Sex-related Variations in Comorbidities in Lichen Sclerosus: A Systematic Review and Meta-Analysis

Abstract

The comorbidities of lichen sclerosus (LS) are presumed but have not been analysed in detail. The purpose of this review was to identify evidence-based associated diseases in patients with LS and explore the potential need for sex-dependent screening protocols. A comprehensive search of the MEDLINE, Embase, and PsycINFO databases from inception to 29 February 2024 was conducted using the key search terms LS and all its synonyms. Pooled odds ratios and 95% confidence intervals of comorbidities were generated using the DerSimonian and Laird random-effects model. A total of 21 case-control studies met the inclusion criteria. Of the 75 comorbidities analysed, only 16 (21.3%) were studied in both sexes, revealing no contrasting associations based on sex. Both female and male LS patients showed significantly increased odds of common dermatological conditions (i.e., lichen planus, vitiligo, alopecia areata, atopic dermatitis, and psoriasis), various cardiovascular risk factors (i.e., essential hypertension, obesity, dyslipidaemia, diabetes mellitus, and diabetes mellitus type 2), genital warts, and hypothyroidism compared with controls. Overall, the scarcity of data currently does not support the implementation of sex-dependent screening strategies. The findings do, however, present significant associations with a range of potentially serious comorbidities, which warrants further elucidation and clinical vigilance.

Fig. 1

PRISMA flow diagram illustrating the selection process of studies included in the meta-analysis.

Fig. 2

Forest plot displaying pooled odds ratios and 95% confidence intervals for comorbidities associated with lichen sclerosus, separated by sex. Significant ORs greater than 1 are shown in red, significant ORs less than 1 are shown in blue, and non-significant ORs are shown in black. Numbers and estimates that rely on data from more than 1 study are emphasized, indicating stronger evidence. Legend: N: number, OR: odds ratio, *p < 0.05, **p < 0.01, ***p < 0.001.

Fig. 3

Forest plot highlighting pooled odds ratios and 95% confidence intervals for comorbidities associated with lichen sclerosus, analysed across both sexes. Significant ORs greater than 1 are shown in red, and non-significant ORs are shown in black. Numbers and estimates that rely on data from more than 1 study are emphasized, indicating stronger evidence. Legend: N: number, OR: odds ratio, *p < 0.05, **p < 0.01, ***p < 0.001.