From the Guidelines
Lichen sclerosus is a chronic inflammatory skin condition that primarily affects the genital and anal areas, characterized by thin, white, wrinkled patches of skin that may be itchy, painful, and can lead to scarring and changes in the skin's architecture over time. The exact cause of lichen sclerosus remains unknown, but several factors are believed to contribute to its development, including autoimmune mechanisms, genetic predisposition, hormonal factors, particularly low estrogen levels, and possibly previous skin damage or trauma to the affected area 1. Some research suggests that certain infections might trigger the condition in genetically susceptible individuals.
Key Characteristics of Lichen Sclerosus
- Primarily affects the genital and anal areas
- Thin, white, wrinkled patches of skin
- Itchy, painful, and can lead to scarring
- Changes in the skin's architecture over time
Treatment and Management
Treatment typically involves potent topical corticosteroids like clobetasol propionate 0.05% applied once or twice daily for 2-3 months, then gradually reduced to maintenance therapy (2-3 times weekly) 1. Regular follow-up is essential as the condition is associated with a small increased risk of skin cancer in the affected areas. While lichen sclerosus cannot be cured, proper treatment can effectively manage symptoms, prevent scarring, and improve quality of life.
Important Considerations
- Early histological confirmation by biopsy is recommended 1
- Patients with lichen sclerosus require long-term follow-up due to the risk of malignant transformation 1
- Extragenital tissue such as buccal mucosa is recommended when tissue transfer is required for reconstruction 1
From the Research
Definition of Lichen Sclerosus
- Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas 2.
- It is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists 3.
- LS is an acquired chronic inflammatory dermatosis predominantly affecting the anogenital area with recalcitrant itching and soreness 4.
Causes and Risk Factors
- The etiology of LS is still unknown, but hormonal status, frequent trauma, and autoimmune diseases are well-known associations for LS 2.
- Genetic predisposition, infections, and autoimmune factors have been implicated in its pathogenesis 3.
- A genetic susceptibility and a link with autoimmune mechanisms are suggested as underlying causes 5.
- The exact pathogenesis of LS remains unknown, but it is believed to involve a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype 2, 6.
Clinical Features and Diagnosis
- The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal, and penile regions 2.
- Symptoms include pruritus and soreness, but asymptomatic presentations are not uncommon 3.
- The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure, or suspicion of a neoplasm 2.
Treatment and Management
- The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus 2.
- Short courses of potent topical corticosteroids form the mainstay of treatment 3.
- Circumcision may be indicated in men, and surgery may be considered in women, to relieve effects of scarring or to treat coexisting carcinoma 5.