Anogenital lichen sclerosus

Abstract

Lichen sclerosus (LS) was first described by Hallopeau in 1887. It is a chronic inflammatory condition most commonly involving the anogenital region with a relapsing course and a potential for destruction, functional impairment, atrophy, and malignant changes. LS affects both sexes with a female preponderance of 5:1. The exact prevalence of the disease is difficult to predict as the lesions are asymptomatic in the initial phase and later when the complications arise patients might visit the surgeon, pediatrician, gynecologist, or urologist. The etiology of LS has a complex interplay of genetic factors, autoimmunity, infections, and trauma. Physical examination to assess the extent of the disease and decide the line of management is the most crucial step in the management. Corticosteroids, calcineurin inhibitor, retinoids, phototherapy, and surgery can be helpful. Self-examination and long-term follow-up are necessary.

Keywords: Balanitis xerotica; kraurosis vulvae; lichen sclerosus.

Figure 1

Atrophic porcelain white, cellophane paper skin with erosions; female genital lichen sclerosus

Figure 2

Late changes showing atrophy and clitoral resorption

Figure 3

Lichen sclerosus in a young girl with hypopigmented plaque and fissuring

Figure 4

Tightened preputial skin with erythema and fissure

Figure 5

Lichen sclerosus in male showing inflammatory urethral involvement

Figure 6

Early lichen sclerosus in a 6-year-old boy presenting with phimosis