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Lichen sclerosus
is an inflammatory dermatosis of unknown cause, possibly autoimmune,
that usually affects the anogenital area.
The earliest signs are skin fragility, bruising, and sometimes blistering. Lesions typically cause mild to severe itching. When lichen sclerosus manifests in children, the appearance may be confused with sexual abuse. With time, the involved tissue becomes atrophic, thinned, hypopigmented (there may be flecks of postinflammatory hyperpigmentation), fissured, and scaly. Hyperkeratotic and fibrotic forms exist. Severe and longstanding cases cause scarring and distortion of normal anogenital architecture. In women, this can even be to the point of total absorption of the labia minora and fusion over the clitoris. In men, phimosis or fusion of the foreskin to the coronal sulcus can occur.
Diagnosis can usually be based on appearance, especially in advanced cases; however, biopsy should be done on any anogenital dermatosis that does not resolve with mild conventional therapy (eg, topical hydrocortisone , antifungal drug). It is especially important to biopsy any area that becomes thickened or ulcerated, because lichen sclerosus is a precursor of squamous cell carcinoma.
Treatment
Treatment consists of potent topical corticosteroids (agents that otherwise should be used with extreme caution in this area). The disease is generally intractable, so long-term follow-up, especially to monitor for squamous cell carcinoma and sexual function and for psychologic support, is indicated.
Last full review/revision August 2009 by Peter C. Schalock, MD
Content last modified August 2009
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