Lichen sclerosus

Question 1

What is lichen sclerosus

Answer 1

Chronic inflammatory skin disease of the anogenital region in women

Question 2

Describe the incidence of lichen sclerosus

Answer 2

Bimodal - peaks in prepubescent girls and post-menopausal women

Question 3

What does lichen sclerosus have the potential to turn into?

Answer 3

Squamous cell carcinoma

Question 4

What are some risk factors of lichen sclerosus?

Answer 4

Genetics - FH

Autoimmune disorders - thyroid disease, T1DM, alopecia areata

Question 5

Describe the findings of lichen sclerosus on microscopy

Answer 5

Atrophy
Thin stratified squamous epithelium
Band like infiltrate of chronic inflammatory cells beneath the epithelial layer

Question 6

Describe the clinical features of lichen scelerosus

Answer 6

White atrophic patches on the skin, usually within the anogenital region - can occur elsewhere on the body such as axillae, buttocks and thigh but is rare

Itching and the skin may undergo fissuring or erosisions causing pain

Majority of sexually active women will experience dyspareunia

Asymptomatic for some

Question 7

Describe the examination findings of lichen sclerosus

Answer 7

White lesions characteristically well defined

Evidence of adhesions and/or scarring - clitoral hood fusion, fusion of the labia minora to labia majora posterior fusion resulting in loss of vaginal opening

Question 8

List the differentials for lichen sclerosus

Answer 8

Lichen simplex
Vitiligo 
Vulval cancer or intraepithelial neoplasia
Candidiasis
Post-inflammatory hypopigmentation

Question 9

What investigations can be done for lichen sclerosus?

Answer 9

Clinical diagnosis

Biopsy if uncertainty in diagnosis

Question 10

Describe the management of lichen sclerosus

Answer 10

Immunosuppression - topical steroids (Clobetasol propionate - once nightly for 4 weeks, then alternate nights for 4 weeks and then twice weekly for 4 nights)

Advice regarding avoiding irritants to the area and minimising urinary contact

Follow up as risk of developing SCC (2-5%)

Question 11

Which antibodies do patients with lichen sclerosus have higher amounts of?

Answer 11

Extracellular matrix protein 1 antibody