| Lichen sclerosus | |
|---|---|
| Other names | Balanitis xerotica obliterans, lichen sclerosus et atrophicus, kraurosis vulvae[1] |
 | |
| Lichen sclerosus of the perineum | |
| Specialty | Gynaecology |
| Symptoms | Typically genital skin: shiny slightly wrinkled pale-white patches surrounded by a purplish area, itchy, skin thinning, scarring[1] |
| Complications | Pain on passing urine, reluctance to pass stool, problems with sex, phimosis, <5% risk of squamous cell skin cancer[1] |
| Usual onset | Before puberty, after menopause[1] |
| Duration | Long-term[1] |
| Causes | Unknown[1] |
| Risk factors | Bone marrow transplantation[1] |
| Diagnostic method | Examination, skin biopsy[1] |
| Differential diagnosis | Guttate morphea, lichen planus, lichen simplex chronicus[1] |
| Treatment | Topical steroids[1] |
| Medication | Ointments: clobetasol, tacrolimus, pimecrolimus[1] |
| Frequency | 1.7% of adult females[1] |
Lichen sclerosus (LS) is a long-term, inflammatory skin disease that affects mainly the genital area.[1] It tends to begin as irregular flat-topped small bumps which become shiny, slightly wrinkled, pale-white patches surrounded by a purplish area.[1] It is extremely itchy and scratching may cause thinning of the skin with small cuts and scarring.[1] Tiny blood vessels may be seen on the vulva or penis.[2] Loss of pigmentation is common on the penis.[1] It rarely occurs elsewhere, though may involve the upper back or breast.[1] Sometimes there are no symptoms.[1] It can lead to pain with urination, vaginal discharge, reluctance to pass stool, problems with sex, and is associated with an increased risk of skin cancer.[2]
The cause is unknown.[2] It is possibly triggered by infection, trauma, and the genital area's tendency to being moist.[2] Bone marrow transplantation may also be a trigger.[1] In transgender people it can occur at surgical sites.[1]
Diagnosis is generally by examination.[2] It can be confirmed by skin biopsy, which shows thick dermal collagen and thin epidermis.[2] LS may appear similar to guttate morphea, lichen planus, and lichen simplex chronicus.[1] Treatment involves strong topical steroids.[2] Sometimes, particularly in children, it gets better without further treatment.[2]
Lichen sclerosus affects around 1.7% of adult females.[1] It typically occurs before puberty and after menopause.[2] In males, it can occur at any age.[2] African Americans are less frequently affected.[1] Up to one third of females have another autoimmune disease.[1] Up to 17% have psoriasis.[1] Lichen sclerosus et atrophicus was first described in 1887 by Dr. Hallopeau.[3]
References edit
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "11. Pityriasis rosea, pityriasis rubra pilares, and other papulosquamous and hyperkeratotic diseases". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. pp. 227–229. ISBN 978-0-323-54753-6. Archived from the original on 2021-12-15. Retrieved 2021-12-15.
- ^ a b c d e f g h i j Wakelin, Sarah H. (2020). "22. Dermatology". In Feather, Adam; Randall, David; Waterhouse, Mona (eds.). Kumar and Clark's Clinical Medicine (10th ed.). Elsevier. pp. 667–668. ISBN 978-0-7020-7870-5. Archived from the original on 2021-12-11. Retrieved 2021-12-11.
- ^ Hallopeau, H (1887). "Du lichen plan et particulièrement de sa forme atrophique: lichen plan scléreux". Ann Dermatol Syphiligr (Paris) (8): 790–791.