Lichen sclerosus Flashcards
What is lichen sclerosus?
A destrutive inflammatory skin condition that affects mainly the anogenital area of women
How common is lichen sclerosus and what is the cause?
1 in 300 women
Thought to be autoimmune because many patients have other autoimmune conditions, such as thyroid disease and pernicious anaemia.
What is the pathophysiology of lichen sclerosus?
- Destructive autoimmune disease
- Underlying inflammation in the subdermal layers of the skin, results in hyalinization of the skin
- This causes fragility and white ‘parchment paper’ appearance of the skin an loss of vulval anatomy (in males it can affect the fireskin and produce a phimosis)
- Evident elsewhere on the body in 15% of patients
Is lichen sclerosus a risk factor for vulval cancer?
Many women with vulval cancer have lichen sclerosis at the time of diagnosis and it is
estimated that there is a low risk of cancer developing in a women with lichen sclerosus (around 3–5%).
Lichen sclerosus is associated with vulval cancer, but is not a cause.
What are the signs and symptoms of lichen sclerosus?
- Itching –> scratching –> soreness of the vulva
- Characteristically presents as a ‘figure of 8’ pattern around the vulva and anus
- Hypopigmentation
- Loss of anatomy
- Vaginal stenosis
- Cracking (particularly in the posterior fourchette)
- Appearance can be subtle in early-stage disease
What is the management of lichen sclerosus?
-
Good skin care
- soap substitute,
- emollients
- avoid irritants
-
Strong steroid ointments
- e.g. CLOBETASOL propionate - apply a pea sized amount daily for 1st month, alternate days for the 2nd month and x2 a week for 3rd month
- review after 3 months
- Biopsy is indicated if the condition does not resolve with treatment
If the lichen sclerosus resolves with treatment what is the management long-term?
Once the course of treatment is completed, the steroid cream can be used by women PRN
