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
• 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

• Candidiasis
• Lichen planus
• Psoriasis
• Dermatitis

Vulvovaginitis

• Bacterial vaginosis
• Candida vaginitis
• Trichomonas vaginalis
• Contact vulvovaginitis
  • Bubble baths and soaps
  • Deodorants, powders, and douches
  • Clothing
• Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
• Lichen sclerosus
• Tinea cruris
• Chlamydia/Gonorrhea infection
• Pinworms
• Vaginal foreign body
  • Toilet paper
  • Other
• Genitourinary syndrome of menopause
• Foreign body
• Allergic reaction
• Normal physiologic discharge

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

References

• https://en.wikipedia.org/wiki/Lichen_sclerosus