Lichen Sclerosis and The Paleo Diet

Lichen Sclerosis and The Paleo Diet | The Paleo Diet

Hi there – I have been following a Paleo Diet for a few weeks now and there is no doubt that I feel much better for it. I did not need to lose weight and I always regarded myself as pretty fit and healthy. However, a little while back I developed a troublesome skin condition called Lichen Sclerosis. Have you ever been asked about this condition and suggested dietary changes? I think part of the problem is that the etiology is not fully understood but many doctors seem to think it has an autoimmune component though I have read recent research that suggests oxidative damage plays a part and that antioxidant therapy may be useful in treatment. This condition is supposedly incurable (though manageable with potent steroids) but I’m sure it would give a great many people some comfort if simple dietary changes could help. Would be really great to hear your thoughts.


Dr. Cordain’s Response:

Dear Simon,

The available evidence indicates that an autoimmune component likely occurs with Lichen Sclerosis (LS). With all autoimmune diseases, an autoantigen (self protein) exists and represents the target protein being attacked by the immune system. About 75% of LS patients maintain an IgG autoantibody to Extra Cellular Matrix Protein 1 (ECM1).1 Acceleration of ECM1 deposition in dermal (skin) blood vessels may underlie the disease symptoms.2, 3 So the question now arises, what causes an accelerated deposition of ECMI in dermal blood vessels in LS patients? The available evidence indicates that increased concentrations of a ubiquitous enzyme in the body called tissue transglutaminase (TG2) is primarily responsible for excessive ECM1 accumulation.3 In medical terms, an increase in a concentration of a substance in the bloodstream by another substance is called “upregulation”.

So, in LS patients, an upregulation of TG2 causes an upregulation and increased deposition of ECMI in the skin blood vessels in the affected area of the body. The next question to be posed is, what event or events trigger an upregulation of TG2? When we answer this question, then dietary recommendations advocated by The Paleo Diet will make sense. A storage protein called gliadin which is fournd in wheat, rye, barley and oats is known to upregulate TG2.4-7 Hence grain free diets may prove to be therapeutic for LS patients, although no current randomized controlled trials of this intervention strategy have yet been conducted.

Loren Cordain, Ph.D., Professor Emeritus


  1. Chan I, Oyama N, Neill SM, Wojnarowska F, Black MM, McGrath JA. Characterization of IgG autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Clin Exp Dermatol. 2004 Sep;29(5):499-504.
  2. Kowalewski C, Kozłowska A, Chan I, Górska M, Woźniak K, Jabłońska S, McGrath JA.Three-dimensional imaging reveals major changes in skin microvasculature in lipoid proteinosis and lichen sclerosus. J Dermatol Sci. 2005 Jun;38(3):215-24. Epub 2005 Mar 3.
  3. Fisher M, Jones RA, Huang L, Haylor JL, El Nahas M, Griffin M, Johnson TS. Modulation of tissue transglutaminase in tubular epithelial cells alters extracellular matrix levels: a potential mechanism of tissue scarring. Matrix Biol. 2009 Jan;28(1):20-31. Epub 2008 Nov 5.
  4. Michaelsson, G., Ahs, S., Hammarstrom, I., Lundin, I. P., & Hagforsen, E. Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer ki67+ cells in the dermis. Acta Dermato-Venereologica, 2003; 83(6):425-429.
  5. Biagi F, Campanella J, Laforenza U, Gastaldi G, Tritto S, Grazioli M, Villanacci V, Corazza GR. Transglutaminase 2 in the enterocytes is celiac specific and gluten dependent. Dig Liver Dis. 2006 Sep;38(9):652-8.
  6. Gorgun J, Portyanko A, Marakhouski Y, Cherstvoy E. Tissue transglutaminase expression in celiac mucosa: an immunohistochemical study. Virchows Arch. 2009 Oct;455(4):363-73.
  7. Villanacci V, Not T, Sblattero D, Gaiotto T, Chirdo F, Galletti A, Bassotti G. Mucosal tissue transglutaminase expression in celiac disease. J Cell Mol Med. 2009 Feb;13(2):334-40.



