Lichen sclerosus Flashcards
What is lichen sclerosus?
a chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin.
It commonly affects the labia, perineum and perianal skin in women.
It can affect other areas, such as the axilla and thighs
Lichen sclerosus only affects women. True/false?
False
can also affect men, typically on the foreskin and glans of the penis
Is lichen sclerosus an autoimmune condition?
Yes
What other autoimmune diseases is lichen sclerosus associated with?
Type 1 diabetes
alopecia
hypothyroidism
vitiligo.
How is lichen sclerosus diagnosed?
usually made clinically, based on the history and examination findings.
Where there is doubt, a vulval biopsy can confirm the diagnosis.
Meaning of “lichen”?
refers to a flat eruption that spreads
What is lichen simplex?
chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin.
This presents with excoriations, plaques, scaling and thickened skin.
What is lichen planus?
an autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.
For lichen planus remember 6p’s to describe lesions:
- Planar (flat-topped)
- Polygonal
- Purpuric (purple)
- Pruritic
- Papules
- Plaques
Typical age affected by lichen sclerosus?
woman aged 45 – 60 years complaining of vulval itching and skin changes in the vulva
Lichen sclerosus can be asymptomatic or present with some symptoms. What are the potential symptoms?
Itching
Soreness and pain possibly worse at night
Skin tightness
Painful sex (superficial dyspareunia)
Erosions
Fissures
What is Koebner phenomenon?
refers to when the signs and symptoms are made worse by friction to the skin. This occurs with lichen sclerosus.
Is also present with other conditions such as psoriasis.
Appearance of lichen sclerosus?
“Porcelain-white” in colour
Shiny
Tight
Thin
Slightly raised
There may be papules or plaques
Main medical treatment choice of lichen sclerosus?
Potent topical steroids are the mainstay of treatment.
The typical choice is clobetasol propionate 0.05% (dermovate).
Steroids are used long term to control the symptoms of the condition. They also seem to reduce the risk of malignancy.
Emollients should be used regularly, both with steroids initially and then as part of maintenance.
With lichen sclerosus, what is the % risk of developing squamous cell carcinoma of the vulva?
5% risk of development
Other complications of lichen sclerosus?
Pain and discomfort
Sexual dysfunction
Bleeding
Narrowing of the vaginal or urethral openings
