Lichen sclerosus

Background
  • A benign, chronic, progressive dermatologic condition characterized by marked inflammation, epithelial thinning, and distinctive dermal changes accompanied by symptoms of pruritus and pain
  • Typically affects postmenopausal women, however it does sometimes occur in men, children, and premenopausal women
  • Thought to be related to low estrogen states

Clinical Features
Lichen sclerosus showing an ivory white coloring in the vulva, and also stretching downward to the perineum.
  • Skin becomes thin, wrinkles, and whitened
  • In males, most commonly affects glans or foreskin[1]
  • Most common symptoms include itching and pain at the affected areas, most commonly the clitoris and labia (although any skin surface can be affected)
  • Other symptoms include anal discomfort, dyspareunia, and dysuria

Differential Diagnosis

Vulvovaginitis

Evaluation
  • Biopsy — A vulvar punch biopsy is taken to demonstrate atypical cell histology
  • Histopathology — Epidermis is thinned, areas of hyperkeratosis may be observed. Early lesions may show irregular epidermal acanthosis
  • Clinical judgment should guide the diagnosis and treatment of LS when biopsy results are not specific

Management
  • Behavioral changes: good hygiene, avoid scratching area
  • topical steroids such as clobetasol proprionate

Disposition
  • Can be chronic
  • Increases chance of vulvar squamous cell carcinoma

See Also

References
  1. Teichman JM et al. Noninfectious Penile Lesions. Am Fam Physician. 2010 Jan 15;81(2):167-174.
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