Lichen Sclerosus

Chronic inflammatory skin disease of the anogenital region

Aetiology

  • Cause largely unknown - may be autoimmune, genetic, microincontinence, hormonal
  • 6-10 times more common in females
  • Can occur at any age, two peaks - prepubertal girls and post-menopausal women
  • Association with other autoimmune conditions and smoking

Pathophysiology

  • Upon microscopy, lichen sclerosus characteristically causes atrophy; producing a thin stratified squamous epithelium
  • A band-like infiltrate of chronic inflammatory cells can be observed beneath this epithelial layer

Clinical presentation

Symptoms

  • Itch, pain and dyspareunia
  • Constipation (especially in children)
  • Psychosexual impact

Signs

  • White papules and plaques (vulval and perineal skin, figure of 8 pattern, ecchymosis, erosions, and fissures)
  • Architectural change
  • Extragenital skin involvement
notion image

Investigations

  • Clinical diagnosis
  • Biopsy can be performed if there is uncertainty about diagnosis

Management

  • Good genital skin care
    • Wash once a day with a soap substitue
    • Avoid tight clothing, rubbing, scratching
    • Avoid irritants
    • Apply emollients
  • Topical steroid - clobetasol propionate 0.05% (aka dermovate)

Complication

  • Patients with lichen sclerosus should be followed-up, as there is a risk of developing squamous cell carcinoma in chronic cases (2-5% lifetime risk)