Diagnosis and Treatment of Lichen Sclerosus

Abstract

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

Vulvar lichen sclerosus: could a moisturizing and healing product reduce the prolonged use of topical steroid?

“…Scarring may result in labial fusion, narrowing of the vaginal opening, clitoral hood adhesion, and clitoral burying, thereby impairing or destroying sexual function. Urination may also become problematic and painful, and certain patients experience discomfort during defecation [7]. In addition to being a debilitating physical condition, LS can have detrimental consequences on affected women's psychosexual and psychosocial life.…”

Lichen Sclerosus with Extragenital Localization in Two Children: Case Report

“…Atrofik formu labial yapışıklıklara, vajinal girişte stenoza, erkek çocuklarda fimozise neden olabilir. [2][3][4]7 Her iki olgumuzda da, anogenital tutuluma rastlanmadı.…”

“…[1][2][3][4][5][6][7][8] Genellikle otoimmün bir hastalık olduğu kabul edilir. 4 Otoimmün hastalık prevalansının yüksek olması, doku spesifik otoantikorların bulunması ve ailesel otoimmün hastalık varlığı bu hipotezi desteklemektedir.…”

“…9 En sık birliktelik gösterdiği otoimmün hastalıklar; Hashimato tiroiditi, alopesi areata, vitiligo, diabetes mellitus (DM) ve pernisiyöz anemidir. 2,4,7,8 Son çalışmalarda, LS ile psöriyazis ve DM arasında güçlü bir ilişki saptanmıştır. 3 Şiddetli güneş yanığı, termal yanık skarları, radyoterapi, cerrahi operasyon, cinsel istismar, dar giysiler, deriyi ovalama gibi durumlar LS'yi başlatabilir.…”

Abnormal vulval lesions: diagnosis and management

“…1 Despite the frequency of vulval symptoms, women often find it difficult to seek medical advice. Research has shown that there are many reasons as to why women do not ask for help including:…”