Lichen sclerosus and lichen planus Flashcards
What is lichen sclerosus?
Chronic inflammatory skin condition, usually affecting genital skin (vulva) and perineum
o Not contagious
What is the epidemiology of lichen sclerosus?
Occurs at extremes of age: <10yo, >60y
0.1% children
3% women >80yo
What are the signs and symptoms of lichen sclerosus?
“white, polygonal papules”
o Hypopigmentation + atrophy
o Pruritis
o White/shiny vulva (“Figure of 8 pattern”)
o May be raised or thickened
o Dyspareunia (due to tightened skin)
o Dysuria (due to tightened skin)
o Can be on wrists, upper trunks, around breasts, neck, armpit
What are the Ix of lichen sclerosus?
clinical diagnosis
What is the management of lichen sclerosus?
o Good skin care
o 1st line (3 months): clobetasol propionate (strong steroid ointments)
o 2nd line: tacrolimus (topical calcineurin inhibitor) + biopsy (as steroid-resistant)
What are the complications of lichen sclerosus?
o Never can be completely cured
o Squamous cell cancer
What are the S/S of lichen planus?
o Clusters of shiny, raised, purple-red blotches on your arms, legs or body
o May see fine white lines on the blotches
o White patches on your gums, tongue or the insides of your cheeks
o Sore red patches on vulva or ring-shaped purple/white patches on penis
What are the Ix of lichen planus?
N.B. not strictly a gynaecological condition but put here for continuity
clinical diagnosis
What is the management of lichen planus?
o 1st line: High-dose topical steroids (e.g. Clobetasol)
o 2nd line: topical calcineurin inhibitor (e.g. tacrolimus)
o If vaginal stenosis, dilatation with manual measures should be attempted in the first instance
What is the aetiology of lichen sclerosus?
Aetiology unknown but associated with autoimmunity and genetics
o Autoimmune – hypothyroidism, Graves’ Disease, T1DM
o Genetic
