Clinical presentations and complications of lichen sclerosus: A systematic review

Abstract

Lichen sclerosus (LS) is a chronic, inflammatory dermatosis most commonly characterized by changes in skin pigmentation and pruritus, with associated dyspareunia and genital architectural changes. There are a variety of complications associated with LS, which further worsen a patient's health-related quality of life. A systematic review was conducted to summarize the literature regarding clinical features of LS, as well as LS-associated complications. In total, 900 studies were included, which represented 17,011 clinical presentations and 2,795 complications of LS in women, and 5,745 clinical presentations and 769 complications of LS in men. In both sexes, the majority of reported cases (77% in females, 99% in males) localized to the genitals. In women, presentations were spread amongst loss of normal architecture (14%), pigmentary changes (21%) and pruritus (18%), whereas in men a greater portion of cases presented with architectural alterations (34%), as well as pigmentary changes (15%) and urogenital symptoms (15%). Other classes of LS-associated presentations included textural changes, atrophy, pain/burning/discomfort, erosions/ulcerations/excoriations, bleeding/bruising/purpura, defecatory symptoms and bullae. A small portion of cases found in the literature presented with asymptomatic LS. LS-associated complications included skin neoplasms, urogenital issues and sexual dysfunction, including dyspareunia.

Keywords: Lichen sclerosus; atrophy; clinical features; complication; pigmentation; presentation; pruritus.

FIGURE 1

PRISMA flow diagram for included studies.