Yes, men can get Lichen Sclerosus (LS), a chronic inflammatory skin condition that primarily affects the genital region, particularly in uncircumcised males. LS is characterized by inflammation and scarring, which significantly alters the skin’s structure over time. While diagnosed more frequently in women, its occurrence in men is a serious health concern due to functional complications and potential long-term risks. Historically referred to as balanitis xerotica obliterans (BXO) when affecting the penis, LS is an inflammatory dermatosis that can affect men of any age.
How Lichen Sclerosus Presents in Men
Lichen Sclerosus in men almost exclusively affects the external genitalia, specifically the glans (head of the penis) and the prepuce (foreskin). Initial symptoms can be subtle or absent, allowing the condition to progress unnoticed. When symptoms appear, chronic itching (pruritus) is common, often accompanied by a burning sensation or soreness.
The chronic inflammation leads to characteristic changes, including the development of white or porcelain-white patches (sclerosis) and thinning of the skin. This hardened, scarred tissue is prone to tearing, splitting, and fissuring, especially during sexual activity. This damage can lead to painful intercourse (dyspareunia) and bruising. The scarring causes the foreskin to lose elasticity, resulting in phimosis, or the inability to retract the foreskin fully.
Progressive scarring can also affect the urinary tract, leading to meatal stenosis, which is a narrowing of the urethral opening. This structural change causes urinary symptoms such as a weak or spraying stream, difficulty passing urine (dysuria), and post-urination dribbling. These alterations result from the inflammatory process causing the skin to become stiff and constricted.
Underlying Causes and Who Is Most Affected
The precise cause of Lichen Sclerosus remains unknown, but current understanding points toward a complex interplay of factors. Autoimmune dysfunction is implicated, suggesting the immune system mistakenly attacks skin tissues, leading to chronic inflammation. However, unlike in women, the evidence for a direct autoimmune cause in men is not entirely conclusive.
A significant local factor influencing development is the chronic exposure of susceptible skin to urine, coupled with the occlusive environment created by the foreskin. Trapped urine, particularly in men who experience post-void dribbling, causes irritation and inflammation. This chronic local irritation can trigger the disease process, an effect known as the Koebner phenomenon.
LS affects uncircumcised men almost exclusively and is rare in those circumcised at birth. The condition can occur at any age, often following a bimodal pattern with peaks in childhood and again in the fifth and sixth decades of life. The strongest risk factor for male genital LS appears to be the uncircumcised state, which facilitates the local irritative process.
Confirming the Diagnosis and Treatment Options
Diagnosis of male Lichen Sclerosus is often made clinically by a healthcare provider, such as a dermatologist or urologist, based on the characteristic appearance of the skin changes. The presence of white, scarred patches, combined with symptoms like phimosis or difficulty urinating, typically suggests the diagnosis. If the appearance is not definitive, or to rule out other conditions, a punch biopsy may be performed to confirm the diagnosis by examining a small skin sample under a microscope.
The first-line treatment for LS is a highly potent topical corticosteroid, with Clobetasol Propionate 0.05% cream or ointment being the standard therapy. This medication is applied directly to the affected areas, typically twice daily for an initial period, aiming to reduce inflammation and halt scarring progression. This treatment is effective in controlling symptoms, showing a significant reduction in itching, pain, and burning.
Following the initial intensive phase, a maintenance regimen is implemented. This may involve less frequent use of the high-potency steroid or a switch to a milder steroid or calcineurin inhibitor like tacrolimus. If the disease has progressed to cause severe scarring, surgical intervention becomes necessary. Circumcision is frequently performed to remove the scarred foreskin, often providing a long-term cure for disease limited to that area.
If scarring has caused meatal stenosis or extensive urethral narrowing, procedures such as urethral dilation or reconstructive surgery (urethroplasty) may be required to restore normal urinary function. Surgical procedures address mechanical complications like phimosis or strictures, but they do not treat the underlying inflammatory skin condition. Therefore, medical management with topical steroids remains necessary to control the disease on the remaining affected skin.
Why Long-Term Monitoring is Necessary
Lichen Sclerosus is a chronic condition requiring ongoing management and long-term surveillance, even when symptoms are controlled. This is necessary due to the disease’s association with an increased risk of developing penile squamous cell carcinoma (SCC). LS is considered a premalignant skin condition, meaning chronic inflammation and scarring can lead to malignant transformation in a small percentage of cases.
The risk of developing penile SCC is higher in men with LS compared to the general population, with lifetime risk estimated between 4% and 8%. This risk increases in cases of longstanding or poorly treated disease, emphasizing the importance of consistent therapy. The pathway from LS to cancer involves local factors, such as persistent inflammation and the accumulation of genetic changes in the affected tissue.
Regular self-examination of the genital area is encouraged to look for new lumps, non-healing ulcers, or changes in skin texture. Periodic check-ups with a specialist, such as a urologist or dermatologist, are also recommended to ensure the disease remains controlled and to detect early signs of cancerous change. Early detection of penile SCC is essential for successful treatment and improved prognosis.