is: the vulva, the area around the anus, the foreskin or tip of the penis, or other skin.
- Everyday effects: pain when passing urine or opening your bowels, painful sex or erections, and a tight foreskin.
- Treatment so far: which ointment, how often, and for how long, and whether it helped.
- Skin changes: a lump, a thickened area or a sore that does not heal.
- Your health: thyroid disease and other autoimmune conditions in you or your family.
Before the call, find a private, quiet space, and have your ointments and any letters from earlier examinations to hand.
Lichen sclerosus symptoms
Lichen sclerosus causes white patches that are usually itchy and can look smooth, shiny or crinkled. The skin is thin and fragile, so it bruises, splits or bleeds easily, sometimes with small blood blisters. Mild lichen sclerosus may cause no symptoms at all. It most often affects the genitals:
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| Area | What you may notice |
|---|---|
| Vulva and around the anus | Itchy white patches, sometimes in a figure-of-eight around the vulva and anus, with cracks or blood blisters; over time the vulva may shrink or tighten, making sex painful |
| Foreskin and tip of the penis | White, firm or scarred skin; the foreskin may tighten, making erections painful, and urine may spray if the opening narrows |
| Other skin | Small, white, slightly raised spots that join into patches, on the back, shoulders, upper arms or breasts, often where the skin is pressed or rubbed |
Lichen sclerosus is about ten times more common in women than in men, and it is most often diagnosed in women over 50, after the menopause, but it can start at any age. It affects people with white, brown or black skin. In about half of women it also affects the skin around the anus, and about 1 in 10 women with vulval lichen sclerosus have patches elsewhere on the body.
What causes lichen sclerosus?
The cause is unknown. It is probably a mix of an overactive immune system, your genes, and earlier damage or irritation of the skin. Many people with lichen sclerosus have other autoimmune conditions, especially thyroid disease, or vitiligo, in themselves or their family. Rubbing or damage to the skin can trigger it or make it worse. The risk is higher:
- after the menopause
- with another autoimmune condition, such as an underactive thyroid
- in men who are not circumcised; it almost never affects men circumcised early in life
- in men with urinary incontinence, because urine irritates the skin
- with a family history of lichen sclerosus
It is not caused by an infection or by poor hygiene, and it is not contagious: you cannot pass it on through close contact, including sex.
Itching in the genital area has other causes too, such as thrush, lichen planus, eczema and anal itching, which is one reason a first examination matters.
How lichen sclerosus is diagnosed
An experienced doctor can often recognise lichen sclerosus by its appearance during an in-person examination. A skin biopsy, where a small piece of skin is removed under local anaesthetic, sometimes with a stitch, is frequently recommended to confirm it, especially when there is an open sore or thickened skin. You may be referred to a specialist in skin or genital conditions for tests and treatment.
What triggers a lichen sclerosus flare?
Friction, irritation and stopping treatment too early can all set off a flare. A flare feels like the first symptoms coming back: itching, soreness or burning, and skin that splits, bleeds or blisters more easily. Common triggers are:
- rubbing and scratching, tight clothing, and cycling or horse riding
- urine on the skin, from leaking, incontinence pads or panty liners
- soap, scented washes, bubble bath, wet wipes and scented panty liners
- washing underwear in detergent rather than water alone
- stopping the steroid ointment as soon as the itch settles
A flare is usually treated by using the ointment more often again for a while, as agreed with the doctor. A flare that does not settle, or a patch that thickens or becomes sore for more than 2 weeks despite the ointment, needs an in-person examination.
Which lichen sclerosus treatment might the doctor recommend?
Treatment aims to stop the itching and soreness, and to protect the skin from scarring. This is the framework the doctors use, in line with NHS and dermatology guidance.
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| New itchy white patches, not yet diagnosed | An in-person examination, often with a biopsy | Yes, to advise | To confirm the diagnosis |
| Diagnosed, with symptoms | A strong steroid ointment used regularly for a few months | Yes | If it does not settle |
| Diagnosed and settled | A maintenance plan: occasional use of the steroid ointment, or a moisturiser | Yes | For regular long-term checks |
| A flare after a quiet spell | Restarting the ointment more often for a while | Yes | If it does not respond |
| A lump, thick area or sore that will not heal | A prompt examination, often with a biopsy | Yes, to advise | Always |
| Tight foreskin or narrowing that affects sex or passing urine | Assessment for surgery | Yes, to assess | For examination and surgery |
Itching or soreness back again? A doctor can review your lichen sclerosus treatment plan in one consultation.
See available times →Treatment options for lichen sclerosus
What you can do yourself
- Wash with an emollient soap substitute instead of soap, and gently dab your genitals dry after passing urine.
