Lichen sclerosus (LS) is a chronic inflammatory condition affecting the genitalia and anal region. It is more common in women than men but may affect both.
In women it affects the labia, perineum and perianal skin. In men it affects the foreskin and glans penis. It may other regions such as the axilla and thighs.
Pathophysiology
The pathogenesis of LS is not quite known, it is believed to be an autoimmune condition linked to T1DM, alopecia, hypothyroidism and vitiligo. The chronic inflammation causes atrophy of the epidermis → white plaque formation.
😷 Presentation
The condition may be asymptomatic.
Affected skin may appear:
- Porcelain-white
- Shiny
- Tight
- Thin
- Raised
There may also be presence of papules or plaques.
Other symptoms that may be felt by the patient include:
- Itching
- Pain
- Superficial dyspareunia
- Dysuria
- Erosions
- Fissures
- Scarring
🔍 Investigations
It is usually a clinical diagnosis.
Biopsy may be done if there are atypical features present. It is mandatory if:
- Suspicion of neoplastic changes
- Disease fails to respond to treatment
- There is extragenital lichen sclerosus
- There are pigmented areas (to exclude melanocytes proliferation)
- Second-line therapy is required
🧰 Management
It is incurable but symptoms can be controlled effectively. Follow up is needed every 3-6 months by a gynaecologist or dermatologist.
- Topical steroids - this is the primary treatment.
- 🥇 Clobetasol propionate 0.05% - this is the first-line option.
- They are initially used once a day for 4 weeks then gradually reduced in frequency to alternate days, and then twice weekly.
- During flares they can be returned to daily use.
- Emollients - these relieve dryness and itching.
- Avoid using soap on affected areas
🚨 Complications
- Squamous cell carcinoma - this is the main complication. There is a 5% chance of it developing into SCC of the vulva.