leukoplakia (vulva)
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Lichen sclerosus (LS) is a chronic lymphocyte mediated inflammation of the skin which most commonly affects the ano-genital epithelium in women (1). Although the aetiology of lichen sclerosus is unknown, there is evidence of an autoimmune mechanism in the pathogenesis (2).

Lichen sclerosus is the most common of the vulval dystrophies, and may represent an autoimmune disorder. It primarily affects the vulva but in 20% of cases, affects other sites such as the perineum, upper trunk, axillae, buttocks and lateral thighs (3). Patient's are usually aged 45 - 60 years. Uncommonly, it may affect prepubertal girls.

Involvement of the vagina and the cervix do not occur.

Lesions may be seen in:

  • interlabial sulci
  • labia minora
  • clitoral hood
  • clitoris
  • perineal body

The initial acute inflammatory phase is noted as a bright red area on the vulva which is itchy and sore. Later, the vulva becomes ivory white and atrophic with small, even absent, labia minor and thin labia majora.

  • might be asymptomatic in some women. Itching which is worse at night (may even disturb sleep) is the chief complaint although pain and dyspareunia may be seen in cases of erosions and fissures (3)

This condition may also affect males (lesions can be frequently seen on the prepuce, coronal sulcus and glans penis) and present with a white area at the tip of the prepuce and glans. There may be phimosis of the prepuce and painful erections due to the tightening of the foreskin (3).

Diagnosis is made clinically but biopsy is recommended in patients with clinical doubt in the diagnosis (3).

Treatment with a potent topical corticosteroid may be useful.

In females:

  • vulvectomy is contraindicated as recurrences following surgery are common.

In males:

  • circumcision may be necessary if severe constriction

Follow-up is important as long standing, untreated cases show a 5% incidence of malignant change (association with development squamous cell carcinoma) (3)).

In children affected by this condition, 50% will resolve by menarche (2).

Click here for an example image of lichen sclerosus

Notes:

  • laser, photodynamic therapy and cryotherapy can also be used in management of lichen sclerosus (3).

Reference:

 
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