Lichen sclerosus is a chronic dermatosis of uncertain etiology affecting the skin and mucosa of individuals of all races. Lichen sclerosus most commonly presents in 2 peaks of incidence: postmenopausal women and prepubertal girls. Childhood and adolescent cases in boys have increasingly been recognized. Lesions occur mostly on the genitalia, perineum, or perianal skin, but extragenital lesions are also observed. Lichen sclerosus lesions are atrophic patches or ivory-white plaques preceded by papules. Because of petechiae, erosions, and purpura, the disease can easily be mistaken for sexual abuse in young girls. Lesions can itch, burn, and cause dysuria, constipation, and painful defecation. Advanced disease may obliterate genital anatomy. Extragenital lesions are rarely symptomatic.
There is a well-documented association of lichen sclerosus and autoimmune diseases such as alopecia areata, autoimmune thyroiditis, and vitiligo. Some cases are thought to due to infectious etiology including Borrelia spp. and hepatitis C virus.
Lichen sclerosus does not usually resolve with puberty, but it may improve.
An increased risk of genital squamous cell carcinoma (SCC) has been observed in adult male and female patients with chronic untreated genital lichen sclerosus. For girls and women with vulvar lichen sclerosus, the lifetime risk of vulvar SCC is about 5%.
Lichen sclerosus in Child
See also in: External and Internal Eye,AnogenitalAlerts and Notices
Synopsis
Codes
ICD10CM:
L90.0 – Lichen sclerosus et atrophicus
SNOMEDCT:
895454001 – Lichen sclerosus
L90.0 – Lichen sclerosus et atrophicus
SNOMEDCT:
895454001 – Lichen sclerosus
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Sexual abuse – Disrupted hymen, may have an associated sexually transmitted disease, purpura, and bruising outside of atrophic areas; a diagnosis of lichen sclerosus does not exclude concomitant sexual abuse, and social work should investigate when suspicion is high.
- Trauma (straddle injury) – no atrophy, consistent history
- Scars – firm, smooth, indurated plaques
- Morphea – indurated; lilac-colored or hyperpigmented border
- Vitiligo – well-defined depigmentation, often not in hourglass configuration, lacks signs of atrophy (purpura, telangiectasias, fine wrinkling, and fissures)
- Lichen planus
- Lichen simplex chronicus
- Psoriasis
- Cutaneous candidiasis – may have erosions, but no atrophy; erythema and satellite lesions
- Allergic or irritant dermatitis – may have postinflammatory hypopigmentation, pruritus, erythema, and erosions, but no purpura or telangiectasias
- Bullous pemphigoid
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:03/08/2017
Last Updated:01/18/2022
Last Updated:01/18/2022
Patient Information for Lichen sclerosus in Child
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Lichen sclerosus in Child
See also in: External and Internal Eye,Anogenital