Lichen sclerosus - Anogenital in
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Synopsis
The main symptom is pruritus, and at times, this can be incapacitating, interfering with daily activity and sleep. Dyspareunia and urinary retention may occur. It can also be asymptomatic, just with scarring and hypopigmentation.
Squamous cell carcinoma (SCC) can occur within LS genital lesions. There is a higher risk of SCC in untreated cases.
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
- Bowen disease – Four percent of patients can have an associated squamous cell carcinoma.
- Chronic radiation dermatitis – Previously radiated in that area.
- Mucous membrane pemphigoid – Look for blisters and erosions, scarring, and stricture formation in later stages.
- Extramammary Paget disease – Look for lichenified or verrucous, dry to macerated plaques.
- Infiltrating basal cell carcinoma – Look for pearly areas and prominent telangiectasias.
- Lichen planus – Look for white streaks (Wickham striae).
- Lichen simplex chronicus – Look for lichenification with exaggerated skin markings on glabrous areas of vulva only, often with excoriations.
- Postmenopausal atrophy – Postmenopausal patient with vaginal dryness and atrophy.
- Psoriasis – Look for psoriasis on other body sites.
- Scar – History of trauma.
- Vitiligo – Bright white fluorescence on Wood's lamp.
- Bullous pemphigoid
- Recessive dystrophic epidermolysis bullosa (vulvar lesions)
- Junctional epidermolysis bullosa (vulvar lesions)
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.Subscription Required
References
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Last Reviewed:08/12/2020
Last Updated:01/18/2022
Last Updated:01/18/2022
Patient Information for Lichen sclerosus - Anogenital in
Overview
Lichen sclerosus refers to a type of inflammation, bleeding, thinning, scarring, and resultant white plaques of the mucous membrane and skin in the genital area, or possibly elsewhere on the body. Its origin is uncertain. There may be a genetic association among some family members.Lichen sclerosus lesions may resemble childhood or adult sexual abuse. Your doctor may need to rule out this possibility.
Who’s At Risk
Lichen sclerosus is reported 6 times more often in females than males. In females, it is most often genital and presents either before puberty or after menopause. Lichen sclerosus in males is almost always in uncircumcised boys and men.Women with genital lichen sclerosus may have a slightly greater risk of skin cancer.
Lichen sclerosus is rarely seen in infants.
Signs & Symptoms
Lichen sclerosus of the anogenital area begins with inflamed, dry, sore, and very itchy areas of genital skin. It may progress to painful, bleeding, red or purple lesions. Female symptoms can include pain during urination, defecation, or intercourse. In males, lesions may occur on the head and shaft of the penis. Other symptoms may include itching and painful urination, defecation, and erection. Impaired sensation of the penis may occur.Lichen sclerosus of other skin areas may occur without any symptoms, or may appear as dry, itchy skin patches. White, scar-like areas appear on the shoulders, arms, neck, and back. It may appear in tattoos or previously injured skin (surgical scars, trauma, burns).
Rarely does it occur in the mouth.
Self-Care Guidelines
Use only mild cleansers. Follow the directions of your health care provider to alleviate the pain, itch, and discomfort of the condition.When to Seek Medical Care
When the skin and mucous membranes begin to show signs of aggravated reddening, irritation, itching, and skin plaques, contact your doctor.If conditions worsen following your medical appointment, contact your doctor for follow-up. Lichen sclerosus, if left untreated, can cause irreversible damage to skin and mucous membranes.
Treatments
Your health care provider may perform tests to rule out other conditions or infections, or to confirm your diagnosis prior to starting treatment. Your health care provider may perform a biopsy to rule out malignancy and other white plaque conditions. A biopsy is not ordinarily performed on children, except in extreme cases.Treatment of symptoms, particularly itching, may be the first approach. Topical steroids have been used with great success. A number of other treatments have had mixed results, such as surgery, injections, cryotherapy, phototherapy, and other laser therapy. Circumcision is believed to be helpful for men.
Lichen sclerosus - Anogenital in
See also in: Overview,External and Internal Eye