Lichen sclerosus in Child
See also in: External and Internal Eye,AnogenitalAlerts and Notices
Synopsis
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%.
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
- 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.Subscription Required
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
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 in Child
See also in: External and Internal Eye,Anogenital