Lichen sclerosus

Last updated: June 14, 2022

Summarytoggle arrow icon

Lichen sclerosus is a chronic inflammatory disease of unknown cause that is characterized by white, atrophic plaques with intense pruritus affecting the skin, nails, hair, and/or mucous membranes. It most commonly affects the anogenital area and often occurs in postmenopausal women. Although the condition is benign, it is associated with an increased risk of squamous cell carcinoma. Lichen sclerosus is diagnosed clinically and should be confirmed via punch biopsy in adults, which can concurrently screen for squamous cell carcinoma. Treatment primarily consists of superpotent topical steroids but may also include surgical excision in steroid-refractory disease.

Epidemiologytoggle arrow icon

  • Prevalence: rare disease (occurs in < 2% of the female population) [1]
  • Sex: most commonly affects (perimenopausal and postmenopausal) women [1]
  • Mean age of onset: : 52 years and, less commonly, prepubertal girls (7–8 years of age) [1]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

  • Unknown
  • Factors such as genetic predisposition, autoimmunity, hormonal changes are thought to play a role. [1]

Clinical featurestoggle arrow icon

  • Early disease [2]
    • Papules and plaques that are white, polygonal, well-demarcated, and potentially surrounded by a red inflammatory halo
    • Dominant symptom: severe pruritus, possibly pain/soreness
    • Most commonly affects the anogenital area
    • Extragenital lesions: oral and areas of skin (e.g., back, shoulders, neck, wrists, thighs, and under the breast)
  • Advanced disease: ulceration, hemorrhage, lichenification, skin thinning/fragility, and erosive scarring

Diagnosticstoggle arrow icon

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Singh N,Ghatage P. Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review. Obstet Gynecol Int.. 2020.doi: 10.1155/2020/7480754 . | Open in Read by QxMD
  2. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
  3. Wedel N, Johnson L. Vulvar lichen sclerosus: Diagnosis and management. Journal for Nurse Practitioners. 2014; 10 (1): p.42-48.doi: 10.1016/j.nurpra.2013.10.009 . | Open in Read by QxMD
  4. Susanna K. Fistarol and Peter H. Itin. Diagnosis and Treatment of Lichen Sclerosus. American Journal of Clinical Dermatology. 2013.
  5. S M Neill, F M Lewis, F M Tatnall, N H Cox. British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. British Journal of Dermatology. 2010.
  6. Renaud-Vilmer C, Cavelier-Balloy B, Porcher R, Dubertret L. Vulvar Lichen Sclerosus. Arch Dermatol. 2004; 140 (6).doi: 10.1001/archderm.140.6.709 . | Open in Read by QxMD

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