Lichen sclerosus: Role of occlusion of the genital skin in the pathogenesis

Abstract

Lichen sclerosus (LS) is a chronic inflammatory skin disease, which most commonly involves the anogenital region. The etiology of LS is obscure, but genetic susceptibility, autoimmune mechanisms, infective agents like human papillomavirus and spirochaetes, and Koebner phenomenon has been postulated as causative factors. We report our observation in 6 patients (3 males and 3 females) with histologically proven lichen sclerosus that showed relative sparing of the uncovered areas of the genitals, thereby suggesting that the occlusion of the genital skin may be playing a greater role in the causation of LS than is currently thought, in both sexes.

A Case of Lichen Sclerosus et Atrophicus Accompanying Bullous Morphea

“…However, various hypotheses may explain bulla formation. Templeton claimed that bulla are caused by a lymphatic obstruction, and that the presence of enlarged lymphatic channels in the upper dermis supported this claim2. Additionally, due to increased hydrostatic pressure, bullous lesions are more frequently observed on the lower extremities.…”

“…The etiology of LS is obscure, but genetic susceptibility, autoimmune mechanisms, infective agents such as human papilloma virus and spirochaetes, as well as Koebner phenomenon have been postulated as causative factors2.…”

“…Coexistence of morphea and lichen sclerosus et atrophicus (LSA) has been identified in some cases2-11. Some authors believe that these two diseases are different clinical manifestations on the same spectrum.…”

Occlusion, urine and genital lichen sclerosus

“…Gupta, Malhotra and Ajith on their perspicacious observations concerning the distribution of genital lichen sclerosus (GLSc), recently published in your journal. [1] I also applaud the clarity of their interpretation, with which I unequivocally agree, that occlusion of susceptible skin is central to the pathogenesis of this cryptic but important dermatosis. My own view is that it is occlusion specifically with urine that is key.…”

“…Moreover angiogenesis, vascular endothelial growth factor (VEGF)-positive cells and mast cells are increased in the center compared to the periphery. [1][2][3] Based on the above we investigated the thickness of keratin, the subjacent epithelium and the length of the basement membrane in the center (final stage) and the periphery (initial stage) of vitiligo, in order to find any difference between the two areas of the same lesion and a possible correlation between epidermal thickness and increased dermal angiogenesis.…”