Overview
What is lichen sclerosus (LS)?
What is the pathophysiology of lichen sclerosus (LS)?
What are the findings within lichen sclerosus (LS) tissue?
What causes lichen sclerosus (LS)?
Which infections are associated with lichen sclerosus (LS)?
Which genetic and autoimmune factors are associated with lichen sclerosus (LS)?
What is the role of oral contraceptives in the etiology of lichen sclerosus (LS)?
Which inflammatory conditions are associated with lichen sclerosus (LS)?
What is the prevalence of lichen sclerosus (LS)?
What is the prevalence of genital lichen sclerosus (LS) in prepubertal girls?
What is the prevalence of vulvar lichen sclerosus (LS) in elderly women?
What is the prevalence of lichen sclerosus (LS) in males?
What is the prevalence of extragenital lichen sclerosus (LS)?
What are the race-related demographics for lichen sclerosus (LS)?
Is lichen sclerosus (LS) more common in males or females?
What are the age-related demographics for lichen sclerosus (LS)?
What is the prognosis of lichen sclerosus (LS)?
What is the prognosis of lichen sclerosus (LS) in pediatric patients?
What is the mortality rate for lichen sclerosus (LS)?
What are the morbidities of lichen sclerosus (LS)?
What is included in the patient education information for lichen sclerosus (LS)?
Presentation
What complaints are associated with extragenital lichen sclerosus (LS)?
What are the symptoms of genital lichen sclerosus (LS)?
What are the physical findings in lichen sclerosus (LS)?
What are the physical findings in vulvar lichen sclerosus (LS)?
What is the typical distribution of extragenital lichen sclerosus (LS)?
What are the physical findings of female genital lichen sclerosus (LS)?
What are the physical findings of male genital lichen sclerosus (LS)?
What is the isomorphic (Koebner) phenomenon in relation to lichen sclerosus (LS)?
What are complications of lichen sclerosus (LS)?
What pitfalls are associated with lichen sclerosus (LS)?
DDX
What are the diagnostic considerations in lichen sclerosus (LS)?
What are the differential diagnoses for Lichen Sclerosus?
Workup
How is lichen sclerosus (LS) diagnosed?
Which study is diagnostic for lichen sclerosus (LS)?
What is the role of imaging studies in the workup of lichen sclerosus (LS)?
Which procedures are used in the workup of lichen sclerosus (LS)?
What are the histologic findings in lichen sclerosus (LS)?
Which types of microscopy are used in the workup of lichen sclerosus (LS)?
Treatment
What are the treatment guidelines for lichen sclerosus (LS)?
What are the treatment approaches for genital lichen sclerosus (LS)?
What is the first-line therapy for genital lichen sclerosus (LS)?
What are the second-line therapies for genital lichen sclerosus (LS)?
What are third-line therapies for treatment-resistant genital lichen sclerosus (LS)?
What is the role of hormone therapy in the treatment of genital lichen sclerosus (LS)?
What are the treatment options for extragenital lichen sclerosus (LS)?
What personal hygiene habits can minimize symptoms in lichen sclerosus (LS)?
How are topical corticosteroids used in the treatment of lichen sclerosus (LS)?
What is the role of topical calcineurin inhibitors in the treatment of lichen sclerosus (LS)?
How are retinoid and acitretin used in the treatment of lichen sclerosus (LS)?
How is phototherapy used in the treatment of lichen sclerosus (LS)?
How is methotrexate used in the treatment of lichen sclerosus (LS)?
What is the of lichen sclerosus (LS)?
What are the surgical options for lichen sclerosus (LS)?
Which tissue destruction procedures are used in the treatment of lichen sclerosus (LS)?
When is referral indicated for the surgical treatment of lichen sclerosus (LS)?
When is surgical care indicated in the treatment of lichen sclerosus (LS)?
Which specialist consultations are indicated for the treatment of lichen sclerosus (LS)?
What dietary restrictions are indicated in the treatment of lichen sclerosus (LS)?
What activity restrictions are indicated in the treatment of lichen sclerosus (LS)?
What is included in the long-term monitoring of lichen sclerosus (LS)?
Guidelines
Medications
What are the goals of drug treatment for lichen sclerosus (LS)?
Which medications in the drug class Corticosteroids are used in the treatment of Lichen Sclerosus?
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Lichen sclerosus demonstrating classic hourglass or figure 8 vulvar and perianal distribution. Courtesy of Wilford Hall Medical Center slide files.
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Extragenital lichen sclerosus demonstrating coalescing pitted white papules. Courtesy of Wilford Hall Medical Center slide files.
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Typical lichen sclerosus histology demonstrating homogenized edematous papillary (upper) dermis and effaced epidermis.
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More advanced vulvar lichen sclerosus; eroded areas need to be carefully examined and a biopsy sample should be taken to exclude coexistent squamous cell carcinoma. Courtesy of Wilford Hall Medical Center Dermatology slide files.
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Male genital lichen sclerosus may present with a sclerotic ring at the edge of the prepuce or anywhere on the glans itself. Advanced disease at the urethral os may lead to urinary obstruction. Courtesy of Wilford Hall Medical Center Dermatology Slide files.
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Late lichen sclerosus may show less edema in the upper dermis and more sclerosis throughout the dermis. Involvement of the lower dermis or fat may occur in lichen sclerosus/scleroderma overlap presentations.