Lichen Sclerosus

Question 1

What other conditions is lichen sclerosus associated with?

Answer 1

1. T1DM
2. Alopecia
3. Hypothyroid
4. Vitiligo

Question 2

What is lichen sclerosus?

Answer 2

Chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin. It commonly affects the labia, perineum and perianal skin in women. It can affect other areas, such as the axilla and thighs. It can also affect men, typically on the foreskin and glans of the penis.

Question 3

What is lichen simplex?

Answer 3

Chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin. This presents with excoriations, plaques, scaling and thickened skin.

Question 4

What is lichen planus?

Answer 4

Autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.

Question 5

In what age group of women is lichen sclerosis most common?

Answer 5

45-60

Question 6

What are symptoms of lichen sclerosis?

Answer 6

1. Itching
2. Soreness and pain possibly worse at night
3. Skin tightness
4. Painful sex (superficial dyspareunia)
5. Erosions
6. Fissures

Question 7

What is the Koebner phenomenon?

Answer 7

Refers to when the signs and symptoms are made worse by friction to the skin. This occurs with lichen sclerosus. It can be made worse by tight underwear that rubs the skin, urinary incontinence and scratching.

Question 8

Can lichen sclerosis be cured?

Answer 8

No but symptoms can be managed

Question 9

How often is lichen sclerosis followed up/ monitored?

Answer 9

Every 3-6 months by experienced gynaecologist or dermatologist.

Question 10

What is the main management of lichen sclerosis?

Answer 10

Potent topical steroids e.g. clobetasol propionate 0.05% (dermovate).

Steroids are initially used once a day for four weeks, then gradually reduced in frequency every four weeks to alternate days, then twice weekly. When the condition flares patients can go back to using topical steroids daily until they achieve good control.

Emollients should be used regularly, both with steroids initially and then as part of maintenance.

Question 11

How long should a 30g tube of dermovate last a patient?

Answer 11

At least 3 months.

Question 12

What is the risk of developing squamous cell carcinoma of the vulva for patients with lichen sclerosis?

Answer 12

5% (steroids seem to reduce risk)