Evidence‐based (S3) Guideline on (anogenital) Lichen sclerosus

Abstract

Lichen sclerosus (LS) is an inflammatory skin disease that usually involves the anogenital area. All patients with symptoms or signs suspicious of lichen sclerosus should be seen at least once initially by a physician with a special interest in the disease in order to avoid delay in diagnosis, as early treatment may cure the disease in some and reduce or prevent scarring. The diagnosis is made clinically in most cases. Biopsies should only be performed under certain circumstances. The gold standard for treatment remains potent to very potent topical steroids; however, mild and moderate disease in boys and men may be cured by circumcision. Certain triggers should be avoided.

Vulvar Lichen Sclerosus and Neoplastic Transformation

“…Cases with clinical diagnosis of VLS along with cases with histological diagnosis were included in the study population, because the diagnosis of VLS is based on the typical clinical appearance of VLS, and biopsy should only be performed in clinically dubious cases. 22 None of the patients included in the study had a history of vulvar neoplasms before or at the time of diagnosis. Follow-up was performed at 1 month, 4 months, and then at least yearly, according to patients' need.…”

Benign male genital dermatoses

“…Spontaneous remission might occur in early and mild cases, but the incidence is not known as these patients might not present to a doctor. 28 No standardised treatment regimen exists. The frequency of application and maintenance treatment remains debatable.…”

“…32 The use of topical calcineurin inhibitor is not recommended in lichen sclerosus owing to a theoretical risk of carcinogenesis and unknown long term safety. [28][29][30] Surgical referral is necessary in patients with symptoms refractory to topical corticosteroids, or those with phimosis, meatal stenosis, or urethral stricture. Refer urgently if there are features suggestive of these, such as erosive, hyperkeratotic, or verrucous change because of the association with penile intraepithelial neoplasia and squamous cell carcinoma.…”

Current views on the diagnosis and treatment of genital lichen sclerosus

“…Przedstawione poniżej metody terapeutyczne opierają się na danych opublikowanych w 2015 roku, które są podsumowaniem najbardziej aktualnej wiedzy medycznej [31].…”