Complaints & connections · borters.ch
Lichen sclerosus et atrophicus
Night-time genital itching with pale, thin skin — well treatable, and fear of the steroid ointment is what costs most of the years here.
Also known as: white patches in the genital area · vulval itching · parchment-like skin · splitting · acquired phimosis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A chronic inflammatory skin condition that almost always affects the genital area and in women typically involves the vulva and perineum right around the anus — in a shape often described as a figure of eight. The skin becomes paler, thinner and parchment-like, it splits easily, and it itches, especially at night. That night-time itch is often the only early sign. It occurs at any age, most commonly after the menopause and in girls before puberty, where it is regularly taken for irritation or for worms. In men it shows itself as a progressive tightening of the foreskin. In many cases the diagnosis is made by looking, and if in doubt by a small biopsy. Two things matter. First, it responds very well to a steroid ointment used to a set schedule and then continued at a small maintenance dose — fear of steroids is the commonest cause of needless suffering here. Second, it needs regular review, because the skin can scar over the years and because changes are then noticed early. Treated, it usually runs quietly.
The diagnosis is usually made by looking. If a question remains, or a spot does not heal despite treatment, a small biopsy settles it.
It is the accepted treatment here and is used over weeks to a fixed plan set by the doctor. Too little and too short is the commonest mistake — not too much.
Once or twice a week, ongoing. That keeps the symptoms away and prevents scarring. Stopping altogether once it settles usually means being back at the start within months.
No soap, no shower gels, no intimate washes, no wet wipes. Water only, then a greasy base — it is part of the treatment, not cosmetics.
Once a year, even when it is quiet. The point is to notice scarring early and to look in good time at any spot that behaves differently.
Repeated antifungals without improvement are one of the commonest signs that the diagnosis is wrong.
An additional contact eczema from washes and wipes often sits on top and makes the treatment fail.
A strong cortisone ointment is the treatment here, not a stopgap — applied daily over three months and then continued once or twice a week, permanently. That continuation is exactly the point: it keeps the itch away and lowers the risk of scarring and later cell change. Fear of thinning skin often leads to too little use — in this condition, leaving it out is the greater risk.
About one to three in a hundred women are affected, with two peaks: before puberty and after the menopause; men more rarely. From the first signs to the diagnosis, five years pass on average. A strong cortisone ointment daily over three months brings freedom from symptoms in most; maintenance once or twice a week lowers, in studies, both the scarring and the risk of later cell change, which untreated is about four to five in a hundred.
Often the first and for a long time the only sign — and the reason it is first taken for worms or thrush.
Whitish, shiny, parchment-like, sometimes with small bruises. The colour often only stands out compared with the surrounding skin.
Small, very painful splits that open on opening the bowels or during sex, always in the same place.
Affected at the front and around the anus, free in between. Looking only at the back shows half of it.
In girls before puberty it is put down to irritation or worms; in men it shows as an increasingly tight foreskin.
Here the itching goes with paler, thinning skin and fine splits. That is what sets it apart from simple irritation.
Thyroid disease sits alongside more often than chance — checking it once makes sense.
An empty store increases itching and delays the healing of small splits.
A raised sugar favours additional fungal overgrowth that overlays the picture.
With chronic inflammatory and autoimmune pictures low levels are common — partly because the illness itself lowers the level, partly because less time is spent outdoors. Whether correcting it changes the course is being studied; for bone and muscle it is worthwhile regardless.
Skin and lining renew themselves quickly and need zinc for it. With places that heal badly, cracked corners of the mouth and frequent skin infections a lack is a serious possibility.
They give rise to messengers that tend to end inflammatory reactions rather than fuel them. Oily sea fish twice a week is the simplest route; capsules are an option but replace no treatment.
Without vitamin C no stable collagen forms — the wound closes but holds less well. With a very one-sided diet, smoking and alcohol the intake is often tighter than assumed.
Steers the horn-forming of the skin. Too little makes it rough and dry, too much over longer periods harms liver and bone — and in pregnancy a strict upper limit applies.
Low levels have been found more often with this condition, as with other autoimmune situations. Measured and replaced if deficient — the treatment that changes the course is the prescribed cortisone ointment.
Traditionally used as an oil from outside to keep the skin supple. It is not studied as a replacement for the cortisone ointment — and here in particular consistent treatment decides on lasting scarring.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
The condition occurs mostly before puberty and after menopause — that is, when oestrogen is low. The link is described; oestrogen does not treat it, though — the prescribed cortisone ointment does.
Autoimmune thyroid conditions come along here more often — in about one in five of those affected. A single value settles it, and it is rarely measured.
Treatment is a steroid ointment over months; that is the established route. A vitamin D deficiency is often found alongside and corrected, but changes little about the skin itself.
No dietary approach is established here. The steroid ointment over months is the route that works — and it also prevents scarring changes.