Lichen sclerosus

Question 1

What is lichen sclerosus?

Answer 1

A destrutive inflammatory skin condition that affects mainly the anogenital area of women

Question 2

How common is lichen sclerosus and what is the cause?

Answer 2

1 in 300 women

Thought to be autoimmune because many patients have other autoimmune conditions, such as thyroid disease and pernicious anaemia.

Question 3

What is the pathophysiology of lichen sclerosus?

Answer 3

• Destructive autoimmune disease
• Underlying inflammation in the subdermal layers of the skin, results in hyalinization of the skin
• This causes fragility and white ‘parchment paper’ appearance of the skin an loss of vulval anatomy (in males it can affect the fireskin and produce a phimosis)
• Evident elsewhere on the body in 15% of patients

Question 4

Is lichen sclerosus a risk factor for vulval cancer?

Answer 4

Many women with vulval cancer have lichen sclerosis at the time of diagnosis and it is
estimated that there is a low risk of cancer developing in a women with lichen sclerosus (around 3–5%).

Lichen sclerosus is associated with vulval cancer, but is not a cause.

Question 5

What are the signs and symptoms of lichen sclerosus?

Answer 5

• Itching –> scratching –> soreness of the vulva
• Characteristically presents as a ‘figure of 8’ pattern around the vulva and anus
• Hypopigmentation
• Loss of anatomy
• Vaginal stenosis
• Cracking (particularly in the posterior fourchette)
• Appearance can be subtle in early-stage disease

Question 6

What is the management of lichen sclerosus?

Answer 6

1. Good skin care
   
   • soap substitute,
   • emollients
   • avoid irritants
2. Strong steroid ointments
   
   • e.g. CLOBETASOL propionate - apply a pea sized amount daily for 1st month, alternate days for the 2nd month and x2 a week for 3rd month
   • review after 3 months
3. Biopsy is indicated if the condition does not resolve with treatment

Question 7

If the lichen sclerosus resolves with treatment what is the management long-term?

Answer 7

Once the course of treatment is completed, the steroid cream can be used by women PRN