Lichen Sclerosus Specialist in London

Lichen Sclerosus of the Penis

Overview

Penile lichen sclerosus (LS) is a chronic inflammatory skin condition that affects the foreskin and glans penis. It causes thinning, whitening, and scarring of the skin and can interfere with urination and sexual function if untreated.

It is not sexually transmitted and is believed to have an autoimmune basis.

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Causes & Risk Factors

The exact cause is unknown, but contributing factors include:

• Autoimmune mechanisms

• Genetic susceptibility

• Chronic irritation or occlusion (especially in uncircumcised men) - urine in contact with skin

• Hormonal influences

• Previous trauma (Koebner phenomenon)

LS is more common in uncircumcised males and may occur at any age, though most frequently in middle-aged or older men.

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Symptoms & Clinical Features

Patients may experience:

• White, shiny, porcelain-like patches on the glans or foreskin

• Tightening of the foreskin (phimosis)

• Cracking or fissuring of skin

• Painful erections

• Burning or discomfort during urination

• Reduced urinary stream (if urethra involved)

• Bleeding from fragile skin

On examination, the skin may appear thin, sclerotic (hardened), and scarred.

 

Investigations

- Clinical Diagnosis

Often diagnosed based on appearance by a clinician experienced in genital dermatology.

- Dermoscopy

May help visualize structural changes.

- Skin Biopsy

Indicated when:

• Diagnosis is uncertain

• Lesions are atypical

• Malignancy is suspected

• Poor response to treatment

Histology typically shows:

• Epidermal thinning

• Dermal hyalinization

• Lymphocytic inflammatory infiltrate

- Additional Tests

Only performed if clinically indicated (e.g., autoimmune screening).

 

Associated Conditions

• Autoimmune diseases (thyroid disorders, vitiligo)

• Type 1 diabetes

• Other inflammatory skin conditions

 

Complications & Risks

If untreated, LS can lead to:

• Progressive scarring

• Phimosis

• Meatal stenosis (narrowing of urethral opening)

• Urethral strictures

• Sexual dysfunction

• Secondary infections

• Increased risk of penile squamous cell carcinoma (small but significant risk, particularly in long-standing untreated disease)

Regular monitoring is important.

 

Treatment Options

- First-Line Treatment

Ultra-potent topical corticosteroids (e.g., clobetasol propionate) applied in a structured regimen.

- Adjunctive Care

• Regular emollients

• Avoidance of irritants

• Gentle hygiene practices

- Surgical Treatment

• Circumcision — often curative if disease limited to foreskin

• Surgery for urethral strictures (if present)

- Refractory Disease

• Topical calcineurin inhibitors (e.g., tacrolimus)

• Referral to specialist dermatology or urology

 

Monitoring & Follow-Up

• Review at 3 months after starting treatment

• Ongoing monitoring every 6–12 months may be needed

• Biopsy if new ulceration, thickening, or non-healing lesions develop

 

When to Seek Urgent Review

• Rapidly enlarging lesion

• Persistent ulcer

• Bleeding

• Difficulty passing urine

• Severe pain

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Frequently Asked Questions

1. Is lichen sclerosus contagious?
No.

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2. Does circumcision cure it?
Often yes when confined to the foreskin, but follow-up may still be required.

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3. Can it come back?
Yes — long-term maintenance treatment may be necessary.

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Book a consultation

If you have persistent genital skin symptoms, you can book a consultation with Dr Bryan McDonald for an expert, discreet assessment and treatment plan.​