Lichen Sclerosus et Atrophicus

Medically reviewed by The Dermatologists and written by  Dr. Aayushi Shah

  •         Inflammatory condition affecting genital and perianal regions
  •         More common in women than in men
  •         Rarely affects the trunk and other areas
  •         Diagnosis by skin biopsy

Lichen Sclerosus et Atrophicus (LSeA) is a common inflammatory disorder that can affect the anogenital region. Its exact cause remains unknown; however, it is thought to be autoimmune in nature. A role for the bacteria Borrelia burgdorferi has also been proposed.

Although LSeA can occur in both men and women, the incidence of LSeA in women is much higher than in men. In women, it is more commonly seen in the prepubertal and postmenopausal age groups. It may also be associated with other autoimmune disorders such as thyroid disorders.

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Signs and Symptoms

Lichen sclerosus initially starts as small, flat topped, pink or ivory, slightly raised spots. These white spots can later coalesce to form bigger patches. The affected skin is frequently thinned out and wrinkled, leading to the characteristic appearance and nomenclature.

LSeA commonly affects the vulvar region and perianal region in women, while the penis is affected in men. It often presents as irreversible retraction of a previously retractile foreskin in men and prepubertal boys, while in women it presents with itching, difficulty in passing urine, pain during intercourse, and constipation.

With advancement of the disease, the papules coalesce to form plaques with a dull, smooth, white atrophic surface (wrinkled tissue paper look). When the perianal region is also affected in females, it leads to a characteristic figure of eight appearance.

Adult LSeA is more common in postmenopausal women, where it runs a prolonged course. There is typically intense itching, which leads to excoriations with delayed healing and skin atrophy. This forms a cycle which ultimately results in a narrowed vaginal opening.

LSeA of the penis in adults is also known as balanitis xerotica obliterans. It may start as recurrent white rashes on the glans and foreskin, which worsen with intercourse, leading to erosions of the skin which eventually heal with contractions.

Rarely, LSeA of the foreskin may be associated with certain types of skin cancers.

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What can I do?

If you suspect you have this condition, it is best to visit a qualified dermatologist to confirm the diagnosis and begin adequate treatment. Since the cause remains unclear, we do not know how this condition can be prevented.

If you do have LSeA, avoid using harsh soaps or antiseptics to clean the area, as the skin is already dry and damaged. Frequent use of bland moisturisers and emollients will help in early healing.

Although this condition can be accompanied by severe itching, avoid scratching so as to avoid damage to the already thinned out skin. Keeping the area clean and dry will promote early healing of any scratches or cuts.

 

Should I seek medical care?

If you have any itching of white patches over the genital skin, or elsewhere on your body, it is best to seek medical advice. Lichen sclerosus needs to be diagnosed and treated by a qualified dermatologist for the best outcome. It is a longstanding condition which needs to be monitored and treatment needs to be adjusted according to the response to treatment.

 

Treatment

Lichen sclerosus can be diagnosed clinically, however, most doctors will require a small biopsy (microscopic examination of a sample of skin tissue from the affected area) to confirm the diagnosis before starting any treatment.

LSeA responds well to treatment with steroid creams. Clobetasone 0.05% cream may be prescribed for use. It is to be applied twice daily over the affected area for a 2 to 8 weeks, depending upon the response. This cream should not be used unsupervised, or for prolonged periods.

After the symptoms improve, long term use of moisturizers or bland emollients is recommended to soothe the itchy, dried skin.

Investigations may be needed in certain cases to rule out co-infections or malignancies. A skin biopsy is helpful for the same.

In advanced cases with severe scarring, surgical treatment may also be needed for symptomatic relief.

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Sources:

  1. Habif, Thomas P. Clinical dermatology. 5th ed. Mosby Elsevier. 2010.
  2. Griffiths C EM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. 9th Ed. Wiley Blackwell. 2016.

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