Lichen Sclerosus (Complete) Flashcards
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Define lichen sclerosus
Inflammatory skin condition predominantly affecting the genital and anal regions
Lichen sclerosus is more common in which demographic of patients?
Elderly woman
What are the main risk factors for lichen sclerosus?
Female sex
Uncircumsised state
What are the main features of lichen sclerosus?
White patches which may progress to scarring
Itchiness and pain
- Worsened during sex
- Worsened during urination
Bleeding over patches
- Worsened after sex or bowel movements
Scarring:
Women:
* Clitoral hood fusion
* Labia majora fusion
* Narrowed introitus
Men:
- Constrictive posthitis (foreskin tightening) which can progress to paraphimosis and painful erection
What scarring complication can occur in men with lichen sclerosus?
Constrictive posthitis (foreskin tightening)
What scarring complications can occur in women with lichen sclerosus?
Clitoral hood fusion
Labia majora fusion/resorption
Narrowed introitus
What differentials should be considered alongside lichen sclerosus? (4)
Lichen planus
Psoriasis
Vitiligo
STD
What investigations should be considered if patient is suspected of having lichen sclerosus?
Bedside:
Vulval examination
- Usually enough to make diagnosis
Invasive:
Skin biopsy
- Can be considered to confirm diagnosis
What is the management plan for patients with lichen sclerosus?
Conservative:
Topical emollients
Avoid tight clothing
Avoid soap in affected areas
Medicine:
First line: Very potent topical corticosteroids (e.g. dermovate)
Topical calcineurin inhibitors (e.g. tacrolimus)
- Consider in adjunct with corticosteroids
Topical oestrogen cream
- If atrophic vaginitis presenting alongside lichen sclerosus
Oral therapy (Severe cases):
- Corticosteroids
- Retinoids
- Methotrexae
- Ciclosporin
What is the first-line management for lichen sclerosus?
Very potent topical corticosteroids (e.g. dermovate)
To reduce inflammation and itching
Name an example of a very potent topical corticosteroid used in management of lichen sclerosus
Dermovate
What can be considered in adjunct with topical corticosteroids?
Topical calcineurin inhibitors (e.g. tacrolimus)
What side effects typically occur upon initial use of topical calcineurin inhibitors?
Burning and discomfort
Should inform patients of this and that it will resolve in a couple of days
What medication can be considered in management of severe presentations of lichen sclerosus?
Oral corticosteroids
Retinoids
Methrotrexate
Ciclosporin
Lichen sclerosus is associated with increased risk of which type of malignancy?
Squamous cell carcinoma
(Present in 5% of patients with lichen sclerosus)
Vulval cancer
What infections are associated with lichen scelrosus?
Candida albicans
Staphylococcus aureus
HSV
Due to breaks in the skin
What complications are associated with lichen sclerosus
Vulval cancer (squamous cell carcinoma)
Infections
- Candida
- Staph A
- HSV
Constipation (due to pain during bowel movements)
