Lichen sclerosus (in males)

What causes lichen sclerosus is not fully understood. It almost never occurs in men who have been circumcised early in life.

Lichen sclerosus is not caused by an infection and, although the genital area is affected, cannot be passed to a sexual partner.

Lichen sclerosus may affect some men with auto-immune diseases such as thyroid disease or diabetes, although this link is more common in women. It may also be linked to atopic conditions such as eczema, asthma and hayfever.

Friction or damage to the skin can bring out lichen sclerosus and make it worse. This is called a 'Koebner response' and is sometimes seen after surgery. Some men dribble a small amount of urine after passing water, and it is thought that the trapping of urine under the foreskin may cause male genital lichen sclerosus.

There is a link in some men between lichen sclerosus and penis cancer, but it is rare. Although circumcision may reduce the risk, it does not absolutely prevent penis cancer.

Is male genital lichen sclerosus hereditary?

Although there are some reports of familial lichen sclerosus, it does not usually run in families.

The affected skin may feel uncomfortable, sometimes itchy, burning, and sore, especially during or after sex. Often the foreskin gets tighter and more difficult to retract, leading to painful erections. The skin may tear and bleed during sexual intercourse.

When the opening in the tip of the penis is affected, the urine may spray. Some men, however, do not experience any symptoms.

What does male genital lichen sclerosus look like?

The affected skin of the penis can look red, with little cracks, sores, bleeding points or small blood-blisters. When the skin has been inflamed for some time, it can turn white and become thinned. On the other hand, thickening of the skin may sometimes be seen. Scarring can develop and change the appearance of the foreskin or tip of the penis. When the tightened foreskin is retracted, it may draw in around the shaft of the penis like a tight band ('waisting').

Sometimes the foreskin may be too tight to withdraw, making it impossible to clean the tip of penis. If this happens it is important to seek advice from a doctor as there may be an increased risk of cancer if this problem is left untreated.

Captions describe below images from left to right.

Figure 1: Male genital lichen sclerosus. Scarring of the frenulum and inner aspect of the foreskin, with associated etiolation of the head of the penis .

Figure 2: Male genital lichen sclerosus. Redness of the penile head and foreskin. Tight band of scarring on the foreskin leading to an ‘hourglass’ appearance.

Figure 3: Male genital lichen sclerosus. Glistening redness of the penile head and foreskin (Zoonoid inflammation), blunting of the coronal groove, and scarring of the foreskin.

Figure 4: Male genital lichen sclerosus. Tight, band-like, scarring that causes inability to retract the foreskin (phimosis).

Courtesy of Dr George Kravvas & Professor Chris B. Bunker.

The affected skin of the penis can look red, with little cracks, sores, bleeding points or small blood-blisters. When the skin has been inflamed for some time, it can turn white and become thinned. On the other hand, thickening of the skin may sometimes be seen. Scarring can develop and change the appearance of the foreskin or tip of the penis. When the tightened foreskin is retracted, it may draw in around the shaft of the penis like a tight band ('waisting').

Sometimes the foreskin may be too tight to withdraw, making it impossible to clean the tip of penis. If this happens it is important to seek advice from a doctor as there may be an increased risk of cancer if this problem is left untreated.

Captions describe below images from left to right.

Figure 1: Male genital lichen sclerosus. Scarring of the frenulum and inner aspect of the foreskin, with associated etiolation of the head of the penis .

Figure 2: Male genital lichen sclerosus. Redness of the penile head and foreskin. Tight band of scarring on the foreskin leading to an ‘hourglass’ appearance.

Figure 3: Male genital lichen sclerosus. Glistening redness of the penile head and foreskin (Zoonoid inflammation), blunting of the coronal groove, and scarring of the foreskin.

Figure 4: Male genital lichen sclerosus. Tight, band-like, scarring that causes inability to retract the foreskin (phimosis).

Courtesy of Dr George Kravvas & Professor Chris B. Bunker.

The diagnosis is often made by a dermatology doctor after looking at the affected skin.

Sometimes a small skin sample may be taken and checked under the microscope to confirm the diagnosis, especially if there is an open sore or a thickened area of skin. This is known as a skin biopsy and requires a local anaesthetic injection and possibly stitches to close the wound, leading to a small scar.

Can male genital lichen sclerosus be cured?

Although circumcision can cure lichen sclerosus in some men, in others the condition may continue or change after surgery. Lichen sclerosus will not go away on its own but may not cause any symptoms when the correct treatments are used.

How can male genital lichen sclerosus be treated?

Lifelong regular self-examination is very important for all men who have or have had genital lichen sclerosus. If any skin changes develop which do not respond to steroid creams, in particular any persistent skin thickening or soreness, it is important to tell the doctor without delay. A skin biopsy may be necessary to test for skin cancer.

CAUTION: This leaflet mentions 'emollients' (moisturisers). Emollients, creams, lotions, and ointments contain oils. When emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that they could catch fire more easily, even if the emollient products have dried.

To reduce the fire risk, patients using skincare or haircare products are advised to be very careful near naked flames or lit cigarettes to reduce the risk of clothing, hair or bedding catching fire. It is advisable to wash clothing daily and bedlinen frequently, if they are in contact with emollients; however, this may not remove the risk completely, even if washed at high temperatures, so caution is still needed.

More information may be obtained at https://www.gov.uk/guidance/safe-use-of-emollient-skin-creams-to-treat-dry-skin-conditions.