Introduction
Lichen sclerosus was previously termed lichen sclerosus et atrophicus. It is an inflammatory condition which usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming
Epidemiology
- Incidence: 100.00 cases per 100,000 person-years
- Peak incidence: 70+ years
| Condition | Relative incidence |
|---|---|
| Vaginal candidiasis | 40.00 |
| Atrophic vaginitis | 10.00 |
| Lichen sclerosus | 1 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
- Itch is prominent
Diagnosis
The diagnosis is usually made on clinical grounds but a biopsy may be performed if atypical features are present.
The RCOG advises the following
Skin biopsy is not necessary when a diagnosis can be made on clinical examination. Biopsy is required if the woman fails to respond to treatment or there is clinical suspicion of VIN or cancer.
and the British Association of Dermatologists state the following:
A confirmatory biopsy, although ideal, is not always practical, particularly in children. It is not always essential when the clinical features are typical. However, histological examination is advisable if there are atypical features or diagnostic uncertainty and is mandatory if there is any suspicion of neoplastic
change. Patients under routine follow-up will need a biopsy if:
The RCOG advises the following
Skin biopsy is not necessary when a diagnosis can be made on clinical examination. Biopsy is required if the woman fails to respond to treatment or there is clinical suspicion of VIN or cancer.
and the British Association of Dermatologists state the following:
A confirmatory biopsy, although ideal, is not always practical, particularly in children. It is not always essential when the clinical features are typical. However, histological examination is advisable if there are atypical features or diagnostic uncertainty and is mandatory if there is any suspicion of neoplastic
change. Patients under routine follow-up will need a biopsy if:
- (i) there is a suspicion of neoplastic change, i.e. a persistent area of hyperkeratosis, erosion or erythema, or new warty or papular lesions;
- (ii) the disease fails to respond to adequate treatment;
- (iii) there is extragenital LS, with features suggesting an overlap with morphoea;
- (iv) there are pigmented areas, in order to exclude an abnormal melanocytic proliferation;
- (v) second-line therapy is to be used.
Management
- Topical steroids and emollients
Complications
Follow-up:
- Increased risk of vulval cancer