LBR in Dermatology
In dermatology, LBR refers to Lichen sclerosus (formerly called "Balanitis Xerotica Obliterans" in males), an inflammatory scarring dermatosis characterized by a lymphocytic response with predilection for genital skin in both sexes. 1
Definition and Terminology
LBR is an outdated acronym for "Lichen sclerosus et atrophicus" or specifically "Balanitis Xerotica Obliterans" when referring to penile lichen sclerosus; these terms should no longer be used. 1
The suffix "et atrophicus" has been dropped because some cases present with hypertrophic rather than atrophic epithelium. 1
The term "kraurosis vulvae" is similarly obsolete and refers to vulvar lichen sclerosus. 1
Clinical Presentation
Female Patients
Lichen sclerosus presents as porcelain-white papules and plaques affecting the interlabial sulci and labia minora, often with areas of ecchymosis. 1, 2
The disease has a bimodal age distribution with peaks in prepubertal girls and postmenopausal women. 1, 2
Scarring may lead to labial fusion or introitus narrowing if left untreated. 2
Male Patients
In males, lichen sclerosus typically affects the prepuce and glans, potentially causing phimosis and urethral stenosis. 1
The disease rarely occurs in boys circumcised at birth, suggesting that a moist environment under the foreskin predisposes to development. 1
Perianal involvement is extremely rare in males. 1
Diagnostic Approach
Biopsy is essential for definitive diagnosis, particularly when lesions are pigmented, indurated, fixed, ulcerated, or fail to respond to standard therapy. 3, 2
Classical histological features include thinned epidermis with hyperkeratosis, a wide band of homogenized collagen below the dermoepidermal junction, and a lymphocytic infiltrate beneath the homogenized area. 1
Screen for other autoimmune diseases, particularly thyroid disease in women, as lichen sclerosus has autoimmune associations. 1
Treatment Recommendations
First-Line Therapy
Clobetasol propionate 0.05% ointment applied once daily for 1-3 months is the first-line treatment for confirmed lichen sclerosus. 3, 2
Use emollients as soap substitutes and barrier preparations. 3
For male patients, treatment with topical clobetasol propionate 0.05% cream twice daily for 2-3 months is recommended. 3
Refractory Cases
Consider repeat 1-3 month courses of topical corticosteroids for relapses. 3
Intralesional triamcinolone (10-20 mg) may be used for steroid-resistant hyperkeratotic areas after biopsy excludes malignancy. 3
For male patients with urethral stricture who fail topical steroids and/or circumcision, refer to a urologist specialized in lichen sclerosus management for surgical options such as total or partial glans resurfacing and split-skin grafting. 1
Surgical Management
In males with lichen sclerosus limited to the glans and foreskin, circumcision alone is successful in 96% of cases. 3
All removed tissue from circumcision must be sent for histological examination to confirm lichen sclerosus and exclude penile intraepithelial neoplasia. 3
For female patients with fusion over the clitoris, optimal surgical management remains an area requiring further research. 1
Critical Pitfalls and Long-Term Management
Untreated genital lichen sclerosus carries an increased risk of progression to squamous cell carcinoma; long-term surveillance is therefore mandatory. 3, 2
Even asymptomatic lichen sclerosus should be treated to prevent disease progression and potential malignancy. 2
In children, phimosis may actually represent undiagnosed lichen sclerosus, as this condition is underrecognized in pediatrics. 3
Avoid potent topical steroids in children due to risks of cutaneous atrophy, adrenal suppression, and hypopigmentation. 3
Do not confuse lichen sclerosus with other white plaque conditions such as lichen planus, as there can be an overlap syndrome with hyperkeratosis and poor response to ultrapotent topical corticosteroids. 1