Lichen sclerosus: The 2023 update

Abstract

Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.

Baricitinib treatment of extragenital lichen sclerosus caused by COVID‐19 vaccine

“…Moreover, the T-cell response is low following one dose of inactivated vaccines, but it is demonstrably sustained after two doses. 3 This explains the occurrence of LS being initially confined to the injection sites of the first two vaccines, then spreading throughout the body after a third dose.…”

“…1 Accordingly, LS is a Th1-dominant disease with high levels of Th1 cytokines, 2 and lichenoid CD8 + T-cell infiltration in the dermis is also an important trigger of LS pathogenesis. 3…”

Conservative Management of Penile and Urethral Lichen Sclerosus: A Systematic Review

“…These studies include 507 male patients and 6 treatments: clobetasol propionate, tacrolimus, platelet-rich plasma (PRP), CO 2 laser vaporization, acitretin, and polydeoxyribonucleotide (PDRN) injection (Figure 2). [17][18][19][20] All studies recruited adult men aside from 1 study examining the use of topical tacrolimus in boys. The median Newcastle-Ottawa Scale quality rating was 6 stars (Supplementary Appendix 2, https://www.jurology.com).…”

Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomised controlled trial

“…Each parameter is scored as 0 (normal/none), 1 (a few signs/moderate), or 2 (clear signs/severe). 4,19,20,22,23 The total LS score therefore has a range of 0 (normal) to 12 (most severe). A total LS score of ≥4 identifies LS with a probability of >90%.…”

“…1,3 The recommended first-line therapy for LS is the topical application of potent corticosteroids. 2,4 Corticosteroid therapy reduces inflammation, alleviates symptoms, prevents disease progression and reduces malignant potential, but needs to be continued for life. 3 Some patients may have a negative attitude towards corticosteroid therapy that can result in noncompliance and steroid phobia, and in some cases, steroids may not help.…”