- Apply a barrier cream, such as petroleum jelly, regularly, for example morning and evening and after using the toilet, to protect the skin from urine.
- Use a lubricant if sex is uncomfortable.
- Wear cotton or silk underwear, and avoid tight clothing.
- Avoid scratching or rubbing, scented products, and washing underwear in strong detergent.
- Avoid cycling and horse riding until symptoms improve, and do not smoke.
Prescription treatment
A prescription is never issued without a consultation. Lichen sclerosus cannot be cured, but a strong prescription steroid ointment, such as clobetasol, usually relieves the symptoms. It is used regularly at first and then less often over about three months, as the doctor directs, and then stepped down to a weaker steroid, a moisturising cream, or occasional use of the strong ointment to stop it coming back. Used this way it is safe on genital skin, even though the leaflet may warn against it, and it softens the skin and lowers the need for surgery. Non-steroid ointments called calcineurin inhibitors, such as tacrolimus, are sometimes used instead of or alongside steroids. If the doctor prescribes, use the prescription at a pharmacy near you.
Surgery
In severe cases, surgery can widen the entrance to the vagina, and circumcision, removing the foreskin, is effective when lichen sclerosus affects the foreskin and tip of the penis, and cures it in some men. When narrowing at the vaginal entrance makes sex painful, lubricants and vaginal dilators help some women before surgery is considered.
What does not help
Scented washes, wipes and creams irritate the skin, and scratching or rubbing can make lichen sclerosus worse. Stopping the ointment as soon as the itching settles often lets it come back.
Long-term care and the changes to check for
Without treatment, the affected skin can become scarred and tight over time. Long-term follow-up is recommended to keep it under control and to find any change early.
Lichen sclerosus increases the risk of skin cancer on the vulva, penis or anus. The risk is low: fewer than 5 in 100 women with vulval lichen sclerosus develop skin cancer there. It is higher with some thickened types, and lower when symptoms are well controlled. Not smoking lowers it too. Check the skin regularly for the rest of your life, have a check-up every 6 to 12 months, and see a doctor promptly about:
- a lump
- a change in skin texture, such as thickening
- an ulcer or sore that does not go away
These changes need an in-person examination, often with a biopsy, rather than more ointment.
Special situations
Pain during sex
Painful sex is common when lichen sclerosus affects the vulva. Treatment usually helps, and the doctor can talk through what else would help, including in-person options when the entrance has narrowed.
Men and the foreskin
A tight foreskin, painful erections or splitting of the foreskin are common reasons men are diagnosed. Similar symptoms can come from balanitis, so the diagnosis matters. Urine trapped under the foreskin may play a part: dry carefully after passing urine, keep pubic hair trimmed, avoid aqueous cream, which can irritate, and use a lubricant during sex.
Thyroid disease
About one in five people with lichen sclerosus has thyroid disease, so the doctor may suggest a blood test if you have symptoms such as tiredness or weight change.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When lichen sclerosus is treated online, and when you need in-person care
Treated online: advice on symptoms before diagnosis, ongoing treatment of diagnosed lichen sclerosus, steroid ointment plans and repeat prescriptions, flares, self-care, and questions about long-term care.
In-person care: the first examination and biopsy, any lump, thick area or sore that does not heal, regular long-term checks, symptoms that do not respond to treatment, and surgery.
When to get in-person care
Call 112 or go to an emergency department now for:
- being unable to pass urine at all, with pain or swelling in the lower tummy
- a tight foreskin stuck behind the head of the penis that you cannot pull forward, with swelling
Get medical advice the same day for:
- pain or great difficulty passing urine
- skin that has split and is bleeding heavily or is very painful
- a sore area with spreading redness, pus or a high temperature
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about lichen sclerosus: describe your symptoms in private, say which ointments you have used, and mention any lump or sore that will not heal.
- Leave with a plan: what to do, what to use and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s lichen sclerosus? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Lichen planus can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about lichen sclerosus
What is lichen sclerosus?
Lichen sclerosus is a long-term skin condition that causes itchy, white, fragile patches, most often on the genitals and around the anus. It is much more common in women over 50 but can affect anyone.
What is the root cause of lichen sclerosus?
The exact cause of lichen sclerosus is unknown. It is probably a mix of an overactive immune system, genes and earlier skin damage or irritation, and it is linked with thyroid disease and other autoimmune conditions. It is not caused by infection, poor hygiene or an allergy.
Is lichen sclerosus an STI?
No. Lichen sclerosus is not a sexually transmitted infection, it is not caused by an infection or poor hygiene, and you cannot pass it on through close contact, including sex.
