Chapter 78 Lichen Sclerosus
INTRODUCTION
Description: Lichen sclerosus is a chronic condition of the vulvar skin characterized by thinning, distinctive skin changes and inflammation. It is non-neoplastic and involves glabrous skin and the vulva. The term lichen sclerosus et atrophicus has been dropped because the epithelium is metabolically active, not atrophic. (At one time, the condition was referred to as kraurosis vulvae.)
ETIOLOGY AND PATHOGENESIS
Causes: Unknown. Proposed—immunologic (autoimmune), genetic, inactive or deficient androgen receptors, epidermal growth factor deficiency.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Thinned, atrophic-appearing skin, with linear scratch marks or fissures (the skin often has a “cigarette-paper” or parchment-like appearance); these changes frequently extend around the anus in a figure-eight configuration
• Atrophic changes result in thinning, or even loss, of the labia minora and significant narrowing of the introitus
DIAGNOSTIC APPROACH
Workup and Evaluation
Laboratory: Thyroid function studies should be considered because up to one third of patients have coexisting hypothyroidism.
Special Tests: Culture or KOH (potassium hydroxide) wet preparations of skin scrapings may help to evaluate the possibility of candidiasis. Punch biopsy of the skin will establish the diagnosis.
