Treatment of lichen sclerosus

Lichen sclerosus, also known as atrophic lichen sclerosus, is a chronic inflammatory disorder that affects the skin of the penis and appears between the ages of 30 and 50. Its cause is unknown and the main sign is the appearance of white patches on the penis.

Types of lichen on the penis

1. Lichen planus of the penis
2. Lichen sclerosus penis 3
3. Lichen nitidus penis

White spots appearing on the skin of the penis are associated with:

• Penile skin infections, whether fungal, bacterial even human papillomavirus that can trigger penile lichen.
• Diabetes mellitus.
• Frequent penile skin irritations.
• Autoimmune diseases, such as vitiligo and some thyroid diseases and alopecia areata.

White spots are the main warning sign of a possible lichen on the penis, but there are other affecting symptoms that indicate its appearance. These are:

1. Cracks and phimosis. When the white spots on the penis affect the preputial ring, they can produce a thickening and narrowing of its circumference. The foreskin, unable to stretch during erection, tears and causes the appearance of cracks. If the process continues to evolve, the glans penis cannot come out during erection, leading to phimosis. In case of phimosis, circumcision is essential.
2. Urethral meatus stenosis. Occurs when the lichen in its growth affects the orifice of the urethra and the first centimeters of the urethra. The orifice becomes whitish, hard and narrow, causing a narrowing of the urethra. If the process is not stopped, it eventually leads to acute urinary retention.
3. Cancer of the penis. The association of penile cancer and lichen sclerosus has been the subject of multiple scientific publications. Statistics vary, but it is believed that approximately 2 to 8% of patients with penile lichen sclerosus eventually develop penile cancer, especially if the situation is not corrected.

Treatment of lichen sclerosus

There are different forms of penile lichen sclerosus treatments:

• Potent corticosteroid ointments. These are administered in the early stages of the disease and treatment of lichen sclerosus with anti-inflammatory ointments should be performed. These are only effective for cases with whitish patches.
• Improving triggering factors. In diabetic patients it is very important to first correct the blood glucose levels, since when the candidiasis balanitis disappears, the improvement of the penile lichen is spectacular.
• Circumcision. It is the most effective form of penile lichen treatment and is indispensable in cases where it has evolved into phimosis. It is also likely to reduce the risk of penile cancer. In these cases, treatment with ointments has proven ineffective.
• Meatotomy. This is a surgical intervention that consists of opening and widening the urethral meatus. It is performed when the lichen in its growth affects the urethral orifice causing a narrowing of the same. When the narrowing also affects the urethra it is necessary to perform a meatoplasty.

Five important things to remember

1. It can appear at any age.
2. In patients with diabetes mellitus, xerotic balanitis obliterans caused by lichen is common.
3. Flat white lesions that do not produce phimosis can improve with anti-inflammatory ointments applied correctly.
4. When the lichen affects the urethral orifice, the treatment is surgical by means of an intervention called meatotomy.
5. When the lichen causes phimosis, the treatment of choice is circumcision. In these cases topical treatments fail.