Lichen Sclerosus and Lichen Planus in Women and Girls

Abstract

Lichen planus and lichen sclerosus are common, chronic inflammatory vulvar dermatoses with significant morbidity. The course may wax and wane but disease often persists for decades. These autoimmune diseases have varied clinical presentations that extend beyond the genitalia. Management is best undertaken using a multidisciplinary approach and active patient involvement. The first-line treatment of both conditions is superpotent topical corticosteroids. Supportive measures and adjunct therapies can optimize patient outcomes. Patients who fail to improve despite correct medication use should be re-evaluated, and clinicians should be vigilant in detecting concomitant contact dermatitis, secondary infection, and malignancy.

Lichenoid vulvar disease: A review

“…It has since been referred to as kraurosis vulvae, vulvar dystrophy, white spot disease, lichen albus, guttate scleroderma, and lichen sclerosus et atrophicus (Fistarol and Itin, 2013, Schlosser and Mirowski, 2015). …”

“…2; Fistarol and Itin, 2013). A wrinkled or cigarette paper-like appearance is characteristic (Schlosser and Mirowski, 2015). Clitoral hood edema may be present as well as lichenification if patients scratch affected areas (Schlosser and Mirowski, 2015).…”

“…A wrinkled or cigarette paper-like appearance is characteristic (Schlosser and Mirowski, 2015). Clitoral hood edema may be present as well as lichenification if patients scratch affected areas (Schlosser and Mirowski, 2015). Vulvar LS usually involves the interlabial sulci, labia minora, labia majora, clitoris, clitoral hood, perineum, and perianal area, forming a figure-of-eight pattern (Fistarol and Itin, 2013).…”

“…Perineal and anal involvement were present in 68% and 32% of patients, respectively (Lorenz et al, 1998). LS can leave scars later in the disease course and result in the fusion of the labia minora with the labia majora, complete resorption of the labia minora, fusion of the clitoral hood, and/or scarring of the introitus, which may lead to sexual dysfunction and in extreme cases interference with urination (Fistarol and Itin, 2013, Schlosser and Mirowski, 2015). …”

“…Pathognomonic histological changes in patients with LS include hyperkeratosis, epidermal atrophy, and homogenization of collagen in the papillary dermis (Schlosser and Mirowski, 2015). Histopathology in patients with early LS, however, may be nonspecific and difficult to differentiate from LP because both involve a lymphocytic, lichenoid interface dermatitis (Fung and LeBoit, 1998).…”