Lichen sclerosus clinical features and treatment
Lichen sclerosus clinical features and treatment
Lichen sclerosus is a distinctive inflammatory condition inwhich lesions are usually white. The commonest site is theanogenital skin. The cause is unknown.
Clinical features Most patients are female, and present either in middle orlater life or, less commonly, before puberty. Whereas patients in the older age group tend to have a more protracted course, in prepubertal girls the disease may resolve spontaneously at or around puberty. Usually the vulva isaffected, often together with the perianal skin, giving afigure-of-eight appearance. The initial lesion is a white papule; lesions tend to coalesce, and involved skin often becomes wrinkled and atrophic. In the vulva, purpura iscommon and resorption of the labia may occur. Pruritus isvery common. Scratching will often produce excoriationsand erythema, which can mask the characteristic whiteness.Dysuria, dyspareunia and, in children, constipation are complications. In the male, involvement of the foreskin andglans can lead to balanitis, phimosis and meatal stricture.Squamous carcinoma is a risk in both sexes. Extragenitallesions occur in a minority. There is an increased likelihoodof organ-specific autoimmune diseases.
Differential diagnosis Vitiligo can involve the genital skin but does not cause pruritus, and apart from the pallor the skin is otherwise normal. When the pallor is not evident, eczematous conditions,intraepidermal neoplasia and lichen planus may needto be excluded. A biopsy is usually diagnostic.
Treatment A superpotent topical corticosteroid twice daily for several weeks initially, and then for shorter periods as necessary,can reverse clinical and histological manifestations in the genital area. Circumcision is often indicated for phimosis.Long-term follow-up is worth while in view of the risk of carcinoma.
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