Lichen Sclerosus

Question 1

Lichen Sclerosus

Answer 1

Chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin

Question 2

Where does lichen sclerosus normally affect

Answer 2

Women: labia, perineum and perianal skin

Men: foreskin and glans of the penis

Others:
Axilla and thighs

Question 3

Which conditions is lichen sclerosus associated with

Answer 3

T1DM

Alopecia

Hypothyroid

Vitiligo

Question 4

How is lichen sclerosus diagnosed

Answer 4

Clinical - history and examination

If doubt - vulval biopsy

Question 5

Presentation of lichen sclerosus

Answer 5

Women aged 45 – 60 years complaining of vulval itching and skin changes in the vulva.

May be asymptomatic or present with:

• Itching
• Soreness and pain possibly worse at night
• Skin tightness
• Painful sex (superficial dyspareunia)
• Erosions
• Fissures

Question 6

Koebner phenomenon

Answer 6

Signs and symptoms are made worse by friction to the skin

Question 7

Appearance of lichen sclerosus

Answer 7

The affected skin appears:

“Porcelain-white” in colour

Shiny

Tight and thin

Slightly raised

May be papules or plaques

Question 8

Management of Lichen sclerosus

Answer 8

Cannot be cured

Potent topical steroids - dermovate

Emollients

Followed up every 3 – 6 months by gynae or derm

Question 9

How to use dermovate for liche sclerosus

Answer 9

Initially used OD for 4 weeks, then gradually reduced in frequency every four weeks to alternate days, then twice weekly.

Flares - back to using topical steroids daily until they achieve good control.

Question 10

Complications of lichen sclerosus

Answer 10

Squamous cell carcinoma of the vulva

Other complications:

• Pain and discomfort
• Sexual dysfunction
• Bleeding
• Narrowing of the vaginal or urethral openings