Vulvar Lichen Sclerosus: Current Perspectives

Abstract

Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO₂ laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.

Keywords: clitoral phimosis; corticosteroids; fractional CO2 laser; lichen sclerosus; lysis of vulvar adhesions; vulvar granuloma fissuratum.

Figure 1

Ivory white atrophic patches and plaques with a waxy texture, often described as a “cigarette paper” appearance. Agglutination, labial resorption, phimosis of the clitoris, and narrowing of the introitus.

Figure 2

Classic histology of vulvar LS includes hyperkeratosis of the epidermis (A), epidermal atrophy with loss of rete ridges (B), homogenization of the collagen below the dermal-epidural junction (C), and lichenoid T-lymphocyte infiltrate near the basement membrane (D).