About Loren Cordain, PhD, Professor Emeritus

Loren Cordain, PhD, Professor EmeritusDr. Loren Cordain is Professor Emeritus of the Department of Health and Exercise Science at Colorado State University in Fort Collins, Colorado. His research emphasis over the past 20 years has focused upon the evolutionary and anthropological basis for diet, health and well being in modern humans. Dr. Cordain’s scientific publications have examined the nutritional characteristics of worldwide hunter-gatherer diets as well as the nutrient composition of wild plant and animal foods consumed by foraging humans. He is the world’s leading expert on Paleolithic diets and has lectured extensively on the Paleolithic nutrition worldwide. Dr. Cordain is the author of six popular bestselling books including The Real Paleo Diet Cookbook, The Paleo Diet, The Paleo Answer, and The Paleo Diet Cookbook, summarizing his research findings.

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“8” Comments

  1. To D Bennett,
    I, too, have been diagnosed with LS as of one month ago. I would be interested in volunteering for any type of trials you may be conducting on this horrible disease. I’m going to try to Gluten Free/Low Oxalate Diet. I”ve also heard that taking VSL#3 (probiotic) is very helpful. Any info on these I would love to hear!

  2. I was diagnosed with LS two years ago and have had intermittent “outbreaks” of painful burning, itching, and scarring. I also began a ketogenic diet shortly after the diagnosis though for unrelated reasons. I have not been symptom free, but outbreaks are far fewer in frequency. I’d like to know if I really could completely control this disease with diet and if there are studies (someone’s dissertation!) which could help us get closer to an answer. I’d happily participate.

  3. Dear Dr Cordain,

    I was diagnosed with Lichen Sclerosus 4 years ago by my Dr who prescribed Steroid cream, however my skin became very thin and has added to my condition. My skin has discoloured and has become a daily occurence to be deal with the itchyness. I get very down and depressed as my condition worsens. I have removed sugar, alcohol, and white grains from my diet and still I suffer. If you decide to do a trial based on this condition following your Paleo Diet I would very much like to be part of it.

    I look forward to hearing from you.

    Josephine Sweeney

    • I hope he replies! I too have been diagnoses with Lichen Sclerosus, about 15 years ago, though I am not sure the diagnosis is correct, as mine seems to come and go and I don’t have the white patches or skin thinning as far as I know. The itching is horrible though. Sorry for everyone that deals with this. I had the celiac blood test done several years ago (TTG) a couple times and both were negative. My doctor agreed to the test at my request because I have a couple signs of gluten sensitivity (very late menarche, osteopenia, anemia sometimes, and the lichen if that’s what it is). So if everyone with LS is producing these tissue tranglutaminase antibodies, then I must not have LS?

    • I also suffer from Lichen and I have done a tremendous amount research and self trials regarding diet and its effects on my condition. I can without a doubt tell you that there are two major triggers. Gluten and Oxalates. Both of these two when consumed will trigger an episode within minutes. When I am free of gluten and maintain a low oxalate diet then I become basically symptom free. If for some reason I am in a situation where I find that I can not limit these two items then I know I am looking at a break out of symptoms. Please do yourself a huge favor and go immediately on a gluten free low oxalate diet. This can not do any harm and you will know in a short period of time if it helps you. I have read through my research that you also need to tapper down your oxalate levels slowly as not to create an oxalate dump from your body and make your symptoms much worse suddenly. Please read up on oxalates and where they are located in food.

      • I am in the process of being diagnosed with LS – awaiting biopsy – but my doctor seems convinced. I have been suffering from the symptoms for years but thought that it was yeast due to having had overgrowth issues earlier in life. I am happy to have more information, and more answers, but still in shock. I have said for several months now that when I eat certain foods (gluten based, as it seems) I get almost instantaneous itching. I have recently started following something like the Paleo approach and the last two weeks have gone pretty well. Anyway, your post was the first time I have ever read something so similar to my own experience and I wanted to reply. I just can’t believe that it’s not all in my head, like I had started to think. I would love to talk more with you about what you’ve tried, but I am going to start looking into your suggestion around decreasing/eliminating oxalates. Thank you so much for your post. I am always trying to learn more about foods and how they affect me and this gives me someplace to start with this new (pending) dx.

    • HI

  4. Pingback: Diet lichen sclerosus

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