Lichen Sclerosus Flashcards
Definition
Chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin.
Which areas does it commonly affect
Most commonly affects women on the:
- labia
- perineum
- perianal
- thighs and axilla (less common)
men:
- foreskin
- glans of the penis
Risk factors
Associated with other autoimmune diseases:
- type 1 diabetes
- alopecia
- hypothyroid
- vertilgo
Epidemiology
Women
45-60
Signs and symptoms
- The typical presentation is a woman aged 45 – 60 years complaining of vulval itching and skin changes in the vulva.
- The condition can be ASx
- Other symptoms:
= Itching
= Soreness and pain possibly worse at night
= Skin tightness
= Superficial dyspareunia
= Erosions
= Fissures
Koebner phenomenon
When symptoms are made worse by friction to the skin.
= tight underwear that rubs the skin,
= urinary incontinence
= scratching
Appearance
- There can be associated fissures, cracks, erosions or haemorrhages under the skin. The affected skin appears:
= “Porcelain-white” in colour
= Shiny
= Tight
= Thin
= Slightly raised
= There may be papules or plaques
Diagnosis
- Clinical diagnosis
GOLD STANDARD = vulval biopsy (Where there is doubt)
Treatment
Lichen sclerosis cannot be cured:
- FIRST LINE = Potent topical steroids = clobetasol propionate 0.05% (dermovate).
= Help control symptoms of the condition + reduce the risk of malignancy.
- Emoliants = with steroid and as maintenance
How should steroid be used?
- At start: Once daily for four weeks,
- Next 4 weeks: The reduced to alternate days.
- Next 4 weeks: Reduced further to twice weekly.
When the condition flares patients can go back to using topical steroids daily until they achieve good control.
A 30g tube should last at least three months.
Complications
- 5% risk of developing squamous cell carcinoma of the vulva.
- Pain and discomfort
- Sexual dysfunction
- Bleeding
- Narrowing of the vaginal or urethral openings
