Sexual Health - Lichen Sclerosus

Question 1

What is Lichen sclerosus?

Answer 1

Chronic inflammatory skin condition

Presents with porcelain-white skin

Affects the labia, perineum and perianal skin in women

Foreskin and glans in men

Question 2

How is lichen sclerosus diagnosed?

Answer 2

Clinical diagnosis

History and exam findings

Vulval biopsy can confirm diagnosis

Question 3

What does Lichen mean?

Answer 3

Flat eruption that spreads,

Lichen sclerosus is not the same as Lichen simplex or planus

Question 4

How does Lichen sclerosus present?

Answer 4

Women 45-60
Vulval itching
Skin changes
Soreness and pain worse at night
Superficial dyspareunia
Erosions
Fissures

Question 5

What is the Koebner phenomenon?

Answer 5

Signs and symptoms made worse by friction to the skin

Occurs with lichen sclerosus

Made worse by tight underwear that rubs the skin, urinary incontinence and scratching

Question 6

How does Lichen sclerosus appear?

Answer 6

Changes affect the labia, perianal and perineal skin
- Porcelain white
- Shiny
- Tight
- Thing
- Slightly raised

Question 7

How is Lichen sclerosus managed?

Answer 7

Potent topical steroids
Clobetasol propionate (dermovate)

Used once a day for 4 weeks, then reduced to alternate days, ten twice weekly

Emollients

Question 8

What are the complications of Lichen Sclerosus?

Answer 8

5% risk of SCC of the vulva
- Pain and discomfort
- Sexual dysfunction
- Bleeding
- Narrowing of the vagina or urethral openings