Lichen Sclerosus Flashcards
What is lichen sclerosus?
Lichen sclerosus is a chronic inflammatory skin condition that typically affects the anogenital region, causing atrophic and sclerotic changes.
Who is most commonly affected by lichen sclerosus?
It primarily affects postmenopausal women but can occur in men and children.
What causes lichen sclerosus?
The exact cause is unknown, but it is thought to involve an autoimmune component, genetic predisposition, and hormonal factors.
What are the key symptoms of lichen sclerosus?
Symptoms include itching, soreness, burning, pain during intercourse (dyspareunia), and difficulty urinating or defecating in severe cases.
What are the typical signs of lichen sclerosus on examination?
Signs include white, shiny plaques, atrophic skin, loss of normal genital architecture, and fissures or erosions in severe cases.
What areas are most commonly affected by lichen sclerosus?
The vulva, perineum, perianal area (creating a “figure-of-eight” pattern), and, less commonly, extragenital sites.
How is lichen sclerosus diagnosed?
Diagnosis is clinical, based on characteristic features, but a biopsy may be performed if the diagnosis is uncertain or malignancy is suspected.
What are the complications of lichen sclerosus?
Complications include vulvar scarring, narrowing of the vaginal introitus, fissures, and an increased risk of vulvar squamous cell carcinoma.
What is the first-line treatment for lichen sclerosus?
High-potency topical corticosteroids, such as clobetasol propionate, are the first-line treatment.
How often should topical corticosteroids be used for lichen sclerosus?
Initially, they are applied daily for 4-12 weeks, followed by maintenance therapy (e.g., 1-2 times per week).
What supportive treatments are recommended for lichen sclerosus?
Supportive treatments include emollients, avoiding irritants, and wearing loose-fitting clothing.
When is a biopsy indicated in lichen sclerosus?
A biopsy is indicated if there are atypical features, poor response to treatment, or concern about malignancy.
What are the histological features of lichen sclerosus?
Features include epidermal atrophy, hyperkeratosis, a thickened basement membrane, and a band-like lymphocytic infiltrate in the dermis.
How is vulvar squamous cell carcinoma related to lichen sclerosus?
Lichen sclerosus increases the risk of developing vulvar squamous cell carcinoma, particularly in untreated or longstanding cases.
What are the differential diagnoses for lichen sclerosus?
Differential diagnoses include lichen planus, atrophic vaginitis, vulvar eczema, and vulvar psoriasis.
What is the prognosis for lichen sclerosus?
With appropriate treatment, symptoms can be well-controlled, but the condition is chronic and requires long-term management.
How does lichen sclerosus affect men?
In men, it can affect the foreskin and glans penis, leading to phimosis, meatal stenosis, or balanitis xerotica obliterans.
How is lichen sclerosus in men managed?
Management includes topical corticosteroids and, in severe cases, circumcision.
What is the role of patient education in managing lichen sclerosus?
Education about the chronic nature of the condition, adherence to treatment, and recognising signs of complications is crucial.
What lifestyle advice is given to patients with lichen sclerosus?
Patients are advised to avoid soaps and irritants, use emollients regularly, and wear breathable, loose-fitting clothing.
How is lichen sclerosus monitored over time?
Regular follow-ups are necessary to monitor symptom control, assess for complications, and check for signs of malignancy.
What psychological impacts can lichen sclerosus have on patients?
The condition can lead to distress, embarrassment, reduced self-esteem, and sexual dysfunction, necessitating counselling or support.
How does lichen sclerosus affect children?
In children, symptoms often include itching and soreness; it may be mistaken for abuse or other conditions.
Can lichen sclerosus resolve spontaneously?
In some children, lichen sclerosus may resolve spontaneously, but in adults, it is usually chronic and requires long-term treatment.
What are the long-term outcomes of untreated lichen sclerosus?
Untreated cases can lead to scarring, severe functional impairment, and increased risk of vulvar cancer.
What are the alternative treatments for lichen sclerosus if corticosteroids are not effective?
Alternatives include calcineurin inhibitors (e.g., tacrolimus), phototherapy, or surgical options for severe scarring.
