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Lichen sclerosus - Anogenital in
See also in: Overview,External and Internal Eye
Other Resources UpToDate PubMed

Lichen sclerosus - Anogenital in

See also in: Overview,External and Internal Eye
Contributors: Sabrina Nurmohamed MD, Belinda Tan MD, PhD, Antoinette L. Laskey MD, MPH, MBA, FAAP, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Lichen sclerosus (LS) is a chronic inflammatory and fibrosing dermatosis. Lesions originate as white or yellow papules and evolve to atrophic or white ivory patches, ecchymoses, and sclerosis. They occur mostly on the genitalia, perineum, or perianal skin but can appear anywhere. Atrophic LS lesions of the penis are known as balanitis xerotica obliterans. The majority of cases of male genital LS occur in uncircumcised males.

In children, it is the most common skin condition mistaken for sexual abuse. Although onset is typically around 35-45 years of age, about 7%-15% of cases begin in childhood.

LS may be asymptomatic, although it often results in pruritus and burning. Additionally, there may pain on defecation, constipation, dysuria, or anal or genital bleeding. A major goal of treatment for male pediatric anogenital LS is to prevent urethral stricture.

Children may seek parental attention. They may also present with behavioral changes; for example, caregivers (teachers, parents) may describe a child as "always having their hands in their pants," "rubbing on everything," and "unable to sit still." Behavior caused by itching may be misinterpreted as masturbation that is persistent and resistant to requests to stop.

Misdiagnosis for sexual abuse most often occurs when the presentation is bullous, hemorrhagic, or erosive. Submucosal hemorrhages ("blood blisters") are rarely due to sexual abuse and are a common finding in LS. The presence of hypopigmentation, atrophic skin, and telangiectasias should help differentiate this condition from sexual maltreatment. Findings of confirmed sexual abuse are primarily associated with acute injuries to the genitalia, anus, or oral cavity, genital scarring, sexually transmitted diseases, or evidence of a deep notch. Case reports of LS coexisting with child abuse have been documented.

Childhood sexual abuse can affect children of all ages and economic and cultural backgrounds. Practitioners working with this population should consider this diagnosis routinely. Childhood sexual abuse is a serious allegation with major repercussions to a child and their family, and the differential diagnosis of genital lesions suggestive of sexual abuse includes LS and other anogenital dermatoses.

Genital LS confers a small risk of squamous cell carcinoma (SCC).

Codes

ICD10CM:
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

  • Vitiligo
  • Diaper irritant contact dermatitis
  • Lichen simplex chronicus
  • Psoriasis
  • Diaper dermatitis candidiasis
  • Lichen planus
  • Child sexual abuse
  • Bullous pemphigoid of childhood

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:03/08/2023
Last Updated:03/09/2023
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Patient Information for Lichen sclerosus - Anogenital in
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Lichen sclerosus - Anogenital in
See also in: Overview,External and Internal Eye
A medical illustration showing key findings of Lichen sclerosus : Eyelids, Glans of penis, Labia majora, Smooth plaque, White color, Inguinal region, Pruritus, Skin atrophy, Hardened skin
Clinical image of Lichen sclerosus - imageId=174921. Click to open in gallery.  caption: 'A shiny white plaque in the intergluteal fold.'
A shiny white plaque in the intergluteal fold.
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