Linchen Sclerosis Flashcards
What is it?
A chronic inflammatory skin condition of anogenital region in women
Thought to be an autoimmune disorder
What age group is affected?
Bimodal incidence - peaking in prepubertal girls and post-menopausal women
What has it the potential to progress to?
Squamous cell carcinoma- 5% of the post menopausal group
How does it appear?
Bruised red and purpuric initially
Then gradually becomes white, flat and shiny
The patches usually within the anogenital region - can occur elsewhere on body but this is rare
What symptoms are associated?
Most common symptom = itching
Skin may undergo fissuring or erosions, which is painful
Dyspareunia
Some are asymptomatic
On examination, the white lesions are well defined with evidence of adhesions and or scarring such as…
Clitoral hood fusion
Fusion of labia minora to labia majora
Posterior fusion - loss of vaginal opening
The white patches are often in what distribution?
Figure of 8
The elastic tissue turns to…
Collagen
What is seen on microscopy?
Characteristically causes atrophy - thin stratified squamous epithelium
Infiltrate of chronic inflammatory cells
What differentials are there?
Linchen simplex Vitiligo VIN or vulval cancer Candidiasis Post inflammatory hyperpigmentation
How is it managed?
First line: topical steroids - clobetasol propionate cream daily for 4 weeks, then alternate nights, then as needed
Follow up as risk of squamous cell carcinoma
What risk factors are there?
FH
Other autoimmune disorders - thyroid, DM1, alopecia areata