Can lichen sclerosus be cured?
Lichen sclerosus cannot be cured, but a strong steroid ointment usually relieves the symptoms. Many people use it occasionally for years to keep it under control.
How long does lichen sclerosus last?
Lichen sclerosus is usually lifelong once it has started, with symptoms that come and go; the itch and soreness typically settle within weeks of starting the steroid ointment, but the tendency remains, so most people keep using the ointment once or twice a week for years and have a check every 6 to 12 months. In children it sometimes clears at puberty, and in a minority of adults it burns out, but scarring that has formed does not reverse.
What is the best cream for lichen sclerosus?
For lichen sclerosus, a strong prescription steroid ointment, used every day at first and then less often, as the doctor plans. It is safe on genital skin for this condition, even though the leaflet may warn against it. A soap substitute and a barrier ointment help alongside it.
What triggers a lichen sclerosus flare?
Rubbing, scratching, tight clothes, cycling, urine on the skin, panty liners, soap and scented products, and stopping the ointment too soon. A lichen sclerosus flare feels like the itching, soreness or burning coming back, with skin that splits more easily.
Can lichen sclerosus flares be prevented?
Largely, yes: use the steroid ointment on the schedule the doctor sets, including the maintenance doses, protect the skin from friction and urine with a barrier ointment, avoid soaps, wipes, panty liners and scented products, treat thrush or urine leakage promptly because both inflame the skin, and keep the regular check-ups. Lichen sclerosus cannot be prevented from starting, but well-controlled skin flares less and carries a lower cancer risk.
Should I be worried if I have lichen sclerosus?
Usually not. With the right ointment and self-care, most people keep lichen sclerosus well controlled. The main reason for regular checks is a low risk of skin cancer in the affected area, which good control helps to lower.
Does lichen sclerosus cause cancer?
It increases the risk of skin cancer on the vulva, penis or anus, but the risk is low: fewer than 5 in 100 women with vulval lichen sclerosus. Warning signs are a lump, a thickened area, or a sore or ulcer that does not heal.
How is lichen sclerosus diagnosed?
A doctor examines the skin in person: the white, thinned, often wrinkled patches in their typical position are usually recognisable, and a small skin sample, called a biopsy, is frequently taken to confirm lichen sclerosus and to rule out other causes, especially before long-term steroid treatment or when a patch looks unusual. Blood tests for thyroid disease may be suggested because the two often go together.
Is it lichen sclerosus or something else?
Lichen sclerosus is white, shiny, thinned or wrinkled skin, often with bruise-like marks and splits, that itches intensely and is worst at night. Thrush is red, swollen and itchy with discharge and responds to antifungals; vulval eczema or contact dermatitis is red and dry rather than white; lichen planus is purple-red and often involves the mouth too; and vitiligo is white but smooth, painless and unchanged in texture. A persistent white patch needs an in-person examination, sometimes a biopsy.
What should you not do with lichen sclerosus?
With lichen sclerosus, do not use soap, scented washes or wet wipes, scratch or rub the skin, wear tight clothing, cycle or ride horses while it is sore, or smoke. Use a soap substitute, dab dry after passing urine and apply a barrier ointment instead.
What can I do at home for lichen sclerosus?
Wash with a soap substitute and water only, dab rather than rub dry, apply a plain barrier ointment such as petroleum jelly before passing urine and before sex, wear loose cotton underwear and avoid tight trousers, use a lubricant during sex, keep the steroid ointment going as planned rather than stopping when symptoms ease, check the skin monthly with a mirror for any new lump, ulcer or thickened patch, and photograph changes for the doctor. Good home care makes lichen sclerosus flares rarer.
Can men get lichen sclerosus?
Yes. In men lichen sclerosus usually affects the foreskin and the tip of the penis, and can tighten the foreskin and make erections painful. Circumcision is effective when other treatment is not enough.
Can an online doctor treat lichen sclerosus?
Partly. A first diagnosis of lichen sclerosus needs an in-person examination. After that, a doctor by video can manage ongoing treatment, flares and repeat ointment, and tell you when a change needs examining.
- Lichen sclerosus, NHS, National Health Service (UK), reviewed 9 December 2024.
- Lichen sclerosus, DermNet, New Zealand, updated January 2016.
- Lichen sclerosus in females: patient information leaflet, British Association of Dermatologists, updated September 2026.
- Lichen sclerosus in males: patient information leaflet, British Association of Dermatologists, updated September 2022.
- Lichen sclerosus: symptoms and causes, Mayo Clinic, 18 September 2024.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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